Thread: Circumcised die in South Africa

Originally Posted by TSR2

So there are no drawbacks with circumcision then !

LOL. There was a minute or two of whoosh, as that went straight over my head. But LOL indeed.

^Indeed interesting to note, yet these young African boys who died of unhygienic, and inhumane procedures, will never live to know.

circumcision is no skin off my nose !!

Go on......

Male Circumcision and Risk for HIV Transmission: Implications for the United States | Factsheets | CDC HIV/AIDS

Male Circumcision and Risk for HIV Transmission

Several types of research have documented that male circumcision significantly reduces the risk of HIV acquisition by men during penile-vaginal sex.
Biologic Plausibility
Compared with the dry external skin surface, the inner mucosa of the foreskin has less keratinization (deposition of fibrous protein), a higher density of target cells for HIV infection (Langerhans cells), and is more susceptible to HIV infection than other penile tissue in laboratory studies [2]. The foreskin may also have greater susceptibility to traumatic epithelial disruptions (tears) during intercourse, providing a portal of entry for pathogens, including HIV [3]. In addition, the microenvironment in the preputial sac between the unretracted foreskin and the glans penis may be conducive to viral survival [1]. Finally, the higher rates of sexually transmitted genital ulcerative disease, such as syphilis, observed in uncircumcised men may also increase susceptibility to HIV infection [4].
International Observational Studies
A systematic review and meta-analysis that focused on male circumcision and heterosexual transmission of HIV in Africa was published in 2000 [5]. It included 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study. A substantial protective effect of male circumcision on risk for HIV infection was noted, along with a reduced risk for genital ulcer disease. After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at sexually transmitted disease (STD) clinics, for whom the adjusted relative risk was 71% lower for circumcised men.
Another review that included stringent assessment of 10 potential confounding factors and was stratified by study type or study population was published in 2003 [6]. Most of the studies were from Africa. Of the 35 observational studies in the review, the 16 in the general population had inconsistent results. The one large prospective cohort study in this group showed a significant protective effect: the odds of infection were 42% lower for circumcised men [7]. The remaining 19 studies were conducted in populations at high risk. These studies found a consistent, substantial protective effect, which increased with adjustment for confounding. Four of these were cohort studies: all demonstrated a protective effect, with two being statistically significant.
Ecologic studies also indicate a strong association between lack of male circumcision and HIV infection at the population level. Although links between circumcision, culture, religion, and risk behavior may account for some of the differences in HIV infection prevalence, the countries in Africa and Asia with prevalence of male circumcision of less than 20% have HIV infection prevalences several times higher than those in countries in these regions where more than 80% of men are circumcised [8].
International Clinical Trials
Three randomized controlled clinical trials were conducted in Africa to determine whether circumcision of adult males will reduce their risk for HIV infection. The study conducted in South Africa [9] was stopped in 2005, and those in Kenya [10] and Uganda [11] were stopped in 2006 after interim analyses found a statistically significant reduction in male participants’ risk for HIV infection from medical circumcision.
In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a few men who had been assigned to be circumcised did not undergo the procedure, and vice versa. When the data were reanalyzed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised. The Uganda study investigators are also examining the following in an ongoing study: 1) safety and acceptability of male circumcision in HIV-infected men and men of unknown HIV infection status, 2) safety and acceptability of male circumcision in the men’s female sex partners, and 3) effect of male circumcision on male-to-female transmission of HIV and other STDs.
Male Circumcision and Male-to-Female Transmission of HIV
In an earlier study of couples in Uganda in which the male partner was HIV infected and the female partner was initially HIV-seronegative, the infection rates of the female partners differed by the circumcision status and viral load of the male partners. If the male’s HIV viral load was <50,000 copies/mL, there was no HIV transmission if the man was circumcised, compared with a transmission rate of 9.6 per 100 person-years if the man was uncircumcised [7]. When viral load was not controlled for, there was a nonsignificant trend toward a reduction in the male-to-female transmission rate from circumcised men compared with uncircumcised men. Such an effect may be due to decreased viral shedding from circumcised men or to a reduction in ulcerative STDs acquired by female partners of circumcised men [12]. A clinical trial in Uganda to assess the impact of circumcision on male-to-female transmission reported that its first interim safety analysis showed a nonsignificant trend toward a higher rate of HIV acquisition in women partners of HIV-seropositive men in couples who had resumed sex prior to certified postsurgical wound healing and did not detect a reduction in HIV acquisition by female partners engaging in sex after wound healing was complete [13].