Circumcision and HIV: Difference between revisions

The idea that circumcision prevented HIV transmission was invented by Valiere Alcena, long before there was any "research" to substantiate the claim.<ref>{{REFjournal

}}</ref> In 1986, California urologist [[Aaron J. Fink| Aaron J. Fink]], (1926-1994) adopted this idea,<ref>{{REFbook

  |last=Glick

  |note=

}}</ref> and vehemently promoted it,<ref>{{REFjournal

}}</ref> without any kind of proof whatsoever.

Recent studies, however, disprove this hypothesis. One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why uncircumcised men are at higher risk for HIV infection."<ref>{{REFjournal

}}</ref> Another study found that "no difference can be clearly visualized between the inner and outer foreskin."''<!-- <ref>{{REFcontribution

  | contribution=HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures

deWitte found that not only are Langerhans cells found all over the body and that their complete removal is virtually impossible. Furthermore, deWitte found that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact, acting as a natural barrier to HIV-1 transmission by Langerhans cells.<ref>{{REFjournal

}}</ref>

==== Bacterial Environment Hypothesis ====

This hypothesis attempts to identify the change in bacterial environment that results in the penis as a result of circumcision, as the mechanism whereby circumcision reduces the spread of HIV transmission. A desparate ad-hoc hypothesis, the explanation is rather farfetched. The argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflamation, a condition that facilitates the transmission of viruses. The chances for penile inflamation are reduced, thereby reducing the chances of sexually transmitted viruses, such as HIV.<ref>{{REFjournal

}}</ref>

Using a population-based survey, Westercamp et al. examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with the belief that circumcised men are less likely to become infected with HIV.<ref>{{REFjournal

}}</ref>

  |accessdate=2019-09-29

}}</ref> Furthermore, HIV prevalence was found to be higher amongst circumcised males and females for virgins and adolescents in Kenya, Lesotho, and Tanzania.<ref>{{REFjournal

}}</ref>

|- style="background:#efefef;"

|+ Estimated per act risk for acquisition<br/>of HIV by exposure route (US only) <ref name=MMWR3>{{REFjournal

}}</ref>

|- style="background:#efefef;"

! style="text-align:left"| Blood Transfusion

| 9,000<ref name=Donegan>{{REFjournal

}}</ref>

|-

! style="text-align:left"| Childbirth <small>(to child)</small>

| 2,500<ref name=Coovadia>{{REFjournal

}}</ref>

|-

! style="text-align:left"| Needle-sharing injection drug use

| 67<ref name=Kaplan>{{REFjournal

}}</ref>

|-

! style="text-align:left"| Percutaneous needle stick

| 30<ref name=Bell>{{REFjournal

}}</ref>

|-

! style="text-align:left"| Receptive anal intercourse^*

| 50<ref name=ESG>{{REFjournal

}}</ref><ref name=Varghese>{{REFjournal

}}</ref>

|-

! style="text-align:left"| Receptive penile-vaginal intercourse^*

| 10<ref name=ESG /><ref name=Varghese /><ref name=Leynaert>{{REFjournal

}}</ref>

|-