Circoncisione Infantile Maschile

Malawi ‘no’ to circumcision as tool to stop HIV/AIDs

Il governo del Malawi ha respinto gli appelli a promuovere la circoncisione maschile come una profilassi contro l'HIV / AIDS.

In uno studio del Malawi del 2010 - HIV & AIDS Research e Best Conference Practices - il presidente del paese, la Commissione Nazionale AIDS, l'arcivescovo Bernard MALANGO hanno detto che in base a un confronto tra i tassi di infezione nei quartieri musulmani, dove la maggior parte degli uomini sono circoncisi, e nelle aree cristiane del Malawi, dove la circoncisione non è praticata, non ha mostrato alcuna differenza nel tasso di infezioni da HIV/AIDS.

"Non abbiamo alcuna prova scientifica che la circoncisione è un modo sicuro per rallentare la diffusione dell'AIDS," aggiunge il Dr. Maria Shaba, the government’s chief HIV/AIDS officer.

The UNAIDS agency estimates that approximately 930,000 people, or 12 per cent of Malawi’s population, are living with HIV of whom 840,000 are adults aged 15 and above.

However, the archbishop said the 12 per cent prevalence rate of HIV/AIDS does not accurately reflect the incidences of the disease in the country,

In Malawi, il tasso di HIV è del 13,2% tra gli uomini circoncisi, ma solo il 9,5% tra gli uomini intatti. (Aids Society -MDH 2010)

Archbishop Malango said that most overseas NGOs look at the overall rate of infection, or the prevalence of the disease, within the population when devising prevention and treatment strategies. However in Malawi, the rate of new infections has been decreasing, while people with HIV/AIDS were living longer, thus keeping the prevalence rate at 12 per cent.

“With the continued scale up of the treatment programme, we will have more and more people alive and therefore considerably contributing to the high prevalence of HIV,” Archbishop Malango said.

“The number of those who were already infected is being maintained and by 2015, we should minimize the new infections by educating people,” the archbishop said.

Dr. Shaba told the conference the number of new cases was estimated to be 90,000 per year. “The difference between incidence and prevalence is that incidence is number of infections that are taking place now while prevalence is the number of people who are considered positive at that time.”

“The prevalence has been 12 per cent for a long time but we need to look at how many infections are taking place. If we are going to move from prevalence from 12 per cent to almost zero, it means the incidences are the ones which have to be zero,” she said.

FONTE: http://geoconger.wordpress.com/2010/10/03/...oct-1-2010-p-8/

Zambia: Another study fails to find that foreskins increase risk of HIV

September 30, 2011

A study of the possible link between genital herpes and increased risk of HIV in Zambia did find that men with herpes were more likely to be HIV-positive, but also found that lack of circumcision did not increase the risk of HIV infection. Quite the contrary, the study found that uncircumcised men were less likely to contract HIV. In their discussion of the results, however, the authors of the study failed to mention this vital fact, and concluded by recommending that circumcision be promoted as an AIDS control strategy – thus violating the most basic principles of evidence-based medicine.

The Zambian study was conducted by researchers from the United States Centers for Disease Control – well known for its pro-circumcision agenda. They recruited 1062 male farm workers at a sugar estate in Zambia to participate in an experiment known as a prospective cohort study. The researchers were looking for a link between genital herpes (herpes simplex type-2 or HSV-2) infections and developing an infection with HIV-1. The study had two outcomes of interest.

First, they looked at factors that affect the prevalence of HIV-1 infection (whether the men were infected at the time of recruitment). Second, they measured the incidence of HIV-1 infection (new infections detected during the follow-up period). At the time of recruitment 20.7% of the men were HIV-positive. Men with a positive blood test for past herpes were five times more likely to be HIV-positive at the time recruitment. Other factors significantly associated with being HIV-positive were self-reported genital ulcers in the past year and being widowers. Rates of HIV-1 infection at the time of recruitment were the same in circumcised men and uncircumcised men (20.71% versus 20.76%). When adjusted for other factors, there was no significant association between circumcision status and HIV-1 prevalence.



The second half of the study involved following 731 participants who started off as HIV-negative and who made at least one follow-up visit. Becoming HIV-positive during the follow-up period was independently associated with a positive blood test for herpes at the beginning of the study, and 18 times more likely in men who developed a first-time HSV-2 (herpes) infection during the follow-up period. During the follow-up period uncircumcised men developed 23 infections in 5686 months of patient follow-up (4.04 per 1000 months), while circumcised men developed four infections in 817 months of follow-up (4.89 per 1000 months). This means that uncircumcised men had a slightly lower (but probably not statistically significant) risk of HIV infection. When adjusted for other factors, circumcision status made no difference to the risk of infection with HIV.

A significant weakness of the study is its reliance on self-reported circumcision status – something about which men are surprisingly uncertain. While the investigators assumed that all the HIV infections were transmitted sexually, it is also possible (even likely) that men with genital herpes would seek medical care, and in doing so placed themselves at greater risk of HIV infection through non-sterile medical treatment (iatrogenic infection) – notoriously common in the over-stretched health services of underdeveloped countries.

This is yet another study that fails to confirm the “60% reduction in risk of HIV infection” claimed for circumcision in the three famous randomized clinical trials. Such a reduction is outside the 95% confidence intervals of this and several other studies, indicating serious doubts about the clinical trials. Despite this, the researchers in the Zambia study recommend that company health centres should “promote and provide medical male circumcisions” as a part of the effort to decrease infection rates: yet their own data that shows that circumcision would either have no impact, or might even increase the risk of HIV infection. It would appear that the authors, even in light of their own negative findings, are unwilling to stray from the CDC’s pro-circumcision agenda, and thus fail to observe the basic principles of evidence-based medicine: that recommendations for treatment must follow logically and directly from the evidence. According to the data in this study, to recommend circumcision as a preventive strategy in Zambia is ideological and plainly anti-scientific.

