Male Circumcision as the Answer to the African AIDS Epidemic?
Eugene McCray, MD, tells WebMD, "The question of using circumcision as an intervention against HIV infection is very community-specific. You have to demonstrate that the operation will be accepted in the community before it can be attempted." McCray is the head of the CDC's global initiative to fight AIDS based in Atlanta.
Addressing that concern, Bailey said he and his colleagues conducted a series of interviews about circumcision with Kenyan men and women. More than 90% of those interviewed were uncircumcised.
Bailey said the focus group discussions determined that those interviewed were interested in circumcision because they believed it made it easier for men to maintain sexual cleanliness; because uncircumcised men were perceived as being more likely to contract a sexually transmitted disease; and uncircumcised men were believed to enjoy sex less and give women less sexual satisfaction.
"Given a choice, 60% of uncircumcised men would prefer to be circumcised, and 62% of women would prefer a circumcised partner," Bailey said. He was surprised at the results because few, if any, of the 110 women interviewed had ever had sex with an uncircumcised man.
McCray says, "The CDC is willing to support pilot projects to look at circumcision as a way to combat AIDS." He said such studies might be difficult to establish due to ethical concerns.
However, McCray said communities exist in Africa, particularly in Zimbabwe, where cultural norms and rituals circumcision would make controlled studies possible and medically ethical.
At the symposium, however, Ronald Gray, PhD, professor of population and family health sciences at Johns Hopkins School of Hygiene and Public Health in Baltimore, suggested that the differences seen between circumcised and uncircumcised men might have more to do with cultural and religious practices than a biological advantage to circumcision.
Almost all the circumcised men studied in a southwestern Uganda district by Gray and colleagues were Muslim. He suggested that Muslim religious prohibitions against alcohol and risky sexual behavior and religious mandates requiring cleansing of the genitals before prayer might play a role for lower risks of HIV infection.
McCray said researchers also need to study whether having a circumcision with its widely believed lower risk for suffering infection might lead to riskier sexual behavior that could wipe out gains of having the procedure performed. Controlled studies, he said, could also tease out questions of whether earlier circumcision -- before puberty or first sexual experience -- can have an effect on protection against HIV infection.