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Can a circumcised man get hiv easily

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The surgical removal of the foreskin of the penis the retractable fold of tissue that covers the head of the penis to reduce the risk of HIV infection in men. Statistical tests are used to judge whether the results of a study could be due to chance and would not be confirmed if the study was repeated. The result of a statistical test which tells us whether the results of a study are likely to be due to chance and would not be confirmed if the study was repeated. All p-values are between 0 and 1; the most reliable studies have p-values very close to 0. A p-value of 0.

SEE VIDEO BY TOPIC: Circumcision - Nucleus Health

HIV in Canada: A primer for service providers

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Jared M. Baeten, Barbra A. Bwayo, Joan K. A lack of male circumcision has been associated with increased risk of human immunodeficiency virus type 1 HIV-1 acquisition in a number of studies, but questions remain as to whether confounding by behavioral practices explains these results.

The objective of the present study was to model per-sex act probabilities of female-to-male HIV-1 transmission i. Data were collected as part of a prospective cohort study of HIV-1 acquisition among Kenyan truck drivers.

Sexual behavior with wives, casual partners, and prostitutes was recorded at quarterly follow-up visits. The overall probability of HIV-1 acquisition per sex act was 0. Female-to-male infectivity was significantly higher for uncircumcised men than for circumcised men 0. The effect of circumcision was robust in subgroup analyses and across a wide range of HIV-1 prevalence estimates for sex partners.

Moreover, female-to-male infectivity of HIV-1 in the context of multiple partnerships may be considerably higher than that estimated from studies of HIVserodiscordant couples. These results may explain the rapid spread of the HIV-1 epidemic in settings, found throughout much of Africa, in which multiple partnerships and a lack of male circumcision are common.

Heterosexual transmission is responsible for the vast majority of new HIV-1 infections, particularly in sub- Saharan Africa, where the HIV-1 pandemic already has had the greatest impact [ 1 ]. The spread of HIV-1 has not been uniformacross Africa [ 2 ], and, although many biological and behavioral factors likely contribute to country-by-country variation, ecological and large-survey studies suggest that one principal explanation may be differences in the frequency of male circumcision [ 3 , 4 ].

In spite of the consistency of these findings, questions remain as to whether residual confounding, especially by differences in sexual behavior, may be responsible for this apparent increased risk of HIV-1 acquisition for uncircumcised men.

The probability of HIV-1 transmission per sex act, or infectivity, has been calculated from several studies of HIVserodiscordant couples from whom detailed information on sexual frequency over time was collected [ 8 ]. In these studies, the probability of femaleto- male HIV-1 transmission for a single act of penilevaginal intercourse was estimated to be on the order of 0.

No study has estimated per-contact infectivity in the context of multiple partner types, although such partnerships are common in areas where HIV-1 transmission risk is greatest. Accurate estimates of HIV-1 infectivity are important for understanding sexual transmission of HIV- 1 and are essential for modeling the effect of interventions aimed at controlling the HIV-1 pandemic [ 11 ]. From to , we conducted a prospective cohort study of risk factors for HIV-1 acquisition among male truckingcompany employees in Mombasa, Kenya [ 12 , 13 ].

At regular follow-up visits, information on sexual encounters and condom use with different partner types was collected. This detailed accounting of sexual behavior allowed us to estimate percontact risk of HIV-1 acquisition in this population in which multiple, concurrent partnerships are common.

We previously reported that being uncircumcised was associated with a significantly increased risk of HIV-1 acquisition in this cohort [ 13 ], and here we report the effect of circumcision status on per-sex act HIV-1 transmission probability. Participants and procedures. Study procedures have been detailed elsewhere [ 12 , 13 ]. Briefly, all male employees were invited to attend a mobile research clinic that visited each company weekly.

One thousand five hundred men underwent HIV-1 pretest counseling. Demographic, employment, and sexual history characteristics were recorded, and circumcision status was verified by physical examination. At quarterly follow-up visits, data were collected on sexual behavior during the prior 3 months, including the number of sex partners, the number of sex acts with each of 3 different partner types wives, casual partners, and prostitutes , and the number of sex acts in which condoms were used with each partner type.

A physical examination was conducted to identify symptoms of sexually transmitted diseases STDs —specifically, urethral discharge and genital ulcers. Men were asked whether they had had similar STD signs during the interval since their last clinic visit. Individualized, confidential risk-reduction counseling was performed at each visit, and free condoms were provided.

Informed consent was obtained from participants, and study procedures were approved by the ethical review committees of the University of Washington and the University of Nairobi.

Statistical analysis. Data were analyzed using SPSS version Comparisons of categorical variables were conducted using x 2 tests, and comparisons of continuous variables were conducted using Mann-Whitney U tests. Per-sex act transmission probability estimates were obtained using an extension of a model summarized by Allard [ 14 ].

