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Circumcised HIV men infect women

20th July 2009

A clinical trial investigating the effects of male circumcision on the transmission of HIV has ended after it failed to find any sign that female sexual partners of circumcised men benefited from the procedure.

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Male circumcision has been clearly linked to reduced overall transmission of HIV to men, however, and therefore still carried a secondary benefit to women, the Uganda-based research team concluded.

Writing in The Lancet, lead author Maria Wawer of Baltimore's Johns Hopkins University, said the researchers had hoped to show that a woman having unprotected sex with a circumcised man was at less risk of becoming infected with HIV.

But this was not shown to be the case, and the team judged it futile to continue.

Sub-Saharan Africa is home to a large proportion of the 33 million people currently infected with HIV, an incurable immunodeficiency virus which can only be controlled with antiretroviral therapy (ART).

Mostly transmitted through sex, the virus has killed 25 million people worldwide since first being identified by medical science in the early 1980s.

Several studies have shown that men who are circumcised are less likely to become infected by female partners, because the cells in the the foreskin of the penis, which is removed during circumcision, are particularly vulnerable to infection with HIV.

Scientists believe that the removal of these cells makes infection more difficult.

The study recruited  922 uncircumcised, HIV-infected, men aged 15 to 49 years, some of whom were immediately circumcised.

Another group delayed having the procedure for two years. A total of 163 female sex partners of the men were also followed.

Wawer's team found that circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months. The longer-term effects could not be assessed because the trial was ended as soon as the result became clear.

The team warned that it was still necessary for circumcised men to use a condom to avoid infecting their female partners with HIV.

Male circumcision only offered protection to women against one sexually transmitted infection: trichomonas, they said.

They said men should continue to seek circumcision as a method of protection against HIV infection, however.

Women would see an indirect benefit if more and more men were circumcised, as the amount of virus in circulation would decrease over time, they added.





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