A circumcision program in a South African township reduced the rate of new HIV infections among men who had the procedure by 76 percent, according to the first data to show the effect of circumcision in the nation with the most AIDS cases.
More than 20,000 circumcisions were performed between 2007 and 2010 in Orange Farm, near Johannesburg, according to findings presented at an AIDS conference in Rome today. The percentage of circumcised men from 15 to 49 years of age increased to 49 percent from 16 percent in the period, said Bertran Auvert, a public-health professor at the University of Versailles outside of Paris, who presented the results.
Today’s findings are the first evidence that circumcision is altering the course of the world’s deadliest infectious disease in the nation hit hardest by it. Botswana, Kenya, Swaziland, Tanzania and Zimbabwe are among 14 African countries promoting the procedure in an effort to expand the proportion of circumcised men in Africa to 80 percent from about 66 percent now, said Auvert.
“We are changing the social norms,” he said in an interview in Rome. “It’s the first time in the world that we have a successful intervention in a community to reduce the sexual transmission of HIV between adults.”
Circumcision is the surgical removal of a skin that covers the tip of the penis. Studies have shown the pocket between the foreskin and the tip of the penis gives viruses and bacteria a spot to grow, and circumcision eliminates it. The foreskin has been shown to be rich in cells that carry HIV into the body.
Transmission to Women
The researchers surveyed almost 1,200 men in Orange Farm in 2007 and the same number in 2010. There were 0.42 infections in every 100 circumcised men per year, compared with 2.86 among uncircumcised men, according to the study. After statistical adjustment, the decline worked out to 76 percent, Auvert said.
Among circumcised men in Orange Farm, 6.2 percent have HIV, compared with 20 percent of those whose foreskins are intact, today’s findings show. The researchers said they’re now collecting data to measure the effect of circumcision on the transmission of HIV from men to women.
Each circumcision costs about 750 rand ($108), said Dirk Taljaard, who participated in the study as a researcher with Progressus Research and Development Consultancy in Johannesburg. He’s now a program manager at the Centre for HIV and AIDS Prevention Studies, which operates a circumcision clinic in Orange Farm.
For every five circumcisions performed, one HIV infection is prevented in the next 10 years, and every dollar spent on circumcision will save about $15 that would need to be spent later on treating HIV infections, the researchers said.
South Africa’s government aims to have 4.5 million men, or 80 percent of the male population, circumcised within five years, Taljaard said.
“It’s really quite simple as an intervention,” Taljaard said. “It’s not something that you’re trying to get somebody to do every day of his life.”
Circumcised men were no more or less likely to use condoms than uncircumcised men, the study found.
About 500,000 men have been circumcised in Africa since 2008 in programs funded by the U.S. President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Malaria and Tuberculosis, Auvert said.
-- Editors: Phil Serafino, David Risser