Maximum-likelihood estimation was used to obtain infectivity estimates, and the likelihood-ratio test was used for hypothesis testing. Confidence intervals were calculated using the bootstrap method. Stratified analyses were performed to assess the effect of potential confounding factors, as has been done in other studies of HIV-1 transmission probabilities [ 10 , 15 ].

We used self-reported data on sexual behavior, collected at quarterly study visits, to calculate each participant's total number of sex partners and sex acts during the study follow-up period.

Data were categorized by partner type wives, casual partners, or prostitutes. Detailed information about specific partnerships was not collected, and repeated encounters with individual partners could not be verified over time. Thus, men who reported sexual contact with a wife or wives at multiple visits were assumed to be referring to the same partner s. In contrast, casual-partner and prostitute contacts reported at multiple visits were assumed to be with independent partners.

To test this assumption, we also performed infectivity calculations under the assumption that casual-partner reports from multiple visits were with the same partner s , since these likely comprised a mixture of singleepisode encounters and repeated encounters with more-stable partners, such as girlfriends. We felt that it was unlikely that sex acts with prostitutes reported at different visits were with the same partner.

We also performed calculations under the assumption of no protective effect of condoms. Men were censored at their last follow-up visit or, for men who experienced seroconversion to HIV-1, at the midpoint between their last HIVseronegative and first HIVseropositive visits. Published surveillance data collected at the same time as our study were used to estimate HIV-1 prevalences among wives, casual partners, and prostitutes.

To estimate HIV-1 prevalence among prostitutes, we used data collected in various locations in Kenya, to account for sexual activity during long-distance trucking jobs. In other parts of Kenya, especially along trucking routes, HIV-1 prevalence among prostitutes was often higher during this period [ 17 ].

Because our study cohort did not include both circumcised and uncircumcised participants who became infected with HIV-1 and reported sex acts exclusively with each partner type, there was insufficient information to model separate infectivity parameters for wives, casual partners, and prostitutes.

As detailed elsewhere [ 12 , 13 ], men who did and did not return for follow-up were generally similar with respect to age, marital status, religion, history of sex with prostitutes, history of condom use, and circumcision status. We excluded 6 men who were partially circumcised, 1 man whose circumcision status was not recorded, 1 man who provided no sexual behavior information during follow-up, and 3 men who had no HIV-1 testing performed after enrollment.

Two men subsequently underwent circumcision, and data collected after their last uncircumcised visits were excluded. The median duration of follow-up was days interquartile range [IQR], — days.

The median number of follow-up visits was 4 IQR, 2—8 , and visits were spaced at a median of 98 days IQR, 91— days. Forty-three men 11 uncircumcised; 32 circumcised experienced seroconversion to HIV-1 during follow-up, at an incidence of 3. At enrollment, the majority of men were married, although extramarital sexual activity was common overall and was practiced by the majority of married men table 1.

Circumcised men were older and more likely to be Muslim. They were more likely to report a history of condom use, and, if married, to report extramarital sex, which may reflect that they were more commonly occupied as drivers or driver's assistants and thus spent more days per month on the road than did uncircumcised men.

The median total number of sex acts per month was 4. No participants reported sexual activity with men. Per-contact infectivity of HIV Overall, the probability of female-to-male HIV-1 transmission for a single act of penile-vaginal intercourse was estimated to be 0.

Infectivity for uncircumcised men was significantly higher than for circumcised men 0. Overall transmission probability estimates ranged from 0. To explore this hypothesis, we calculated HIV-1 transmission probabilities with Muslim men excluded table 3.

In this analysis, the magnitude of our estimates changed relatively little and remained higher for uncircumcised men than for circumcised men 0. Because only 1 Muslim man in our study was uncircumcised, we were unable to compare the effect of circumcision on HIV-1 infectivity among subjects in this subgroup. However, among those who were circumcised, HIV-1 infectivity was lower among Muslim than among non-Muslim men 0. Per-contact HIV-1 transmission probabilities among all study participants and within subgroups.

We also considered whether ethnicity influenced our results. In Kenya, large differences in HIV-1 regional prevalence exist, with the highest prevalence found among members of the Luo ethnic group, who traditionally do not practice circumcision [ 20 ].

Some have suggested that studies of circumcision and HIV-1 risk involving Luo men may be confounded by differences between Luo and non-Luo men in HIV-1 prevalence among sex partners or in sexual practices [ 21 ]. However, when we repeated our analyses with Luo men excludedexcluded, we found that per-act probability of HIV-1 transmission remained significantly higher for uncircumcised men than for circumcised men 0. Among Luo men, infectivity was also higher for uncircumcised men than for circumcised men, although the difference was not statistically significant 0.

