23 February 2007

African Trial Shows Circumcision "Can Save A Lot Of Lives"

by Kate Melville

A circumcision trial conducted in Kenya, led by University of Illinois at Chicago professor of epidemiology Robert Bailey, has provided strong evidence that circumcision can indeed prevent HIV infection. In fact, the evidence was so strong that the study's independent data safety monitoring committee ordered the trial be stopped, so that the uncircumcised participants could undergo the procedure.

The trial involved 2,784 HIV negative, uncircumcised men between 18 and 24 years old in Kisumu, Kenya; where an estimated 26 percent of uncircumcised men are HIV positive by the age of 25. Half the men were randomly assigned to circumcision and half the men remained uncircumcised for two years. The majority of the men in the study were Luo, an ethnic group that does not traditionally practice circumcision. Published in The Lancet, the results show that 47 of the 1,391 uncircumcised men contracted HIV, compared to 22 of the 1,393 circumcised men.

"Our study shows that circumcised men had 53 percent fewer HIV infections than uncircumcised men," said Bailey. "We now have very concrete evidence that a relatively simple surgical procedure can have a very large impact on HIV." Adverse events related to the surgery were few, according to Bailey. He said in 1.7 percent of the surgeries there were minor complications - usually bleeding or a mild infection. There were no severe adverse events.

But Bailey sounded a note of caution, warning that circumcised men may feel they are protected from becoming HIV infected and may be more likely to engage in risky behavior. "Circumcision is by no means a natural condom," he said, adding that circumcision will be most effective if it is integrated with other prevention and reproductive health services.

Estimates suggest that millions of new HIV infections, tens of thousands of deaths, and several million dollars could be saved if male circumcision became routine in sub-Saharan Africa. "This is really the first good news we've had in quite a long time. If we can reduce the risk of infection by such a substantial amount then we can save a lot of lives," said Bailey. "People are getting infected at a rate of approximately 5,000 persons per day. We cannot treat our way out of this epidemic. Prevention of new infections is crucial."

Source: University of Illinois at Chicago