Why does circumcision play a role in the fight against HIV infection?

Question

There's a recent report that talks about how circumcision can help reduce the chance of contracting HIV. The article is here:
http://www.msnbc.msn.com/id/22043754/

Unfortunately, the article doesn't explain how and why. Any medical experts out there able to explain this?

Thanks

Answer 1

The article doesn't explain how or why because scientists don't know exactly how or why either. Some scientists have ideas, but none of them are proven. At this point, a skeptic/critic could easily say that the studies showing the correlation between circumcision and a reduced HIV rate may just be a really lucky coincidence.

Some scientists think that the foreskin is more likely to rip and tear during sex, causing cuts too small for the naked eye to see but large enough for the HIV virus to enter. This is interesting because the foreskin's supposed to help reduce some friction during sex and make things go easier/smoother, thus reducing abrasions from sex.

Other scientists believe the Langerhan cells (immune cells) in the foreskin attract HIV to it. There's some truth to this, but an interesting study found that these cells degrade HIV inside them so they might never actually enter the body (see 1st link). So even this thought should be cautioned.

In any case, safe sex (i.e. condom use and single partners at a time) and good genital hygiene are much better at preventing HIV infection than circumcision ever could. See the remaining links. They poke some holes in the circumcision studies and make good points. Although some of the links are from clearly anti-circumcision sites, the points they make are still interesting and meaningful.

The end point is, scientists don't know how or why, and because they don't know, those studies should be taken with a grain of salt. They may/may not reflect what's actually going on. In 10-20 years or so, scientists might say that removing the foreskin was unnecessary and had virtually no effect (this has already happened with circumcision and masturbation, circumcision and various hygiene issues, circumcision and various STDs, etc etc).

Answer 2

If the Langerhans cell theory is correct, circumcision should also be implemented in women as Langerhans cell are also present in the female prepuce (clitoral hood) and labia.


Since AIDS has only been a problem since the 80's, and circumcision is older than that, could we not expect that the countries with high circ rates have the lowest AIDS stats? The 60% claim should make a huge difference. But in fact the 5 countries with the least AIDS problem are mostly uncut.
The US is the only first world country to circumcise most of its sons and we have a AIDS problem 3 times worse than any other first world country.

Answer 3

This is based on some studies done in Africa and it hasn't been proven. However, these studies don't seem very conclusive at all. I suggest you read the studies or their abstracts at this web site http://www.cirp.org to make up your own mind.

Although the researchers found that there were fewer circumcised men infected with HIV during their trial period, they didn't quite no the reason. AFAIK there is one argument that the foreskin is more likely to tear during sex thus letting in the virus. The other argument is about Langerhans cells. (These are also found on a female's clitoral hood though, and nobody suggests removing that.)

Simple statistics seem to show it's not true though, as the 5 countries with the lowest HIV rates don't circumcise, and the USA is the developed nation with both the highest HIV rate and circumcision rate.

Personally I think it's irresponsible to promote this. IF there is a reduction, it's only a slight one, and only happens in female-to-male transmission. Nothing is going to be as good protection as condoms and/or not sleeping around. HIV is spread more commonly through male-to-male intercourse or male-to-female. In fact in places like Africa, creating open wounds is going to be worse for transmission I would imagine, especially if people mistakenly believe (which I imagine they would) that being circumcised means they can't get HIV and even worse can't pass it on. Then again, don't some people in Africa believe condoms cause HIV?

In addition, I really don't think this should be even considered as a reason to circumcise babies. When they become sexually active they can be presented with the evidence and make their own choice. Bearing in mind babies born today will not be sexually active for 15-20 years, and there may well be a vaccine (or we'll be closer to one) by that time. (And there will be some kids who will end up being gay or waiting till marriage with a virgin, so circumcision would be no benefit to them.)

For all the other things circumcision apparently cures/prevents, check out this slideshow: http://www.icgi.org/medicalization/ (they have all since been proven to be false, unsurprisingly)

Answer 4

I think if it did stop HIV and AIDS the USA and Africa would have the lowest HIV and AIDS rates but they have the highest. This article is to convince Americans to circumcise. No other countries but America circumcise there new borns. Africa it is done when there 16 in most tribes. If it did stop it why are ALL the other countries not then?

In 50’s – 60’s Circumcision was to stop masturbating
(Found to be not true)
In 70’s – 80’s Circumcision was to be cleaner
(Found to be not true)
In 90’s It stopped Cancer
(Found to be not true)
And today people say it stops AIDS and STDS

What will they think of next? It stops global warming.

