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Use of Circumcision to Fight AIDS Epidemic Is Debated
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Data presented Tuesday suggest that this "risk compensation" is not taking place, at least over the short term.
The randomized study of about 2,800 men in Kenya, which is still underway, found that at the outset 20 percent of the men reported always using condoms. That has now increased to 35 percent. The proportion of men who reported paying for sex has fallen from 18 percent to 9 percent.
"Our behavioral counseling seems to have had some effect," one of the study leaders, Robert C. Bailey of the University of Illinois at Chicago, told the conference.
Another study from Kenya followed what happened to men who chose the procedure and compared them to men who did not. The circumcised men were no more likely to have liaisons outside marriage, to have multiple partners, or not to use a condom.
Two researchers reported on mathematical models that predicted the possible effects of greater circumcision in South Africa, a country with a rising rate of HIV infection.
One predicted that if current trends continue, 17 percent of men in the city of Soweto will be HIV-positive in 20 years, up from 12 percent now. That could be held to 13 percent if 20 percent of uncircumcised men underwent the procedure each year over the next five years. The other model predicted that widespread adoption of circumcision in South Africa could save the country's health system $2,411 in treatment costs for every HIV infection averted.
Whether male circumcision protects women from being infected by men is uncertain. Previous research suggested some benefit to women, but a study described Tuesday found that there was little or no protection in a group of Ugandan and Zimbabwean women when their regular partners were circumcised.
The studies presented Tuesday did not include any investigations of cultural beliefs about circumcision, although several studies did report that circumcised men and their female partners had no complaints after the procedure. The lack of cultural studies was severely criticized by several members of the audience.
One activist said, to scattered applause, that circumcision in adulthood could cause psychological trauma. An Australian anthropologist said the disregard of cultural issues "completely fetishizes this act."
