Circumcision Provides Better AIDS Reduction Than Expected

Back in 2002, three separate sexual health studies began with the aim of assessing the link between circumcision and a lower risk of getting AIDS. The first set of results came in 2005 from a study conducted in Orange Farm township, South Africa, and the research revealed an amazing 63% decrease HIV infection in circumcised, heterosexual men compared to uncircumcised, heterosexual men. According to the French and South African scientists heading up the study, the research had to end on ethical reasons; they were so convinced by their results that they stopped the study in order to offer circumcision procedures to the men in the uncircumcised group.

 

In Africa, about 70% of men are circumcised either when they’re born or during puberty, although the rates of circumcision will vary drastically between regions due to differing cultures. The medical procedure involves the removal of the foreskin of your penis, be it due to religious or wellness reasons. However, the wide range of circumcision rates in Africa is what first tipped researchers off to the possible protective effect to your wellbeing that circumcision has, as rates of AIDS were much lower in regions with much higher circumcision rates. Although the results of the Orange Farm findings were exciting to the medical community, scientists still awaited the results of the other two trials before getting all worked up.

 

In the Orange Farm study, 3273 men had taken part, and all scientific controls were observed tightly, making this the first large-scale trial to report its findings. The second study, undertaken in Kenya, had 3000 subjects while the third, Ugandan trial had 5,000. In this latter research, the researchers found a 48% reduction in AIDS infection in the circumcised group, while that reduction was 53% in the Kenyan findings. Following on from these results, the researchers ended their studies early to offer the men in the control group the opportunity to get circumcised, just like the Orange Farm study. This is because the results were even more positive than the researchers had anticipated, as AIDS vaccine investigators typically aim for a 30% decrease in risk of infection from intercourse with an infected partner.

 

So why does circumcision offer such protection against AIDS? Your foreskin is delicate and very susceptible to tears during sex, providing an easy access point for the AIDS virus to creep in through the torn blood vessels. Moreover, in your foreskin there is a high concentration of a type of white blood cell known as the Langerhans cell, or the “sentinel cell” of the immune system. These cells, which are located in the skin (and on the underside of the foreskin in particular) are some of the first to detect and pick up an antigen or foreign substance for processing.

 

Because there are so many Langerhans cells in the foreskin, and because these particular cells seem to be excellent at binding to HIV antigens, these blood cells are very likely to contact and bind to the virus. Usually, Langerhans cells trigger your body’s antibody response to fight off viruses, but once HIV gets into your system, your body can’t seem to fight it off effectively. Therefore, by removing the foreskin in which these Langerhans cells reside, men lose that increased risk of blood exposure and the higher concentration of HIV-receptors in that blood. This is why researchers believe that encouraging circumcision and offering the procedure for little or no cost could put a serious dent in the spread rate of HIV and AIDS. Thankfully, following the success of the Kenyan and Ugandan studies the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Emergency Plan for AIDS Relief – the two largest AIDS-fighting organizations in the world – have agreed to begin funding circumcision procedures in Africa.

Categories: aids, circumcision, circumcision procedures, circumcision rates, farm study, heterosexual men, langerhans cells, orange farm, Research, study

HIV Prevention v/s Pain: The Pros and Cons of Circumcision

Over the years, parents have been faced with a sexual health issue right in the early stages of their child’s infancy; circumcision. While proponents tout the wellness benefits of circumcision, opponents argue that the barbaric nature of the procedure does no good to a boy’s wellbeing. Now, the latest to join the fray is an anti-circumcision group in San Francisco, who are pushing for a ban on the practice. Unsurprisingly, those in favour of the procedure disagree with the proposal, citing the procedure’s history as a religious ritual, as well as its sexual health benefits, as some research suggests that circumcision helps prevent the spread of HIV. The debate that rages on is, therefore, “Is circumcision a good idea or not?”

 

We can date the process of circumcision as far back as to the Ancient Egyptians in 2,500BC, but the ritual later became more associated with Jewish people. Reasons for this included marking a boy’s passage into manhood, marking to distinguish those of higher social status, male “menstruation” or sign of the onset of puberty, and a way to discourage masturbation. Now, however, circumcision is not just a Jewish ritual but the most common surgery performed on males in the United States. According to a recent survey by the Centres for Disease Control and Prevention (CDC), between the years of 1999 and 2004, 79% of men reported that they were circumcised.

 

The main health reason to be circumcised is that the process is believed to prevent diseases, such as HIV, and some research suggests that circumcision reduces the risk of male-to-female HIV transfer. This is possibly due to the fact that, when you are circumcised, the Langerhans cells in your foreskin are removed, and these cells are more susceptible to HIV infection. Langerhans cells are equipped with special receptors that may allow HIV access into the body. In 2009, three studies published in the Cochrane Database of Systematic Reviews – which included data from more than 11,000 men in South Africa, Uganda and Kenya between 2002 and 2006 – showed that circumcised men were 54% less likely to get HIV than their uncircumcised counterparts.

 

However, while HIV prevention is becoming a well-supported argument for circumcision in developing countries, it is not as strong of an argument for the United States or for us here in Britain. A report from the CDC notes, ‘A number of important differences from sub-Saharan African settings where the three male circumcision trials were conducted must be considered in determining the possible role for male circumcision in HIV prevention in the United States.’ It continues, ‘Studies to date have demonstrated efficacy only for penile-vaginal sex, the predominant mode of HIV transmission in Africa, whereas the predominant mode of sexual HIV transmission in the United States is by penile-anal sex among [men who have sex with men].’

 

Still, is that a reason to ban the practise, especially considering the fact that there’s a lack of strong evidence showing negative side effects? Proponents of the San Francisco ban have now delivered more than 12,000 signatures to the Department of Elections, and, if enough signatures are deemed to be valid, this ban will appear on the ballot in the November election. Under the ban, circumcision of any male under the age of 18 would carry a fine of up to $1,000 and jail time of up to one year. Lloyd Schofield, the leader of the proposal, comments that circumcision is ‘excruciatingly painful and permanently damaging surgery that’s forced on men when they’re at their weakest and most vulnerable.’ However, Scott Bryan, a spokesperson for the CDC, argues, ‘Data has shown that with anaesthesia, the majority of infants have no objective pain reaction.’

Categories: ban, circumcision, HIV, HIV prevention, hiv transmission, langerhans cells, male circumcision, predominant mode, research suggests, san francisco, sexual health, united states