12/12/07

To snip or not to snip – the circumcision dilemma

scalpelUganda is getting ready to offer free circumcision to men nationwide as a way of preventing the spread of HIV, according to a report in the New Vision newspaper. Studies in Uganda, South Africa and Kenya have shown that circumcision reduces the risk of acquiring HIV heterosexually by up to two thirds. But does that mean that men should rush for the scalpel?

Condoms, when they get used in the real world (with bursts, slips and whatnot) reduce the risk of acquiring heterosexual HIV by upwards of 90%. But of course lots of people don’t use them, and lots more only use them some of the time. For an individual, using condoms 73% of the time still offers more protection than circumcision (and obviously the benefit is greater still if people use them with those partners most likely to be infected with HIV). But most people are realistic about their own behaviour. Yes, I’ll try and use condoms, but it’s quite nice to know that when I drift into second bottle territory and perhaps slip up, my chances of getting HIV will only be a third of what they were before I got snipped.

Public health types worry about the “when I perhaps slip up” part of it. They fear that if people start to regard circumcision as a “natural condom”, the latex will go out the window. Where rates of condom use are currently high, the widespread promotion of circumcision could undermine condom use and potentially lead to more risk of infection rather than less. There’s also some concern about how well circumcision protects in anal sex. It’s hard to disentangle, because so many gay men like to be tops and bottoms in anal sex. But a new study among gay men in the US, by Greg Millet of CDC (reported by Reuters) suggests that circumcision does not protect even those men who always take the insertive role.

My own suspicion is that the trauma (by which I mean tears and microlesions) associated with anal sex is greater than the protection associated with lopping off the foreskin, and with it the Langerhans’ cells that are particularly susceptible to HIV infection. Conclusion: If you’ve got a penis and you like to sleep around, by all means get the snip. But use your latex too, (even in second bottle territory).

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This post was published on 12/12/07 in Condomania, Science.

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  1. Comment by David, 16/03/08, 04:32:

    Unfortunately, you repeat the nonsense about Langerhans cells being the cellular entry way for HIV. In fact, the Langerhans cells produce Langerin, which is a barrier to HIV. HIV can overcome the inhibitive functions of the Langerin protein by sheer numbers and thereby gains entry. The problem is one of boosting the production of Langerin, not crudely cutting off the foreskin to get a hardened, drier surface. See the de Witte study on this issue here [pdf warning].

  2. Comment by Dave, 09/01/11, 08:07:

    Condoms prevent HIV better than any sort of genital mutilation done to men/boys does.

    I’m sure if Female circumcision were theoretically shown to prevent HIV infection you’d be all for it too.

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