Male Circumcision and the Spread of HIVAIDS

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• Male Circumcision and the Spread of HIV/AIDS

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Ecologic Relationship Between HIV and Male
Circumcision
HIV Seroprevalence ()
Circumcised males
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MALE CIRCUMCISION AND POPULATION BASED HIV
PREVALENCE IN AFRICA
High (gt80) male circumcision
Low (lt20) male circumcision
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MALE CIRCUMCISION AND HIV IN ASIA
0
Bangladesh
0
Pakistan
Philippines
0.1
High (gt80) male circumcision
0.1
Indonesia
Fiji
Low (lt20) male circumcision
China
0.1
0.30
Vietnam
0.60
PNG
India
0.91
1.2
Burma
Thailand
1.5
2.6
Cambodia
0
1
2
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Sources UNAIDS, 2004
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SERO-CONVERSION AMONG NAIROBI STI CLIENTS AFTER
SEX WITH HIV-POSITIVE SEX WORKER
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Rakai Study

• Study of 415 discordant couples
• 40 infections in 137 uncircumcised men
• 0 infections in 50 circumcised men

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Circumcision Status and HIV Transmission to Women
Of 47 couples in which circumcised male partner
was HIV AND whose viral load was lt50,000
particles, 0 of female partners were infected
after two years, vs. 26 of 143 female partners of
uncircumcised HIV men (9.6/100 py) (p 0.02).
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• The Possible Cause of this

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• Foreskin mucosa contained six times higher
  proportions of CD4 T cells, macrophages and
  Langerhans cells than cervical mucosa.
• Foreskin immune cells expressed predominantly
  CCR5 co-receptors.
• HIV-1 DNA in infected foreskin was nine times
  greater than in infected cervical tissue.
• No HIV-1 DNA was detected in the tissue from the
  outer surface of the foreskin.

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Issues Still to be Addressed

• Disinhibition will circumcised men feel they
  are protected and engage in more risky behaviors?

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