Towards zero HIV infection with male circumcision

Picture yourself relaxing with a partner in some confined place. You only prepared for some nice time to relax. But you find emotions getting the better of you. Regardless of not knowing the partner’s sero-status, you have unprotected sex.

You are a man and you are not circumcised. Do you know that within a short period of you reflecting on the experience or seeing off the partner the Human Immuno-Deficiency Virus (HIV), the virus that causes the Acquired Immune Deficiency Syndromes (Aids), would get into your blood system?

According to a 2008 report, Male circumcision and risk for HIV transmission and other health conditions, which quotes several other pieces of research findings and published on the United States (US) based Centre for Disease Control (CDC) website, the foreskin provides conditions favouring the development.

“Compared with the dry external skin surface, the inner mucosa of the foreskin has less keratinisation (deposition of fibrous protein),” reads the report, quoting a 2004 report titled Neonatal circumcision: a review of the world’s oldest and most controversial operation.

“The foreskin has a higher density of target cells for HIV infection (Langerhans cells) and is more susceptible to HIV infection than other penile tissue in laboratory studies.”

In its posting on December 20, 2005, the journal Science Daily website states that researchers at Yale School of Medicine demonstrated that, contrary to what was thought that they alert the immune system about invasion by pathogens, Langerhans cells dampen the skin’s reaction to infection and inflammation.

Thus, engaging in unprotected sex with an HIV positive partner renders an uncircumcised male vulnerable to HIV infection. Fatima Zulu, Project Coordinator for Johns Hopkins at the Malawi College of Medicine, says an uncircumcised male has the ground prepared for contracting the HIV even before penetration.

“When a man who is not circumcised experiences an erection, the tip of the foreskin stretches. That leads to cracks in the foreskin which create a highway for such a man to contract the virus,” says Zulu.

“That aside, there is a belief by most men across Africa that they are real men if they ejaculate faster. Ejaculating faster mostly goes with dry sex, and dry sex is dangerous for an uncircumcised man.”

She says with the less keratin deposits within it, the foreskin stands higher chances of suffering abrasions during dry sex. Consequently, she adds, the man with such a condition has greater chances of contracting the virus as the foreskin provides a portal of entries.

The report further states that with the foreskin on, the sac between the unretracted foreskin and the glands penis provides a conducive environment for the survival of pathogens, including HIV.

“Viruses often survive in a moisturised environment as a result they stay alive longer,” adds Zulu. “Unfortunately, the longer one keeps the viruses under their foreskin, the more they give out chances for the virus to penetrate into their body.”

She says that all this would never be the case to men who underwent male circumcision, which is defined in the report as the surgical removal of some or all of the foreskin from the penis. But can that bring down the HIV infection rate?

According to the report on the CDC website, several research findings have pointed to circumcision as an effective way of taming the spread of the HIV.

“In these studies, men who had been randomly assigned to the circumcision group had a 60 percent (South Africa), 53 percent (Kenya) and 51 percent (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study,” adds the report.

“In all [the] three studies, a few men who had been assigned to be circumcised did not undergo the procedure, and vice versa. When the data were reanalysed to account for these occurrences, men who had been circumcised had a 76 percent (South Africa), 60 percent (Kenya) and 55 percent (Uganda) reduction in risk for HIV infection compared with those who were not circumcised.”

Unfortunately, the reduction in the infection trend is one way. Zulu says that circumcision only reduces chances of a circumcised man contracting the virus from an HIV positive woman.

“This means that if a man is HIV positive and is circumcised, he will still pass on the virus to a woman who is HIV negative,” she says.

However, the situation should still count as an effective measure of halting the spread of the HIV considering what society holds culturally. It is considered normal for a man to have many women but not vice versa.

This is what has led to several civil rights activists to blame the man for the devastating rate at which the virus has spread. Many say the man gets the virus from other women and dumps it in his own.

Going by such arguments, a man who underwent male circumcision should stand fewer chances of getting the virus from outside his marital confines and dumping it within them.

“But circumcision should not be cause for being promiscuous,” warns Dr Mary Shawa, Principal Secretary in the Office of the President and Cabinet (OPC) responsible for Nutrition and HIV/Aids.

“Research findings indicate that circumcision only reduces chances of contracting the virus by 60 percent. There are 40 percent chances for a man who underwent male circumcision to contract the virus.

“This is why we encourage the usual means of preventing contraction of HIV; namely abstinence, being faithful and using a condom even to those who underwent male circumcision.”

While research findings have backed male circumcision to reduce chances of one contracting the virus, Zulu says there is need for related research to establish whether male circumcision can lead to reduced infections by way of satisfying the woman sexually so she does not increase her chances of getting the virus by seeking such satisfaction elsewhere as some circumcised men have claimed.