- The Washington Times - Friday, April 25, 2003

Circumcised men are at least 50 percent less likely to contract the virus that causes AIDS during unprotected sex than uncircumcised men, according to a soon-to-be released report by the U.S. Agency for International Development (USAID).
Based on a systematic review of 28 scientific studies published by the London School of Hygiene and Tropical Medicine, the USAID report "found that circumcised males are less than half as likely to be infected by HIV as uncircumcised men."
"A sub analysis of 10 African studies found a 71 percent reduction among higher risk men," said the report obtained by The Washington Times.
"There is really an incredible preponderance of evidence. There is really a strong association," between circumcision and HIV protection, Dr. Anne Peterson, assistant administrator for global health at USAID, said yesterday in an interview.
According to the scientific studies, the skin on the inside of the male foreskin is "mucosal," similar to the skin found on the inside of the mouth or nose. This mucosal skin has a high number of Langerhan cells, which are HIV target cells, or doorway cells for HIV.
The rest of the skin on the penis is more like the outer skin on the rest of the body, a barrier that protects against germs.
"HIV looks for target cells, like the Langerhans; it's a lock and key," said Edward C. Green, senior researcher at Harvard University, who has been looking at circumcision and HIV in Africa for 10 years. "The rest of the skin on the penis is armorlike."
He said that it is better to be circumcised as a baby, rather than as a teenager in "rite-of-passage" ceremony, because many teenage boys in Africa are already sexually active.
Mr. Green said that if all males in Africa were circumcised, the HIV/AIDS prevalence rate could be reduced from 20 percent in some regions to below 5 percent.
In addition, circumcision reduces the transmission of other sexually transmitted diseases, is more hygienic, reduces infections associated with poor hygiene and makes it easier to use a condom, Mr. Green said.
"This is something the tribal healers, the herbalists, faith healers and witch doctors have known for years," he said.
The 60-page USAID report is based on presentations given at a USAID conference in September, and will be available on the USAID Web site "soon," Dr. Peterson said.
She said that while the information "looks profound and wonderful," she cautioned there may be other factors that reduce HIV transmission in circumcised men.
She said clinical trials in Kenya and Uganda, under the auspices of the National Institutes of Health (NIH), Johns Hopkins University and the Gates Foundation, would give a clearer picture. Until then, she said USAID would move cautiously to educate and promote male circumcision.
Dr. Peterson said there is no evidence the female circumcision, sometimes called genital mutilation, offers any benefit whatsoever.
In fact, the scarring produced in the procedure may enhance the transmission of disease, she said. "We are adamantly opposed to female circumcision."
Another concern is that by promoting circumcision, circumcised men may mistakenly believe they are invulnerable to HIV. They are not, said Dr. Peterson.
"It reduces your risk. It does not protect you outright," said Dr. Peterson. "People who are circumcised still get HIV. It is still better to abstain, be faithful in marriage," or use condoms, she said.

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