SOUTH AFRICA: "Circumcising Men Cuts HIV Risk Among Women" - study

MedPage Today
July 26, 2014

Circumcising Men Cuts HIV Risk Among Women

by Michael Smith

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
[That hasn't stopped the media from splashing it everywhere - as here - as headline news.]

MELBOURNE, Australia -- The HIV-preventing benefits of circumcision were not just restricted to men, researchers said.

In a region of South Africa where HIV prevalence is high, women whose only sexual partners were circumcised had a significantly lower prevalence of HIV, according to Kevin Jean, PhD, of the French National Institute for Health and Medical research in Villejuif, France, and colleagues.

Moreover, a mathematical model suggested that the incidence of HIV among those women was also lower than among women whose partners included uncircumcised men, Jean reported at the International AIDS Conference here.

The finding -- the first evidence that women also benefit -- is a "compelling argument" to speed up the roll-out of voluntary male circumcision in Africa, Jean argued.

[No mention of the Wawer study in Uganda, which suggested that circumcising men INcreases the risk to women.]
 
Three randomized trials have shown that men who are circumcised are at lower risk of acquiring HIV, including one in the Orange Farm township of South Africa.

Researchers have since demonstrated that a free program of voluntary circumcision could be widely accepted among men in the region, leading to lower HIV prevalence among circumcised men.

But the missing piece of the puzzle has been what happens to women when men are circumcised and the prevalence of HIV drops, as has happened in Orange Farm, a township of about 110,000 adults near Johannesburg.

[So this sample was also taken in Orange Farm. How many of the same men were used? Over-testing the same sample leads to less reliable data. The fact that ALL the studies claiming benefits emerge from the same three sites, and the same cluster of researchers, is increasingly suspicious.]

To find out, Jean and colleagues surveyed a total of 4,538 sexually active women, ages 15-49, in three waves, in 2007, 2010, and 2012.

Participants were asked about their age, ethnic group, occupation, age at first sexual intercourse, alcohol consumption, education, number of lifetime partners, and consistent condom use.

They also were asked about the circumcision status of their partners, and the researchers took a blood sample to analyze HIV prevalence in the cohort, Jean said.

Among the 1,363 women who reported only having had circumcised partners, the HIV prevalence was 22.4%, compared with 36.6% among the remaining 3,175.

[This is quite a loose association - women's HIV status vs her reporting of remembering ever had an intact partner. It can be confounded by faulty memory, lack of interest or misidentification.]

Mathematical modeling from the observed age-specific prevalence rates yielded estimated incidence, Jean said. Although the researchers have also measured new HIV cases in the cohort, that data is still being analyzed, he said.

The analysis showed that incidence among women who only had circumcised partners was 0.032 cases per person-year, compared with 0.039 per person-year among the remaining women.

[So circumcision reduces the risk by 0.006 cases per person-year? That's hardly impressive, even if true.]

The numbers yielded an incidence rate ratio of 0.83 and a risk reduction of 16.9% for the women who only had circumcised partners, Jean said. When the analysis was restricted to women 15 through 29, the risk reduction was 20.3%, he added.

[Data-mining.]

The study extends previous research on circumcision in the region, commented Stefano Vella, MD, of the Istituto Superiore di Sanita in Rome, and a former president of the International AIDS Society.

Evidence is mounting that multiple prevention measures will be needed to slow the HIV/AIDS pandemic, he said, and circumcision seems likely to play an important role since it has been shown to offer partial protection for men.

The evidence that the procedure also reduces the risk of HIV among women is of "paramount importance," he told reporters.

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