New research indicates that unhygienic male and female circumcision practices in eastern and southern Africa may transmit HIV, announced a press release issued by Interdisciplinary Scientific Research.
The research, published March issue of the Annals of Epidemiology, was carried out by a team of researchers led by Devon D. Brewer, director of the research firm Interdisciplinary Scientific Research. “We found that circumcised virgins andadolescents in Kenya, Lesotho, and Tanzania were consistently and substantially more likely to be infected with HIV than their uncircumcised counterparts,” Brewer said.
The researchers analyzed data from the Demographic and Health Surveys, which are based on nationally representative samples of adolescents and adults. In these countries, circumcision is typically performed in adolescence or early adulthood and often in unhygienic circumstances where many individuals are circumcised with shared,unsterilized cutting instruments. Sexually experienced male adolescents were no more likely to be infected than adolescent virgins, further highlighting how HIV may be spreading by means other than sex.
Brewer said “a key problem with nearly all prior research on circumcision in Africa is that researchers have treated circumcision only as an anatomic characteristic, and not as a potential exposure to others’ blood during the circumcision operation.” He continued, “this is striking, because over the last 20 years, many Africans, including children, have warned that HIV can spread through circumcision procedures.”
The new results also raise questions about how to interpret the recent randomized trials of male circumcision in South Africa, Kenya, and Uganda.
These studies, in which some uncircumcised men were randomly assigned to be circumcised in presumablysterile conditions and others were not circumcised, showed that male circumcision reduced HIV acquisition. Brewer said,
“If we had known several years ago what weknow now from the national surveys, there wouldn’t have been a good empirical basiseven to conduct the trials. Therefore, it is crucial to investigate thoroughly the possiblemechanisms—which are speculative at this point—for the protective effect observed inthe trials.”
Brewer and his colleagues also called for more intensive study of HIV transmission in the context of both traditional and medical circumcision in sub-Saharan Africa.