NY Times Editorial: Preventing the Spread of AIDS

The New York Times
October 15, 2005
Editorial
Preventing the Spread of AIDS

For years, doctors and policy makers have suspected that male circumcision is a powerful protector against AIDS. Now a new study in South Africa has found that circumcision reduces men's risk of H.I.V. infection by more than 65 percent. If the results are confirmed by two similar studies in progress, circumcision may offer a way to curb the AIDS explosion in some of the most affected nations.

Researchers have long noted that in Africa, Muslim countries where males are routinely circumcised have much lower H.I.V. infection rates than predominantly Christian ones where circumcision isn't widespread. But other factors could have mattered, like Islam's prohibition on drinking alcohol, which could reduce risky behavior.

The South Africa study is the first to offer a high scientific standard of evidence that circumcision is responsible. The study, by French and South African researchers, recruited young men who were H.I.V.-negative and uncircumcised, as are most men in South Africa. Half were randomly assigned to be circumcised. After adjustment for other factors, circumcision reduced the risk of H.I.V. infection by two-thirds during the 21 months of the study. The difference was so great that the trial was stopped and the other men were immediately offered circumcision. Two similar studies with very different groups of people are under way in Uganda and Kenya. It may take two years to get results.

The most likely theory about why circumcision works is that the penis's foreskin has cells that are particularly receptive to the AIDS virus. The studies are looking at only whether circumcision protects men from infection. Circumcised men may also be less likely to transmit the virus, but the current studies are not examining that. Even if circumcision doesn't make a man less contagious, it helps protect everyone by lowering the infection rate.

Circumcision is no easy sell, but it is at least widely performed and accepted in Africa. If an AIDS vaccine were suddenly discovered that could prevent 7 out of 10 new infections, the world would be rejoicing. AIDS policy makers should be discussing how to promote circumcision so they can be ready to act immediately if the Kenya and Uganda studies confirm the good news in South Africa.