Male circumcision could help diminish the HIV/AIDS pandemic in developing countries, but health professionals are reluctant to publicize this fact, according to an editorial in the Lancet by Daniel Halperin and Robert Bailey. The authors cite a study, published a decade ago, of 422 Kenyan men who habitually visited prostitutes. The research showed that the uncircumcised men had an 8.2 times greater risk of infection. Of 38 additional investigations, 27 from eight different countries found a similar association between uncut men and infection.
Halperin and Bailey say the startling statistics support the widely held theory that the foreskin "provides a vulnerable portal of entry to HIV and other pathogens ... such as chancroid, syphilis and herpes, that are known cofactors for HIV infection." One possible explanation: The tender foreskin is easily torn and scratched during intercourse, enabling the virus to enter.
Circumcision could provide a huge barrier to the AIDS plague in developing countries that have no tradition of circumcision, claim Halperin and Bailey. In Zambia, for example, where 80 percent of the men are uncircumcised, "an estimated 55 percent of HIV-1 infections ... are attributable to lack of circumcision," contend the authors. Their editorial asserts that millions of lives could be spared in populous nations such as India if the foreskin was simply snipped off.
The authors, while cautioning that circumcision could be counterproductive if men believe that the procedure will protect them from HIV transmission, lament that the international health community has disregarded information about the probable link between circumcision and HIV/AIDS transmission. For example, the Johns Hopkins Media/Materials Clearinghouse collection of 30,000 AIDS materials contain no mention of this link.
Although the information is stonewalled in the United States, it is recognized and acted upon in east and south Africa. Traditional healers are recommending circumcision, and private clinics in Tanzania, Kenya, Rwanda and Uganda are advertising foreskin removal as "a way to alleviate chronic STD infection and AIDS."
The Lancet editorial ends with a plea to the international health community to assist the public with education, training and circumcision services, and they urge their colleagues to assist them in this mission.