Circumcision protects men from AIDS but might increase risk to women, early results suggest

LONDON: Circumcision may reduce men's chances of contracting HIV by up to 60 percent — but early results suggest the procedure may put women at increased risk of infection, according to preliminary data presented Tuesday.

Early results announced at a U.N. consultation in Switzerland on the potential impact of male circumcision on AIDS in Africa suggested that if HIV-positive men do not abstain from sex while healing from circumcision surgery, their female partners might have a higher chance of catching HIV from them.

However, experts said the results were not conclusive — and highly susceptible to other factors, such as condom use — demonstrating the difficulties of utilizing circumcision in HIV prevention in sub-Saharan Africa, where more than 60 percent of those with AIDS are women.

Previous studies have confirmed the dramatic impact circumcision has in cutting men's HIV infection rates, but a big question has been the resulting effect on women.

The first evidence — though very preliminary — suggests there is a period immediately following surgery when men may more easily transmit the virus to their female partners.

Women are already so vulnerable in this epidemic, said Jennifer Kates, an AIDS expert at the  Kaiser Family Foundation who is not connected to the study. We need to be particularly careful about anything that could put them at even greater risk.

Researchers at the Rakai Health Sciences Program and  Makerere University in Uganda and the  John Hopkins Bloomberg School of Public Health in the U.S. tracked 997 HIV-positive men in Uganda and their female partners.

Among 70 men with HIV who underwent circumcision, 11 of their female partners became infected with the virus in the month after the surgery. In contrast, only four partners of 54 uncircumcised men with HIV in the control group caught the virus — nearly half the rate, early results showed.

Researchers said the results suggest increased HIV transmission from men who have sex before they had properly healed.

However, they said the numbers so far were too small to be statistically significant, and left open the possibility that the higher rates were due to chance; both groups of men and women were given repeated HIV prevention education and free condoms.

Experts said the study showed the importance of finding ways to protect women in the search for ways to fight AIDS.

We need to err on the side of caution to protect women in any future male circumcision program, said Dr. Maria Wawer, the study's lead investigator, a researcher at Johns Hopkins Bloomberg School of Public Health.

More than 60 percent of AIDS patients in sub-Saharan Africa are women. The social and economic inequalities between men and women are thought to be responsible for the elevated rates of infection in women, with many women trapped in relationships with unfaithful men.

The preliminary results do not call into question the utility of circumcision as a way to prevent AIDS in Africa.

But while male circumcision has extraordinary potential to prevent HIV infection, these new findings remind us that we must proceed with thought and care in developing strategies to expand male circumcision in Africa, said Dr. Kevin De Cock, director of  WHO's AIDS department. Circumcision is an additional prevention strategy rather than a replacement for anything else.

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