It is believed that circumcision may protect heterosexual men from acquiring human immunodeficiency virus (HIV) through sexual intercourse. A new randomized controlled trial adds weight to this claim.
HIV as a Public Health Issue
According to the World Health Organization (WHO), HIV remains a major public health threat in some parts of the world. At the end of 2022, around 39 million people live with HIV, two-thirds of whom are found in African countries.
There is still no cure for HIV infection, but treatment options have improved in recent years. With efforts focused on education and prevention, HIV prevention has become a manageable chronic health condition.
Reduced HIV Susceptibility Through Circumcision
Observational studies suggest that removal of the foreskin can prevent the transfer of sexually transmitted infections (STIs) such as HIV. Still, the possibility of sampling biases has left claims open to debate.
Circumcision may not be a preventive measure as reliable as condom use, but previous studies suggest that it can reduce the risk of HIV transmission in at least some cases. It was shown that male circumcision is linked to lower rates of several STIs, such as syphilis and chancroid.
In a recent study, a team of researchers from Sun Yat-sen University in China assessed the effectiveness of voluntary medical male circumcision (VMMC) in impeding HIV infection among men who have sex with men (MSM). Their findings are discussed in the paper "Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men: A Randomized Controlled Trial."
Led by Dr. Yanxiao Gao, the experts used blood tests to compare two randomly assigned groups of men who underwent circumcision voluntarily over a 12-month period. The team enrolled 247 uncircumcised men between the ages of 18 and 49 from 8 cities in China, all of whom were HIV-seronegative.
All the male participants admitted having insertive anal intercourse with other men and engaging in sex with two or more male partners in the past six months. They all received HIV counseling and testing and were randomly assigned to either the control or the intervention group.
The intervention group was composed of 124 men who received immediate circumcision, while the other 123 men in the control group had their circumcision delayed by one year.
During the entire study period, the members of the intervention group did not experience seroconversions. This is the time window when a person's body begins to produce detectable amounts of antibodies in response to an HIV infection.
In other words, none of the men who immediately received circumcision later became infected with HIV. Meanwhile, the control group experienced five seroconversions, an indication that a handful of men became infected with HIV during the course of the research.
Circumcision is a common practice among many cultures, but this tradition is controversial, especially when done on minors. Promoting non-consensual circumcision as a public health intervention can also be a sensitive subject.
The new study suggests that VMMC may offer some protection against HIV infection for MSM, although the authors are careful not to overstate the implications. Although VCCM could exhibit high protective efficacy, the researchers warn that it is still important to provide comprehensive protection against HIV with additional preventive measures.
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