In our previous study of this cohort, occupation and extramarital sex were found to be associated with HIV-1 seroconversion [ 13 ]. We performed subgroup analyses to examine these factors, as well as STDs and age, since these were associated with HIV-1 infectivity in other studies [ 15 ]. In all models, infectivity was higher among uncircumcised men than among circumcised men.

Genital ulcer disease and urethritis were associated with slightly increased infectivity estimates, although the differences were not statistically significant. Since the number of days of travel per month and a history of condom use differed by circumcision status at study enrollment, we also conducted subgroup analyses based on these characteristics.

Both characteristics also demonstrated higher infectivity for uncircumcised men than for circumcised men. The majority of sex acts were with wives, and wives could have been less likely to be chosen randomly with respect to HIV-1 status than were casual partners or prostitutes, which would bias our results if this was also associated with circumcision status. Thus, we performed an analysis excluding men who reported any sex acts with wives during the follow-up period. We found that uncircumcised men still had higher infectivity than did circumcised men 0.

Two hundred six men reported sexual activity only with wives during the follow-up period, 5 of whom experienced seroconversion to HIV Infectivity among these men was lower than among the cohort as a whole 0. Only 24 of these men were uncircumcised, none of whom experienced seroconversion to HIV-1, so separate infectivity estimates could not be calculated by circumcision status.

We assessed whether our findings were robust when different assumptions were used for our statistical model. If we considered casual-partner reports from multiple visits as being with the same partners rather than as independent partnerships, HIV-1 infectivity was slightly higher than in our original model 0.

To ascertain whether overreporting of condom use influenced our results, we calculated per- sex act HIV-1 infectivity under the assumption that all sexual contacts were unprotected by condoms.

HIV-1 infectivity was reduced only slightly overall 0. Finally, if interpolated sexual contacts were excluded, HIV-1 infectivity increased only slightly 0.

This is the first study to estimate HIV- 1 infectivity in a population with multiple, concurrent partnerships of different types.

The overall probability of femaleto-male HIV-1 transmission per sex act was 0. Only 1 previous study examined per-contact transmission probabilities by circumcision status, although this may be the best method to avoid confounding by sexual behavior.

Among men attending a Nairobi STD clinic, those who were uncircumcised had a higher probability of HIV-1 seroconversion after a single sexual encounter with a prostitute than did those who were circumcised 0.

Fact or Fiction?: Circumcision Helps Prevent HIV Infection

Three randomized controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counseling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use. Voluntary medical male circumcision for HIV prevention in 14 priority countries in eastern and southern Africa.

A study from Orange Farm near Johannesburg in South Africa, the area that hosted the first-ever randomised controlled trial of male circumcision for HIV prevention , which concluded in , has found evidence that women who are partners of circumcised men are less likely to have HIV themselves. A meta-analysis Weiss of the benefits to women of circumcising men found no evidence that having sex with a circumcised, rather than an uncircumcised, man reduced the risk of HIV infection to women, though there have been studies that show that male circumcision reduces the risk of human papillomavirus HPV and genital herpes HSV2 in women. A voluntary medical male circumcision VMMC centre called Bophelo Pele was set up in , funded by the Bill and Melinda Gates Foundation, after the results from the Orange Farm randomised controlled trial were confirmed by two other large trials in Uganda and Kenya.

Advocates and implementers alike have recognised the importance of delivering all HIV services in ways that are nonjudgmental and non-stigmatizing. However, it states that HIV-positive men should not be denied male circumcision unless there is a medical reason to do so. This recommendation reflects concern that denying male circumcision on the basis of HIV status could 1 increase stigma experienced by HIV-positive men who are not circumcised, 2 lead to assumptions that circumcised men cannot have the virus, and 3 increase the chances that HIV-positive men will seek surgery from unsafe or poorly trained providers if they are turned away from medical points of service. For men who test positive, circumcision services offer antiretroviral treatment or referral to these services.

Does Circumcision Prevent HIV?

Some men, understandably, are unwilling to undergo MMC. The goal is to identify how HIV penetrates the foreskin tissue and maybe find a solution for these men who would prefer to remain uncircumcised. Researchers are not certain why the removal of the foreskin leads to lower incidences of HIV but there are some theories. Chigorimbo-Tsikiwa takes foreskin samples from circumcised men with and without asymptomatic STIs. Studying these tissues provided insight on how HIV can infect a man through his foreskin. Chigorimbo-Tsikiwa together with Professor Clive Gray and others have found some important differences between the inner and outer foreskin using proteomics the study of proteins and on a cellular level. The first difference was in the proteins that function as barriers. The second difference was that the outer layer of the foreskin has a thicker layer of keratin than the inner foreskin. Keratin is a protective protein found in skin that makes it impenetrable.

