AIDS: New trial shows needs for caution in adopting circumcision strategy
Posted: 07 March 2007 2038 hrs

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PARIS - Early data from a trial in Uganda shows that policymakers must be prudent when including circumcision among their tactics for fighting AIDS, researchers said on Tuesday.

Last year, three groundbreaking studies conducted in Africa found that male circumcision halved a man's risk of being infected by the human immunodeficiency virus(HIV).

That discovery ignited hopes that the flagging quarter-century-old war against AIDS in Africa could be transformed by a simple, low-cost operation.

The new trial, funded by the Bill and Melinda Gates Foundation, explores a different angle of the circumcision story -- to see whether men who are infected with HIV and are circumcised are any less likely to infect their female partner.

US and Ugandan researchers are following 997 HIV-infected men in Rakai, Uganda. Some of them have been given circumcision, while the others have remained uncircumcised to act as a comparison.

A proportion of volunteers in both groups had uninfected long-term female partners at the start of the study. These women were also enrolled and monitored.

A review at the study's six-month mark looked at 70 couples in the "circumcised" group and found that 11 of the women had become infected. Among 54 couples in the "uncircumcised" group, four women had become infected.

The study is still underway and the data is not considered conclusive.

But the researchers said they were concerned, as several of the infections had been transmitted by men who had had sex before their wounds had fully healed from the circumcision surgery.

The AIDS virus can be carried in the blood, as well as in semen.

This means that, before circumcision can be universally endorsed as a prevention strategy, men and women have to be fully aware about the need to refrain from intercourse for a month or so while the penile wound has healed, the researchers said.

Both partners must be fully versed in safe-sex awareness, especially in condom use.

"We need to err on the side of caution to protect women in the context of any future male circumcision programme," said the study's lead scientist, Maria Wawer of the Johns Hopkins Bloomberg School of Public Health.

"Women make up a majority of people living with HIV in Africa, and these results demonstrate that women need to be educated about the risks and benefits of male circumcision," she said in a press release.

If the finding about infection from post-operative wounds is taken into account, the trial found that there was no protection to partners of HIV-infected, circumcised men within the first six months of surgery.

Circumcised men, though, had a 50-percent lower rate of genital ulceration.

The next step is to see whether that picture changes over the longer term.

The data was released on Tuesday as a contribution to a meeting in Montreux, Switzerland, gathering the UN's World Health Organisation (WHO) and UNAIDS.

The two agencies are mulling the outcome of the three big trials to weigh how far, and how fast, they should endorse circumcision as a prevention policy.

WHO expert Kevin De Cock stressed the need for caution and good preparations.

"While male circumcision has extraordinary potential to prevent HIV infection, these new findings remind us that we must proceed with thought and care in developing male circumcision in Africa," said De Cock.

Volunteers in the Rakai study were repeatedly given safe-sex counselling and provided with free condoms. Women who become infected have been promised access to free HIV care and antiretroviral drugs. -AFP/na