By Jessica Berman

Washington, 17 August 2006

At the International AIDS meeting in Toronto on Thursday, the U.S. National Institutes of Health announced that it is continuing two trials into the effectiveness of male circumcision as a way to limit the spread of HIV. Male circumcision as a way to prevent HIV transmission was once considered a radical notion.

The NIH is funding two studies, one in Uganda and the other in Kenya, in an attempt to repeat the results of a 2005 study by French researchers conducted in South Africa. That study, called the Orange Farm Intervention Trial, found that circumcised men were 60 percent less likely to contract the AIDS virus than men who still had their foreskins.

When the studies on male circumcision first began, Kevin De Cock, the World Health Organization's HIV director, marvels that no one believed a simple, routine surgical procedure might prove to be an effective prevention method.

"It's a pretty radical thing to suggest, or at least a few years ago it seemed so," said Kevin De Cock. "But I think the gravity of the AIDS epidemic in southern Africa definitely and its recalcitrance in the face of other interventions influenced the debate."

De Cock says interest in the role of male circumcision in preventing AIDS began in the mid-1980's, when social scientists noticed that in many countries with high HIV rates, male circumcision was not practiced.

Scientists are only speculating what role circumcision plays in the transmission of AIDS. It is thought that viral particles get trapped in the foreskin and are released later during sexual intercourse. Another possibility is that the extra skin causes abrasions that enable infection.

But circumcision may run into cultural obstacles even if proven effective, according some researchers.

Katherine Hankins of UNAIDS says some religions and cultures practice circumcision and need no coaxing, but to others, the issue is more deeply personal.

"[It goes] To the significance of what it means to be a man in certain cultures," said Katherine Hankins. "And in some cultures, if you are not circumcised you're not a man. And in other cultures, if you are circumcised, you are not a man. I think it goes to the very heart of masculinity and what that means in many cultures."

The results of the NIH-funded study on the effectiveness of circumcision are expected in 2007. A separate project paid for by the Gates Foundation is studying male circumcision in preventing the spread of HIV from infected males to their uninfected female partners. The results of that study are expected at the end of 2008.