Circumcsion does not protect black South Africans
A total of 2585 males over the age of 15 were administered questionnaires and provided specimens for HIV testing. 916 (35.4%) of them said they were circumcised. HIV prevalence among circumcised males was
10.7% and among uncircumcised males was
12.1%, p = 0.9 [i.e. no statistical significance]. Blacks were less likely to be circumcised (28.8%) compared to other racial groups, 42.6%, p = 0.002. When the data was stratified by racial group,
circumcised Blacks showed similar rates of HIV as uncircumcised Blacks, (OR: 0.8, p = 0.4) however other racial groups showed a strong protective effect, (OR: 0.3, p = 0.01)
[or rather, a correlation]. When the data are further stratified by age of circumcision, there is a slight protective effect
[correlation] between early circumcision and HIV among Blacks, OR: 0.7, p = 0.4.
Conclusion In general, circumcision offers slight protection. The effect is much stronger in other racial groups than in blacks. This racial difference cannot be explained by age of circumcision.
HIV and circumcision in South Africa
C.A. Connolly, O. Shisana, L. Simbayi, M. Colvin.
Poster at the XV AIDS Conference in Bangkok [MoPeC3491]
No protection among young South Africans
A 2001 study by Bertran Auvert et al (who also ran
the 2005 Random Controlled Study) of HIV infection among youth in a South African mining town found it is associated with the
Herpes simplex 2 virus
It was "a community-based, cross-sectional study" of a random sample of men (n = 723) and women (n = 784) living in a township in the Carletonville district of South Africa.
Risk factors associated with HIV were recorded by questionnaire and biological tests were performed on serum and urine.
It found that women were much more likely to have HIV (34%) than men (9%) and HSV-2 (53% vs 17%) Two thirds of the 24-year-old women had HIV. Of the men,
Circumcision
status
n
HIV+ Odds
ratio95% Confidence
interval No 498 (89.1%) 11.2% 1
Yes 61 (10.9%)
16.4% 1.6 0.7-3.2 Thus,
the circumcised men in the study were more likely to be HIV+, but the result was not significant (the 95% CI straddles 1.0 - in real terms, 10 of the 61 circumcised men had HIV, three more than would be expected if they had the same rate as the intact men) But it certainly casts doubts on the claim that circumcision protects against HIV infection. Typically, Auvert expresses this cautiously, in terms of the prevailing mythology: "No protective effect of circumcision on HIV prevalence was shown."
No protection to insertive gay men:
"Our finding that 17% of homosexual men with newly acquired HIV infection reported insertive UAI [unprotected anal intercourse] as their highest risk activity suggests that insertive UAI is an important means of HIV transmission in this population. However, we found no association between circumcision status and infection by insertive UAI. In addition, men who had seroconverted despite no reported event of UAI were also no more likely to be uncircumcised. These data strongly suggest that the foreskin is not the main source of HIV infection in homosexual men who become infected by insertive UAI, and that other sites, such as the distal urethra, must be important in HIV infection.
"Our data showing that there is no difference in the circumcision status of men infected by receptive or insertive UAI, in a population with a circumcision prevalence of approximately 75%, suggests that circumcision is not strongly protective against HIV infection in homosexual men. Larger studies, preferably of prospective design, are needed to confirm the absence of a relationship between circumcision and HIV infection risk in gay men. In the meantime, educational messages to homosexual men should continue to emphasize that insertive anal sex is a high-risk activity for HIV transmission whether or not the insertive partner is circumcised."
- Grulich AE, Hendry O, Clark E, Kippax S, Kaldor JM.
Circumcision and male-to-male sexual transmission of HIV.
AIDS 2001 Jun 15;15(9):1188-1189.
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