SciDev.Net

The circumcision procedure itself carries a significant risk of HIV transmission if carried out under unsafe conditions, according to a study.

The research, published in the March issue of Annals of Epidemiology, adds to the debate over the use of male circumcision for the prevention of HIV infection.

The authors say that unhygienic conditions and poor standards in traditional circumcision procedures expose patients to infection from blood-borne diseases.

Lead researcher Devon Brewer, of the US-based Interdisciplinary Scientific Research, said that previous research into circumcision in Africa does not consider the context in which the procedure is conducted, or the risk of exposure to infected blood during the operation.

Brewer and colleagues analysed data on virgins and sexually active adolescents and adults collected by USAID's Demographic and Health Surveys project.

"We found that circumcised virgins and adolescents in Kenya, Lesotho and Tanzania were consistently and substantially more likely to be infected with HIV than their uncircumcised counterparts," said Brewer, according to Afrol News.
 
The paper concludes that sexually-experienced male adolescents were "no more likely to be infected than adolescent virgins". The authors say this highlights how HIV may spread by means other than sex in sub-Saharan Africa.

But Kevin De Cock, director of the World Health Organization's HIV/AIDS department, stressed that sexual intercourse was still the major route of HIV transmission.

He told SciDev.Net that the dangers of unhygienic medical practices were already a well-known problem in Africa, adding, "If circumcision is scaled-up [to prevent HIV infection] it must be done in a safe environment, by trained people with sterilised equipment".

Kasonde Bowa, a surgeon at the University of Zambia Teaching Hospital said, "It is conceivable that traditional circumcision may increase the risk of HIV transmission". But he said that risk would be small, since the percentage of male circumcisions done by traditional means is 1–3 per cent.

Jonathan Weber, professor of Communicable Diseases at Imperial College London, UK, pointed out that the data is based on self-reported virgin status, which is not validated.

Last week (24 February) another study, published in The Lancet, confirmed suggestions that circumcision significantly reduces the risk of HIV infection.

According to the paper, circumcised men in a Kenyan trial had 53 per cent fewer HIV infections than uncircumcised men. A 48 per cent reduction was observed in a Ugandan trial.

The trials were closed early in December 2006, so that uncircumcised participants could undergo the procedure (see Male circumcision cuts HIV risk, UN urges caution).

References:
Annals of Epidemiology 17, 217 (2007)
The Lancet 369, 708 (2007)