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SOUTH
AFRICA: "Study Says Circumcision Reduces AIDS Risk by 70 Percent"
Wall Street Journal (07.05.05):: Mark Schoofs; Sarah Lueck;
Michael M. Phillips
French and South African researchers have found that male circumcision
reduces by about 70 percent a man's risk of contracting HIV through
intercourse with an infected woman. Nothing besides abstinence and safer
sex has been proven to reduce the sexual spread of HIV. Worldwide,
heterosexual sex has been the major route of HIV transmission for many
years.
The circumcision study's findings were so dramatic that the data and
safety monitoring board overseeing the research halted the study in
February, roughly nine months before completion, on the ground that it
would be immoral to proceed without offering the uncircumcised control
group an opportunity to undergo the procedure. Circumcision directly
affected men's chances of infection; women would benefit indirectly if
circumcision reduced the chances of their partners being HIV-positive.
Field researchers are aware of the study's basic findings, but experts
haven't evaluated them because the study has yet to be published. The
British journal Lancet declined to publish the study, for reasons
unrelated to data and scientific content, according to people familiar
with the matter. In accordance with policy, the journal's officials
refused to comment on why the study was turned down.
That an independent board ordered the study halted is considered by some
to be a strong sign that the science is sound. Bertran Auvert, the
French lead researcher, is expected to present the findings later this
month at an International AIDS Society conference in Brazil.
The research was conducted with more than 3,000 HIV-negative South
African men ages 18-24. Half were randomly assigned circumcision while
half remained uncircumcised as controls. After following all the men for
a year, researchers found that for every 10 uncircumcised men who
contracted HIV, only about three circumcised men got the virus.
Stopping trials is common when an intervention is clearly shown to be
effective. The result of the trial may spark discussion of whether to
halt or modify two other major circumcision/HIV studies underway in
Kenya and Uganda, funded by the National Institutes of Health. Ronald
Gray, lead researcher on the Uganda trial, said it would be unwise to
stop the Kenya and Uganda trials because "medicine has been burned in
the past when policy is based on a single trial."
The new study suggests that in countries where male circumcision is
uncommon and heterosexual HIV rates are high or rapidly rising,
circumcision could be a powerful way of reducing the virus's spread.
However, researchers warn of potential pitfalls, stressing that HIV
transmission could rise if men abandon safer sex practices because they
think circumcision completely protects them.
"It will not take very much of an increase in risk behavior to overcome
the benefit from circumcision," said Carolyn Williams, an American
researcher involved in the Kenya trial. AIDS experts say circumcision
would have to be accompanied by intensive counseling.
Furthermore, experts worry that circumcision performed under unsanitary
conditions could lead to dangerous complications. There is also the
question of whether men from African cultures that do not practice
circumcision would consent to the procedure to reduce their risk of
contracting HIV.
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