http://news.yahoo.com/s/afp/20070306/hl_afp/healthaidscircumcision_070306192644

AIDS: New trial shows needs for caution in adopting circumcision strategy

Tue Mar 6, 2:26 PM ET

Early data from a trial in Uganda shows that policymakers must be
prudent when including circumcision among their tactics for fighting
AIDS, researchers said on Tuesday.

Last year, three groundbreaking studies conducted in Africa found
that male circumcision halved a man's risk of being infected by the
human immunodeficiency virus (HIV).

That discovery ignited hopes that the flagging quarter-century-old
war against AIDS in Africa could be transformed by a simple, low-cost
operation.

The new trial, funded by the Bill and Melinda Gates Foundation,
explores a different angle of the circumcision story -- to see
whether men who are infected with HIV and are circumcised are any
less likely to infect their female partner.

US and Ugandan researchers are following 997 HIV-infected men in
Rakai, Uganda. Some of them have been given circumcision, while the
others have remained uncircumcised to act as a comparison.

A proportion of volunteers in both groups had uninfected long-term
female partners at the start of the study. These women were also
enrolled and monitored.

A review at the study's six-month mark looked at 70 couples in the
"circumcised" group and found that 11 of the women had become
infected. Among 54 couples in the "uncircumcised" group, four women
had become infected.

The study is still underway and the data is not considered conclusive.
But the researchers said they were concerned, as several of the
infections had been transmitted by men who had had sex before their
wounds had fully healed from the circumcision surgery.  The AIDS
virus can be carried in the blood, as well as in semen.  This means
that, before circumcision can be universally endorsed as a prevention
strategy, men and women have to be fully aware about the need to
refrain from intercourse for a month or so while the penile wound
has healed, the researchers said. 
(HIV is already present in semen, how could the circ wound be
contributing to the M->F infection rate?  The more likely explanation
is that circumcision increases vaginal abrasion,
http://www.cirp.org/library/anatomy/ohara/
which breaks down the very effective HIV barrier which is normally
presented by intact vaginal epithelial tissue.
http://jvi.asm.org/cgi/content/full/74/12/5577?view=long&pmid=10823865 Thus
Thus this rate-doubling effect is likely to be a permanent consequence
of MGM and will not disappear after a month)

Both partners must be fully versed in safe-sex awareness, especially
in condom use.

"We need to err on the side of caution to protect women in the
context of any future male circumcision programme," said the study's
lead scientist, Maria Wawer of the Johns Hopkins Bloomberg School
of Public Health.

"Women make up a majority of people living with HIV in Africa, and
these results demonstrate that women need to be educated about the
risks and benefits of male circumcision," she said in a press
release.

If the finding about infection from post-operative wounds is taken
into account, the trial found that there was no protection to
partners of HIV-infected, circumcised men within the first six
months of surgery.

Circumcised men, though, had a 50-percent lower rate of genital
ulceration.

The next step is to see whether that picture changes over the longer
term.

The data was released on Tuesday as a contribution to a meeting in
Montreux, Switzerland, gathering the UN's World Health Organisation
(WHO) and UNAIDS.

The two agencies are mulling the outcome of the three big trials
to weigh how far, and how fast, they should endorse circumcision
as a prevention policy.

WHO expert Kevin De Cock stressed the need for caution and good
preparations.

"While male circumcision has extraordinary potential to prevent HIV
infection, these new findings remind us that we must proceed with
thought and care in developing male circumcision in Africa," said
De Cock.

Volunteers in the Rakai study were repeatedly given safe-sex
counselling and provided with free condoms. Women who become infected
have been promised access to free HIV care and antiretroviral drugs.