How does male circumcision protect against HIV infection?
male circumcision main page HIV/AIDS. that male circumcision reduces the risk of heterosexually acquired HIV infection in men by Related topics and links . Studies linking lack of circumcision to HIV infection patients to look for an association between the serostatus and circumcision status of the male partner. between circumcision and HIV infection and STD symptoms (Genital discharge or ulcer/sore) was However, circumcision found to have no association with the symptoms of. STDs. . tion and economical status), access to mass media.
The baseline sexual behavior and CD4 counts and viral load levels were similar between the two groups.
Male circumcision: a role in HIV prevention?
Median follow-up was 18 months but was shorter for partners of uncircumcised men 18 vs. The number of sexual episodes decreased over time between both groups.
There were 64 seroconversions incidence rate of 3. Incidence of HIV was lower among partners of circumcised than uncircumcised men 2. This difference held for both genetically linked and unlinked seroconversions and after adjustment for HIV viral load, use of ART, unprotected intercourse, and incident genital ulcer disease.
Conclusions Male circumcision was associated with a reduction in HIV incidence that was not statistically significant. Quality Rating This was a high-quality study. The sample was representative, and exposed and unexposed groups were similar in terms of HIV risk other than circumcision. Once exposed to infected mucosal secretions, infected T-cells combine with keratinocytes and then transfer HIV to Langerhans cells via dendrites just under the surface of the inner foreskin which then migrates to the basal epidermis and then pass HIV to T-cells leading to infection [ 20 ].
This is aggravated by occurrence of any inflammations and ulceration and also tearing of the foreskin during intercourse [ 20 ]. In addition, randomized trials of male circumcision showed that male circumcision significantly reduced the bacterial load by reducing both the prevalence and abundance of many coronal sulcus bacteria [ 21 ].
Nevertheless, male circumcision does not provide a complete prevention against HIV infection, and circumcised men can become infected, and can transmit the virus to their partners [ 2389 ]. However, there still remain gaps and unanswered questions relating to HIV transmission and circumcision.
Although not supported by literature, one major concern is the behavioral disinhibition where circumcised men could feel more protected against HIV infection and hence may engage in a riskier behavior. Traditionally, and in some communities, young men are taken into seclusion and given advice touching on their responsibilities which includes their sexual behavior [ 14 ].
However, cluster randomized trials done in South Africa to assess the interventions that could prevent men from sexual risky behaviors after circumcision showed that social cultural values dictated how men should behave among traditionally circumcised men [ 22 ] and hence resistance to change; while among those medically circumcised, a focused counseling session had short term effects on reducing risky sexual behavior [ 23 ].
During male circumcision rituals, the period of seclusion constitutes the most significant part where new attitudes, practices and behaviours are learnt which includes sexual issues [ 14 ].
The relationship between male circumcision and HIV infection in African populations.
Whereas sexual reserve and inappropriateness of promiscuity after reintegration into society are emphasized, in other contexts, boys are encouraged to have sex to prove their manhood even during the seclusion period, often referred to as ritual sex [ 14 ]. Although ritual sex is conducted in some communities in Malawi, there is limited information regarding this practice.
However, in Zambia, ritual sex is associated with traditional circumcision and use of condom is not emphasized [ 2425 ]. There is therefore a need to look at the association between type of circumcision and HIV infection in Malawi, as well as analyze the effect of ritual sex on HIV infection. While some studies show that pre-pubertal circumcision is associated with reduced risk of HIV infection [ 2627 ], one study shows no significant association between age at circumcision and HIV infection [ 28 ].
Male circumcision in many African societies is done at puberty [ 29 ] ; however, there are communities that do not have a defined circumcision period and therefore some men are circumcised as infants, while others are circumcised at adulthood. When circumcised at old age, these men are already exposed to sexual activities for a long time, and have higher chances of being exposed to HIV as compared to younger men.
Though recent indicators have shown some decline from a prevalence rate of The AIDS Response Progress Report shows that Malawi has registered progress in the areas of prevention; treatment, care and support; and impact mitigation [ 30 ]. However, the country has been criticized for being slow in the introduction of free male circumcision in public facilities and only recently, inthe Malawi government adopted a policy on medical male circumcision as part of its HIV prevention strategy, offering the service free at public hospitals [ 30 ].
RS reviewed all the relevant literature, carried out the histological examination of the specimens, and wrote the first draft of the manuscript. RVS initiated the study and participated in redrafting of the paper.
Both authors will act as guarantors. R V Short Accepted May In his otherwise excellent review of the AIDS epidemic in the 21st century, Fauci presented no new strategies for preventing the spread of the disease. The most dramatic evidence of the protective effect of circumcision comes from a new study of couples in Uganda who had discordant HIV status; in this study the woman was HIV positive and her male partner was not.
These findings should focus the spotlight of scientific attention onto the foreskin. Why does its removal reduce a man's susceptibility to HIV infection?
Male circumcision and HIV infection among sexually active men in Malawi
Summary points The majority of men who are HIV positive have been infected through the penis There is conclusive epidemiological evidence to show that uncircumcised men are at a much greater risk of becoming infected with HIV than circumcised men The inner surface of the foreskin contains Langerhans' cells with HIV receptors; these cells are likely to be the primary point of viral entry into the penis of an uncircumcised man Male circumcision should be seriously considered as an additional means of preventing HIV in all countries with a high prevalence of infection The development of HIV receptor blockers, which could be applied to the penis or vagina before intercourse, might provide a new form of HIV prevention Methods To compile the information for this review a Medline search was done using the terms circumcision, HIV, Langerhans' cells, penis, foreskin, and prepuce, and extensive email correspondence with other researchers was also undertaken.
Histological observations were carried out on samples of penile tissue obtained from 13 perfusion fixed cadavers of men aged years, seven of whom had been circumcised. The most widely accepted model for the sexual transmission of HIV is based on infection of the genital tract of rhesus macaques with simian immunodeficiency virus.
- How does male circumcision protect against HIV infection?
- The relationship between male circumcision and HIV infection in African populations.
- Global information and education on HIV and AIDS