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  SAATHII Electronic News Letter: Focus on HIV Science from IndiaNew Compiled by Ms Ishdeep Kohli, Dr. L. Ramakrishnan and Dr. Subhasree
Sai Raghavan
[Mar 26, 2004]
Men in India who are circumcised are less likely to be HIV-positive than menwho are not circumcised because of biological, not behavioral differences,according to a study published in the March 27 issue of the Lancet, Reutersreports (Reuters, 3/25). Some researchers have suggested that circumcisedmen are less likely to be HIV-positive because they engage in fewer riskbehaviors because of their religious beliefs or other cultural factors.Other researchers have suggested that circumcised men have a reduced risk ofother sexually transmitted diseases associated with genital ulceration ormucosal inflammation, which can increase the risk of HIV infection,according to the study (Bollinger et al., Lancet, 3/27). Robert Bollingerand colleagues from the Johns Hopkins University Medical School and theNational AIDS Research Institute in Pune, India, examined 2,298 HIV-negativemen who attended a STD clinic in India. The researchers assessed most of themen a total of four times for about a year and found that uncircumcised menwere more than six times as likely to acquire HIV than circumcised men.However, the researchers did not find a similar protective effect againstother STDs, including herpes simplex 2, syphilis or gonorrhea (Lancetrelease, 3/26). Circumcision only had a protective effect against HIV(Lichtarowicz, BBC News, 3/26). "These epidemiological data lend support tothe hypothesis that male circumcision protects against HIV-1 infectionprimarily due to removal of the foreskin, which contains a high density ofHIV-1-specific cellular targets, including CD4+ T-lymphocytes and Langerhanscells," the researchers said (Lancet, 3/27).
The study recommends that clinical trials be conducted where culturallyappropriate to determine the safety and effectiveness of male circumcisionas a means of reducing the spread of HIV. In addition, the study calls foradditional research into methods of blocking the entry of HIV into cellscontained in the foreskin (Reuters, 3/25). Three trials examining theseissues currently are being conducted in Africa, Toronto's Globe and Mailreports. Researchers hope to verify that circumcision is a "truepreventative agent" and that as a surgery it does not have high complicationrates. They also hope to determine whether men change their sexual behaviorafter surgery, including whether there is an increase in risk-relatedbehaviors (Strauss, Globe and Mail, 3/26).
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