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HIV & Circumcision
Current Summary

Circumcision reduces risk of HIV by half

Reasons cannot be found in sexual behaviour
but in the high infection potential of the foreskin [1]

Circumcision of men can reduce the risk of an AIDS infection by half and therefore become an effective instrument against spread of this low immunity syndrome. This is shown by examinations in Kenya and Uganda with circumcised and uncircumcised men that have been published at December 12th 2006 in Washington by US Institute of Allergy and Infectious Diseases (NIAID). [2]

Circumcision not only can reduce the personal infection risk but hopefully the spread of AIDS in society as well, Anthony Fancy, director of the Institute of Allergy and Infectious Diseases at NIH, declared. [3]

According to this 2784 men in Kenya, that hadn't been infected by the virus at first, were observed. At the end the number of AIDS infected and circumcised men was lower than the number of not circumcised by around 53%. It is similar in Uganda were 4996 men had been included. The risk of an infection decreased to 48% with circumcised men. [2]

The studies that were issued Wednesday determine the observations that had already been done in the 1980s. Moreover an examination 2 years ago (2005) in South Africa, testing 3035 sexually active men, concluded that men are protected against HIV infections by about 65% after a circumcision had been done. [9]
The UN population programme estimates that by introducing circumcisions to campaigns against AIDS in the following two decades 3.7 million infections and 2.7 million deaths could be avoided. [2]

A circumcision reduces the risk of infections of men with the virus HIV to one sixth. This is what researchers of John Hopkins University in Baltimore (Maryland) and the Indian AIDS Research Institute in Pune have concluded from a study on Indian men. 2300 men were examined for about 7 years (1993-2000). Circumcised men suffered a lot less from infections, said researcher Bollinger and his colleagues in a scientific journal named "The Lancet" (vol. 363, p. 1039 of March 26th 2004).

According to the study the foreskin is peppered with cells that are very vulnerable to the AIDS virus. CD4+-T-lymphocytes and Langerhanssche cells are two of those. The malicious AIDS virus is able to "easily slip in" the researchers explain. [4]

According to an Australian publication the risk of an infection of an uncircumcised man is even up 8 times higher. It again determines: The virus attacks certain cells on the inside of the male foreskin. Researchers of the Woman's Hospital of University Melbourne found out after the evaluation 40 former studies that there are cells with HIV receptors on the inside of the male foreskin. This is what makes this area highly vulnerable. [6]
Latterly the mini surgery that is known in Africa is not just initiation ritual but that makes boys to men anymore. There now are even boys at those archaic clan ceremonies whose families had never practiced circumcision before. Like that the parents want to avoid that a little skin is going to be the reason for deathly fate: The sons are being protected against HIV infection while having sex. The US virologist Bruce Patterson believes that he observed how those viruses get into the body by passing the anatomic weak spot. He infected about 30 freshly removed foreskins with the deathly virus in vitro.

