More Reports and Research On Uncircumsized Men and HIV

In Tuesday's New York Times there's an article ("Washing After Sex May Raise H.I.V. Risk") on a counter-intuitive result from a study on uncircumcised men in Uganda: immediate washing of the penis after vaginal sex increased the rate of HIV transmission from female to male sexual partners. A summary of the article by the invaluable Kaiser Daily HIV/AIDS Report says:

For the study, Fredrick Makumbi of the Makerere University Institute of Public Health and colleagues examined 2,552 uncircumcised, HIV-negative men ages 15 to 29 in the Rakai district of Uganda. Eighty-three percent of the participants said they washed their penises with all sex partners, the Times reports. The researchers asked the men when and how they washed their penises -- including if they washed with or without cloths -- after sex at the beginning of the study and at six, 12 and 24 months after the study began. According to Ronald Gray, a study co-author and professor of population and family planning at Johns Hopkins Bloomberg School of Public Health, the researchers did not ask details about how the washing was conducted or if soap was used because of an oversight. Some soaps used in Africa are more irritating than soaps used in other places, according to the Times.

The researchers found that men who washed within three minutes after sex had a 2.3% risk of HIV infection, compared with a 0.4% risk among men who delayed washing for 10 minutes or more. Makumbi and other AIDS experts said they do not know why washing might increase vulnerability to HIV, but they offered some explanations. One is that delaying washing and prolonging exposure to vaginal secretions might reduce viral infectivity. Another explanation is that the acidity of vaginal secretions might impair the ability of HIV to survive on the penis, the Times reports. In addition, the use of water, which has a neutral pH, might prolong viral survival and possible infectivity, according to the Times. HIV likely needs to be in a fluid to cross the mucosa and infect cells, Gray said, adding that if HIV-infected fluid dries, its infectivity could decrease. Adding water, therefore, could resuspend HIV and increase its infectivity, the Times reports.

This follows news reports that Bush Administration is going to start allocating some of the funds in PEPFAR (President's Emergency Plan for AIDS Relief) to provide adult male circumcision in African countries such as South Africa, Kenya and Uganda where studies have shown tha male circumcision can reduce HIV transmission rates by as much as 60 per cent among heterosexuals. The Black AIDS Institute sent out a rare statement praising an initiative by the Bush administration.

Meanwhile, public health must begin to make people aware of the dramatic difference circumcision appears to make in HIV risk. In doing so, however, the Bush administration must respect the justified concerns both communities and individuals may present. Too many years of abuse at the hands of pseudoscience have left communities of color around the world distrustful of health officials. Any outsider- driven, top-down campaign urging men to have skin removed from their penises will no doubt deepen that skepticism.

So as the Bush administration gears up its response to the compelling data on circumcision, it will be well advised to help local leaders do the leading, which is something its AIDS program has proven reluctant to do in the past. That includes investing in raising the HIV-science literacy among local leaders and supporting culturally appropriate venues where communities can develop the tools needed to interpret the science.

At the same time, people of color around the world no longer have the luxury of allowing other folks' mistakes to hold us captive. If we're going to survive this epidemic, we must begin taking responsibility for our own lives. That means, no matter what the Bush administration does, and no matter what any local health department does here in the U.S., we must learn the facts about circumcision and HIV.

It is an entirely appropriate choice for any individual to opt against circumcision as a method of HIV prevention. But he must make that choice based on the facts, not as a self-defeating reaction to fears about government abuse.

Mad Professah has been following the ongoing debate(s) about HIV and circumcision quite closely and will continue to do so.