People think the foreskin is just skin and they are wrong. It is the most sensitive part on a man any uncircumcised guy knows that. A lot of perants don’t care about what the child thinks or feels. I think people are sick in the head for doing it to a defenseless child, if you want to be circumcised good for you but don’t bring your innocent children into it.

Answer 5

There were three trials run in Africa recently where men were circumcised during the study and their rate of getting HIV were compared to those partipants of the study who were not circumcised. Although the study was supposed to run for 2 years, after about 14 months it looked like they contracted HIV half as much as those who did not get circ'ed, since it was of an "ethical priority" to make circumcision available to the other half of the study's participants.

The researchers have not provided a proven explanation for their findings but theorize that the Langerhan's cells found in the foreskin make it more susceptible to acquiring the disease. If you look into what these cells do, you will find that there is still much debate in how they function. But what is certain is the they mitigate immune function. In fact there is a Dutch study that found that these cells were directly responsible for why HIV is not spread as easily as many other sexually transmitted dieseases.

Researchers also suggest that the foreskin is susceptible to micro-tears through which disease can enter the body. I am very skeptical of this explanation because a circumcised member with its reduced skin coverage, is much tighter during erection, plus it has a relatively fresh scar (like in the studies), so wouldn't it be more likely to encounter tears?

Perhaps the fact that the circumcised men were taken out of the sexually active pool for about 2 months while they healed has something to do with the result. Perhaps the fact that researchers emphasized to them to importance of wearing condoms for a while after their surgery to avoid contracting disease through their scars, has something to do with it. Possibly, they got used to wearing condoms during this healing period and used it more frequently than their uncircumcised counterparts? Maybe the pain from the actual procedure and the healing period resulted in a behavioral change, namely that they became more conscious of the importance of using condoms?

Possibly a number of factors weaken the studies: the fact that researchers were hoping to find a link to circumcision; a double-blind experiment was impossible; the studies were stopped short and we don't know if the circ'ed participants remained HIV free a few months later; many uncircumcised participants dropped out of the study and were not followed.

At any rate, behavior is the key to preventing HIV. Based on the level of protection circumcision seems to provide in Africa in heterosexual relationships to the male alone, if you have sex without a condom with someone whose status you don't know, your chances of getting the virus is like getting heads or tails at a coin-toss. When you know that condoms protect you nearly 100%, would you take those chances?

Answer 6

They say that the foreskin is more able to rip and let blood transfer happen, but the foreskin is double layered; it shouldn't rip if you don't go extremely rough and if you use lubricant. Africa's climate and poverty really messes that up.

Many of these studies were pretty flawed. For example, see what has been found here:
http://www.circumstitions.com/HIV.html

Check out HIV statistics:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html

As you can see, the United States (the industrialized nation with the highest circumcision rate, has the highest HIV rate). Most of Europe and Latin America (who don't circumcise) have lower rates.

In addition, another medical study found that prostitution, not circumcision (specifically mentioned in the conclusion) is what spreads HIV that much; that makes sense.
http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000543

Circumcision has become a lot less common everywhere and a lot advantages are also held by being uncircumcised, so don't worry much about it. Research here:
http://answers.yahoo.com/question/index?qid=20071201114142AAgnLvE&r=w#F8wrC2S1VTfksfjKU7Fw.rbGZcI_8zgOtdkMw4JCGXLhidgYgynx

Answer 7

I'm no medical expert (I doubt there are ANY on this board) but, I dont think it does. At least not a major role.

If we assume that "most" of the men in the USA are circumsized (for the sake of argument), then why does the US still have the 10th highest population of AIDS-infected people out of all the countries in the world?

Now look at places where circumsizion is not so common:
New Zealand - 133rd highest population of people with AIDS.
Ireland - 123rd highest popultion of people with AIDS.
UK - 63rd highest population of people with AIDS.
I'd say it does jackshit in preventing AIDS and the best combat against it is protected sex.

Answer 8

The most likely explanation is that the men who were circumcised had so much less pleasure in sex that they had fewer partners and thus less risk. Plus they had to abstain while the circumcision healed and probably were too sore to have much action for even longer. Less sex with fewer partners means fewer infections. If they had castrated the men, the rate probably would have dropped even further. Guess that will be the next thing they try.

Answer 9

Apparently it plays no role in the fight against HIV, at least here in the US. Read up:

http://www.reuters.com/article/healthNews/idUSN0345545120071204

Answer 10

I found this article that discusses the possible mechanism behind the circumcision/HIV paradigm.

http://www.bmj.com/cgi/content/full/320/7249/1592