In 2005, a randomised controlled trial conducted among uncircumcised men of 18-24 years in South Africa showed that male circumcision reduced the risk of acquiring HIV infection by 60 per cent. Two further studies conducted in Uganda and Kenya showed similar results. These three studies provide new, compelling evidence that male circumcision offers significant protection against acquiring HIV infection. These findings confirm those from previous observational studies and that of a meta-analysis of 28 published studies conducted in 2000.
What is Safe Male Circumcision (SMC)? Male circumcision involves the surgical removal of the foreskin, the tissue covering the head of the penis. In adult men, a four to six weeks period is required for the wound to heal fully compared to the one-week period when circumcision is performed for babies.
Research shows that surgical removal of the foreskin is associated with a variety of health benefit including:
Reduced frequency of urinary tract infections in male infants who are circumcised.
Circumcision prevents irritation and swelling of male sensual organs resulting from exposure to infectious agents. Men who are circumcised do not suffer health problems associated with the foreskin such as phimosis (an inability to retract the foreskin) or paraphimosis (swelling of the retracted foreskin causing inability to return it to its normal position).
Circumcised men find it easier to maintain penile hygiene. Secretions can easily accumulate in the space between the foreskin and glands making it necessary for an uncircumcised man to retract and clean the foreskin regularly.
Female partners of circumcised men have a lower risk of cancer of the cervix, which is caused by persistent infection with high-risk cancer-inducing types of human papillomavirus.
Circumcision is associated with a lower risk of penile cancer.
Circumcised men have less occurrence of some sexually transmitted infections, especially those that cause ulcers such as chancroid and syphilis.
There are several biological explanations why male circumcision may reduce the risk of HIV infection for men.
By removing foreskin, circumcision reduces the ability of HIV to penetrate the skin of the penis due to keratinisation or toughening of the inner aspect of the remaining foreskin.
The inner part of the foreskin contains many special cells with protective properties such as Langherhans cells, that are prime targets for HIV.
Some of these are removed with the foreskin, while the remaining cells become less prone to the HIV virus due to the keratinisation described above.
Ulcers, which are characteristic of some sexually transmitted infections and which can facilitate HIV transmission, often occur on the foreskin. By removing the foreskin, the likelihood of acquiring these infections is reduced.
The foreskin may suffer abrasions or inflammation during sex that could facilitate the passage of HIV.
When HIV/Aids was first discovered in Uganda in 1982, there was a lot of stigma associated with it. There was very limited information about HIV. Support organisations have come up to give a dignified death to the victims of Aids. Tremendous strides have since been made in the management of HIV as a virus and a scourge. Our government and the international community have come up and started providing free medication for those infected with HIV. Despite what has been done, infections continue to rise. We all know that HIV/Aids prevention is cheaper and better than treatment. Let’s keep hope alive by ensuring that we continue to seek more prevention avenues.
What everybody must know is that circumcision, just like many other prevention methods, is not a 100 per cent guarantee against HIV. It’s not a bullet proof vest to engage in unsafe sexual practices. SMC reduces the probability of getting an infection and has other health benefits as shared above. People must be given correct information and educated about circumcision not as an iron curtain against HIV infection but as a practice of healthy living.
Male circumcision must not be promoted alone, but alongside other methods to reduce the risk of HIV – including avoidance of unsafe sexual practices, reduction in the number of sexual partners, and correct and consistent condom use.
Mr Karugaba is the Public Relations and Communications Manager, Mulago-Mbarara Teaching Hospitals Joint Aids Programme.