Students of Social Work Department painted their faces to spread awareness about HIV/AIDS during a campaign to mark World AIDS Day, at Panjab University in Chandigarh on Friday, November 29 2013. Express photo by Sumit Malhotra

The National Institute of Health cut short studies undertaken in Uganda and Kenya after compelling results indicated that circumcision in men contributed to a decreased risk of acquiring HIV. In the Ugandan study, the group of circumcised men had a 48% decreased chance of acquiring HIV as compared to the control group. Likewise, the Kenyan study had equally astounding results with a 53% difference between the two groups. Because of these results, both studies were stopped on ethical grounds, in order to give the control group the option of undergoing circumcision. Men were randomly assigned to either group and information was collected on their health status, sexual behavior, and views on circumcision. Both groups were also given counseling on HIV prevention and safe sex.

The proposed biological theory that lies behind these results points to the nature of the foreskin. The inner surface of the foreskin has a large number of mucosal and Langerhan cells which are more susceptible to invasion than the cells on the outer surface of the foreskin. During intercourse, the foreskin may incur microscopic tears which allow HIV to enter. In contrast, a circumcised individual develops keratinized epithelial tissue on the shaft and glans of the penis, which is protective.

The results of the NIH studies have had a swift and profound impact on attitudes towards HIV prevention. Experts in South Africa are calling for circumcision to be offered to all males and the United Nations health agencies have become proponents of circumcision.

However, circumcision comes with its own caveats. The wound from circumcision must be given adequate time to heal before engaging in intercourse otherwise the wound, itself, can act as a conduit for the entry of HIV. Also, as with any surgical procedures, there is a risk of infection and the associated risks of a botched job at the hands of one who is unskilled in circumcision. Others are also considering phimosis cure when they are not yet circumcised.

As well, it would be a grievous error to neglect other avenues of prevention in favour of circumcision. Circumcision may be able to reduce the risk of acquiring HIV, but it is not a foolproof means to keeping oneself 100% safe. Education on safe sexual behaviors and improved access to resources must continue. The worst case scenario is that the results of these studies are miscommunicated to give the impression that circumcision can provide adequate protection against HIV in the absence of behavioral modifications. As with many other tools, circumcision can be one of many weapons in the arsenal against AIDS, but alone, it is insufficient.


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