Male circumcision for HIV-positive men

Male circumcision MC has been shown to be protective against heterosexual HIV transmission and is being explored in some parts of the world as a means of combating the epidemic. We review evidence that demonstrates that the inner foreskin is likely to be the main portal of entry for the HIV virus in males. Whether removal of the inner foreskin accounts for all the protection afforded by circumcision is yet to be established. The proposed mechanisms of protection range from inherent immunohistological factors of foreskin such as difference in thickness of keratin layer and density of target cells for HIV between inner and outer foreskin to physiological mechanisms that follow male circumcision such as drying of secretions underneath foreskin after sexual intercourse, loss of microbiome that attract target cells to the genital mucosa and lack of priming the genital mucosa with less abundant sexual transmitted infections among circumcised men. Since peaking in , the annual number of new HIV infections has been in steady decline.

Harm reduction during a pandemic. Penile circumcision is the surgical removal of all or part of the penis foreskin.

The male foreskin—an unassuming flap of skin eagerly discarded in some cultures—has taken center stage in recent debates over HIV prevention. Although researchers now agree that its removal is a proved method to reduce HIV spread in heterosexual men, the picture for homosexual men remains a bit foggy. In the late s observations of heterosexual men in Africa indicated that those who had been circumcised might be at less risk of contracting HIV than men who left their foreskins intact. To definitely test the hypothesis, researchers initiated clinical trials in at-risk populations with low rates of circumcision.

Feature Story

Male circumcision reduces the risk of HIV transmission from women to men. Circumcised men can still become infected with the virus and, if HIV-positive, can infect their sexual partners. Male circumcision should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package, which includes correct and consistent use of male or female condoms, reduction in the number of sexual partners, delaying the onset of sexual relations, and HIV testing and counselling. Observational studies included in the meta-analysis that were conducted prior to the introduction of highly active antiretroviral therapy in demonstrated a protective effect for circumcised MSM against HIV infection.

SEE VIDEO BY TOPIC: Using circumcision to fight HIV

In the second of a special three-part series on the issue of male circumcision and its links. In the second of a special three-part series on the issue of male circumcision and its links to the reduction of HIV acquisition, unaids. Male circumcision and its links to HIV is one of the most talked about issues within the AIDS response over the last years, with latest research findings driving potential change in the way male circumcision is practiced and implemented for the future in relation to HIV prevention. In scientific circles, the perceived links between male circumcision and HIV infection are nothing new. For years, AIDS researchers have observed that many African tribes that circumcise boys or young men had lower HIV rates than those that do not, and that Africa's Islamic nations, where circumcision is near universal, had far fewer AIDS cases than predominantly Christian ones.

Male Circumcision and HIV Transmission; What Do We Know?

In the late s, several small studies conducted in Africa suggested an association between having a foreskin and a greater risk of contracting human immunodeficiency virus HIV. Some of these studies based their conclusion by looking at maps, some looked at high-risk populations, and others looked at patrons of sexually transmitted disease STD clinics. Recently, however, several large random population surveys performed in Africa have found that circumcised men are more likely to be HIV infected. Despite inconsistent findings in the medical literature, there is a misconception that the foreskin places a man at greater risk for acquiring an HIV infection 1 Thirty-five studies have been published in peer-reviewed journals that have addressed what role, if any, the prepuce plays in the transmission of HIV. Available data from these studies have been combined in a meta-analysis. Looking at the corpus of scientific literature concerning the relation of the prepuce with HIV may be helpful in developing recommendations for HIV prevention. Three studies have linked the foreskin to HIV infection by looking at maps, instead of men. These studies found an association between the practice of male circumcision at a societal level and regional HIV seroprevalence in Africa.

This tool will help you learn about the risk of getting HIV or transmitting HIV to someone Also, circumcised men and their partners can still get other sexually.

Related: All topics , HIV transmission. Is it true that if you have had a circumsion that it is harder to catch HIV? Is it possible to catch it from a tattoo needle?

Circumcision and HIV

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How can Circumcision Prevent HIV?

Metrics details. However, the biological mechanisms by which circumcision is protective remain incompletely understood. Furthermore, we provide evidence that the genital microbiome may be an important driver of this immune activation.

Three key studies in Africa in and showed that HIV transmission rates were decreased in men who were circumcised. These clinical trials were conducted on heterosexual males in Uganda, Kenya and areas of sub-Saharan South Africa.

Jared M. Baeten, Barbra A. Bwayo, Joan K. A lack of male circumcision has been associated with increased risk of human immunodeficiency virus type 1 HIV-1 acquisition in a number of studies, but questions remain as to whether confounding by behavioral practices explains these results. The objective of the present study was to model per-sex act probabilities of female-to-male HIV-1 transmission i.



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