The researcher received fresh supply from men of an elder age that were forced to give away their most private tissue due to phimosis. That way he got hold of foreskins of men of the most vulnerable group of 20 to 45 year olds. Each time new tissues arrive at his laboratory at the North-Western University of Chicago Patterson marks the foreskin cells and AIDS viruses with different dyestuffs. If now the viruses infiltrate the skin layers at the inside of the foreskin the tissue discolours visibly - however, at the outside of the foreskin the viruses simply roll off like drops off an umbrella.
Researchers have calculated for uncircumcised men that the infection rate rises by 2.5 to 8 times compared to men without foreskin. Men with foreskin therefore canker more easily with the AIDS virus. Medics thus advise circumcision. Virologist Patterson is convinced: "Circumcision would be the best prevention against AIDS in a lot of countries."
Especially in Africa this recommendation could save lives: The Virus mainly spreads by sexual intercourse between man and woman. 70 per cent of all HIV infected people live south of the Sahara but only 10 per cent of all people world wide. Even scientists have made interesting discoveries in Africa lately. In Uganda doctors tested 187 highly unequal pairs: While the women have already been infected with the Virus the husbands have been untroubled. The scientists enlightened the men about their high sex risk and gave away condoms for free. The efforts of the doctors were in vain. Almost all set the warnings at nought. But 2,5 years later surprisingly none of the 50 men had been infected by the malicious virus - but 57 men that were not circumcised did. Such epidemiologic investigations inspire the doctors to make speculative calculations. In countries like Nigeria or Indonesia were only a short fifth of all men are not circumcised the number of HIV infection could be reduced by 25 per cent the epidemiologist Robert Bailey of the University of Illinois in Chicago shows. And in Zambia or Thailand - only every fifth men lives without foreskin - the spread of the virus could be reduced by half if all men would undergo circumcision [5]
Robert Bailey of the University Illinois in Chicago thus demands the consequent circumcision of men in Asia and Africa. That way the rapid spread of AIDS shall be stopped. The AIDS expert Richard Burzynski disagrees with his colleagues; a circumcision campaign would be too expensive. The costs of 4.50 Euros a man would overstrain the health systems of these countries. Only 3 Euros at an average are being spent per person and year. [7]
The two biggest anti HIV programmes, President Bush' "Emergency Plan for Aids Relief" and the "Global Fund to Fight Aids" now declared to be read to finance programmes like that [8].
According to the UNICEF in the African kingdom Swaziland more than 40% of all adults are infected with the HIV virus, it is almost half of all 20 to 30 year olds. By that the country has the highest quote world wide. To reduce the number of new infections in the future doctors and government focus on the circumcision of all sexually mature men. Tests with this kind of prevention in Kenya and Uganda showed that by that the risk of infection can be reduced by half.
The health department of the country therefore considers a wide circumcision campaign. However, they wait for a signal of the World Health Organisation. Not because they need further scientific proof but because they urgently need international help with the realisation. There are only 100 doctors for over one million people in the African kingdom, which means that there are about 10000 to 11000 patients per doctor. And even if those are not only men a campaign like the government plans cannot be executed like that. At each "Circumcision-Day", where hospitals offer free circumcisions, about 40 man can be treated; about 200 men have to go back home without surgery.

At the same time the enthusiasm for the "snip" has been increasing lately. In the first phase a lot of men refused as they were afraid of a deficit of their esteem or weren't even informed appropriately. The problem was that in Swaziland, contrarily to other South African countries, circumcision is not part of an old tradition. One king of the Swazi prohibited the ritual in the 19th century as the healing process had kept away the young men from military for too long. It is the women that are responsible for the "boom" of the last month that forced their men and sons increasingly to visit the doctor to protect them and themselves. To be able to cope with the rush the health department will focus on the highly vulnerable group of 15 - 30 year olds and looks for help on an international basis for the other males. "With a little help we could do the biggest part of the campaign within a few years" the doctors argue. Above that a positive side effect is the enlightenment of the public about the exact coherences of the disease. "We know that we haven't invented the silver ball against Aids" the organisers of the campaign say. But if there is a cheap, safe and long term method to save the lives of thousands of Swazi they are ready to do a nation wide "snip". [10]
[1] = Der Spiegel Online, 26.03.2004 ("Beschneidung schützt vor Aids")
[2] = AFP, 13.12.2006 ("Beschneidung von Männern senkt Aids-Gefahr deutlich")
[3] = Sueddeutsche, 14.12.2006 ("Kampf gegen Aids")
[4] = dpa / The Lancet, 1999, Bd. 363, S. 1039 ("HIV-Risiko durch Beschneidung bei Männern auf ein Sechstel reduziert")
[5] = Der Spiegel, 15.01.2001 ("Männer mit Vorhaut stecken sich leichter mit dem Aidserreger an")
[6] = Der Spiegel, 2000 ("Beschnittene Männer haben geringeres HIV-Risiko")
[7] = Münchener Abendzeitung, 30.09.1999 ("Kleineres Aids-Risiko für Beschnittene")
[8] = Der Tagesspiegel vom 15.12.2006 ("Beschnittene Männer haben geringeres Aids-Risiko")
[9] =, 28.07.2005 ("HIV: Beschneidung verhindert viele Infektionen")
[10] = Berliner Umschau vom 05.02.2007 ("Aids-Prävention: Swasiland plant den "Snip" für alle")

Latest actualisation: 01.10.2007
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