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Circumcision Cuts HIV Risk

Eight Times Fewer HIV Infections, but Circumcised Men Still Need Condoms
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Oct. 9, 2003 -- Circumcised men get eight times fewer HIV infections, a study of Indian men shows.

But men without foreskins shouldn't stop using condoms, warns Johns Hopkins researcher Steven J. Reynolds, MD, MPH.

"Condoms are still essential for HIV prevention," Reynolds tells WebMD. "You can't take this study and say, 'Oh, I don't need to use a condom, I'm circumcised.' And circumcision didn't protect against sexually transmitted diseases, which are also important in HIV transmission."

Reynolds presented the findings at this week's meeting of the Infectious Diseases Society of America.

Reynolds' team studied some 2,300 sexually active men without HIV infection. All were sexually active -- in fact, they volunteered for the study when they came to STD clinics for treatment between 1993 and 2000. The men lived in Pune, India.

Circumcised men still got HIV, but they got it eight times less often than uncircumcised men. However, circumcision did not offer significant protection against herpes, syphilis, or gonorrhea. The findings confirm earlier reports from several African nations, although some of these reports find more protection against STDs.

Why is this study important? AIDS is poised to ravage India if prevention efforts fail. Many researchers predict an Africa-like scenario for the south Asian nation, says Kimberly Workowski, MD, associate professor of infectious diseases at Emory University in Atlanta.

"India is the next population to be devastated by HIV," Workowski says. "This study is not groundbreaking stuff. We've seen this data before. But it does confirm what we know from Africa."

Protection for Uncircumcised Men

Reynolds says that the foreskin may be particularly sensitive to HIV infection. That's because it's particularly thin-skinned. Just below the surface, the foreskin is rich in CD4+ T cells -- the type of cells HIV best loves to infect.

It probably isn't likely that many men will seek circumcision based on these findings, Reynolds admits. But he has another idea.

Drug companies are finally getting interested in finding virus-killing agents that can be safely applied to the vagina to protect against HIV infection. He suggests that these agents -- when, and if, they become available -- can be used to protect the foreskin.

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