Study touts abstinence following circumcision
By DAVID BROWN
The Washington Post

Men infected with HIV who get circumcised hoping they will be less
likely to transmit the virus may have a greater-than-normal risk of
infecting their partners if they resume sexual activity too soon after
the operation.

That observation, drawn from preliminary analysis of a study in
Uganda, threatens to complicate efforts to roll out circumcision as
new weapon against HIV in Africa.

Specifically, it suggests that public health campaigns promoting
circumcision must also include messages, principally directed at
women, warning of the extreme hazard of intercourse with HIV-positive
men who have just had the procedure.

The new data were presented Tuesday to 75 government health ministers,
scientists and policy-makers from the World Health Organization and
the United Nations' AIDS program, and other experts meeting in
Montreux, Switzerland, to come up with guidance on using circumcision
as a prevention tool.

Three studies, including two published just last month, have shown
that circumcision cuts a man's risk of acquiring HIV infection in half
-- protection roughly equivalent to a moderately effective vaccine.

Researchers hope it may indirectly protect women, as well. That could
happen because circumcised men are less likely to have genital ulcers,
which increase an infected person's risk of transmitting the virus.
More broadly, if circumcision reduces HIV prevalence in a whole
population, both sexes will benefit.

''The data that we have heard do not derail (the potential usefulness
of circumcision) by any means,'' said Kevin De Cock, head of the HIV/
AIDS department at WHO. ''What it does do is provide a little more
insight about the complexities that face us.''

The information came from a study in the Rakai district of southern
Uganda, which has been especially hard hit by the AIDS epidemic. It is
being run by Ugandan researchers and scientists at the Johns Hopkins
Bloomberg School of Public Health.

The study involved about 1,000 HIV-infected men, half of whom were
randomly assigned to undergo circumcision. The researchers looked at
the experience of 124 couples in which the regular female partner was
uninfected at the time the man had the procedure.

Among 70 men who were circumcised, 11 transmitted HIV to their
partners. Of the 54 who were not circumcised, only 4 passed on the
infection. Almost all new transmissions occurred in the first six
months. Because there were so few cases in either group, the findings
were not statistically significant and may have occurred only by
chance.

Of 12 men who resumed sexual activity before a physician had
''certified'' them as healed, one-quarter (or three) transmitted the
virus to a partner. Of 55 men who waited, six transmitted. Healing
takes about a month.

An independent panel of scientists overseeing the study recommended
that no new volunteers be enrolled because, even though the early
findings were not statistically significant, it concluded that the
original hypothesis -- that uninfected women would indirectly benefit
over the short term from male circumcision -- was unlikely to prove
true.

Much remains unknown, however. For example, some infected women may
have acquired HIV from someone other than their regular partner -- a
possibility the researchers will now look into by doing genetic
fingerprinting on both the men's and women's viruses.

One of the leaders of the study, Maria Wawer, of Johns Hopkins, said
that for the moment ''the need for extreme precaution and abstinence
from sex in the post-procedure period cannot be overemphasized.''

David Serwadda, a public health physician at Uganda's Makerere
University, said that in recent months demand for circumcision, both
in male infants and in adults, has risen noticeably in his country.

Ezekiel Emanuel, a bioethicist at the National Institutes of Health
who has written about ethical issues of circumcision research, noted
that ''this is not the first public health measure that will require
careful education of the population that is being targeted.''

Link: http://www.montereyherald.com/mld/montereyherald/living/health/16867492.htm