Originally published on: www.circinfo.org/

The article is: Heffron R, Chao A, Mwinga A, Sylvester Sinyangwe S, Sinyama A, Ginwalla R, Shields M, Kafwembe M Kaetano L, Mulenga C, Kasongo W, Mukonka V, Bulterys M. High prevalent and incident HIV-1 and herpes simplex virus 2 infection among male migrant and non-migrant sugar farm workers in Zambia. Sex Transm Infect 2011; 87: 283-8.

La circoncisione non riduce il rischio di malattie sessualmente trasmissibili

La circoncisione maschile non ha ridotto il rischio di contrarre infezioni trasmesse sessualmente (IST) - quelli che causano la gonorrea, clamidia e la tricomoniasi - tra gli uomini in uno studio in Kenya (Journal of Infectious Diseases , Ottobre 2010). L'analisi dei dati sulle malattie sessualmente trasmissibili negli studi di circoncisione maschile condotti in in Sud Africa, Kenya e Uganda (New England Journal of Medicine and Study of Aids -Maggio 2011) ha mostrato che la circoncisione inoltre non offre protezione neppure contro il papillomavirus umano, anche se potrebbe offrire una protezione parziale dall'herpes genitale.

Adult Male Circumcision Does Not Reduce the Risk of Incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis Infection: Results from a Randomized, Controlled Trial in Kenya e Sud Africa.

Background We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs).
Methods We evaluated the incidence of STI among men aged 18–24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection.
Results There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49–8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective.

Conclusions: Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.

Cox proportional hazards regression: risks for infection with N. gonorrhoeae and/or C. trachomatis

We combined N. gonorrhoeae and C. trachomatis infection at follow-up into a single outcome, owing to similarities in stratified models and to increase our power to detect significant associations (table 3). In a multivariate Cox regression analysis, N. gonorrhoeae or C. trachomatis infection at enrollment (HR, 2.31 [95% CI, 1.64–3.26]), multiple sex partners in the previous 30 days (HR, 2.15 [95% CI, 1.42–3.27]), and sexual intercourse during a woman's menstruation (HR, 1.67 [95% CI, 1.19–2.33]) remained significant predictors of N. gonorrhoeae and/or C. trachomatis infection (table 3). Conversely, higher education (HR, 0.67 [95% CI, 0.50–0.88]) and reported condom use at last intercourse (HR, 0.64 [95% CI, 0.50–0.82]) were protective against infection. There was no statistically significant or meaningful 2-way interaction term and no violation of the assumption of proportionality for each independent variable or for the global test of the model.

We did not find that adult male circumcision had a protective effect against any of the nonulcerative STIs examined (N. gonorrhoeae, C. trachomatis, or T. vaginalis infection) in these sexually active young men in Kisumu, Kenya e in Uganda.


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(da Journal of Africa & Journal of Infectious Diseases)

Potential conflicts of interest: none reported.
Financial support: Family Health International, supported by the US Government and the Bill and Melinda Gates Foundation (to R.C.B.); Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (AI50440); and Canadian Institutes of Health Research (HCT 44180; investigator award to S.M.).

La circoncisione maschile non fornisce alcun beneficio diretto per le donne

Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial

Circoncisione di uomini con infezione da HIV non ridurre la trasmissione dell'HIV ai loro partner sessuali femminili non infetti da oltre due anni in uno studio randomizzato di prova fra 450 coppie in Uganda. La prova è stata effettuata a causa di un precedente studio osservazionale aveva suggerito che i partner di uomini HIV-positivi avevano meno probabilità di acquisire l'HIV se gli uomini sono stati circoncisi. I risultati confermano inoltre che gli uomini con infezione da HIV che fanno sesso prima della cicatrizzazione completa della ferita in seguito a una circoncisione, possono essere ad aumentato rischio di trasmissione del virus. "La stretta osservanza di astinenza sessuale durante la guarigione della ferita e l'uso del preservativo deve essere coerente in seguito fortemente promosso", scrivono gli autori. Un commento sulle note di studio che le donne con partner circoncisi sono anche a maggior rischio di diverse infezioni trasmesse sessualmente.

922 uncircumcised, HIV-infected, asymptomatic men aged 15—49 years with CD4-cell counts 350 cells per μL or more were enrolled in this unblinded, randomised controlled trial in Rakai District, Uganda. Men were randomly assigned by computer-generated randomisation sequence to receive immediate circumcision (intervention; n=474) or circumcision delayed for 24 months (control; n=448). HIV-uninfected female partners of the randomised men were concurrently enrolled (intervention, n=93; control, n=70) and followed up at 6, 12, and 24 months, to assess HIV acquisition by male treatment assignment (primary outcome). A modified intention-to-treat (ITT) analysis, which included all concurrently enrolled couples in which the female partner had at least one follow-up visit over 24 months, assessed female HIV acquisition by use of survival analysis and Cox proportional hazards modelling. This trial is registered with ClinicalTrials.gov, number NCT00124878.

The trial was stopped early because of futility. 92 couples in the intervention group and 67 couples in the control group were included in the modified ITT analysis. 17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0·36). Cumulative probabilities of female HIV infection at 24 months were 21·7% (95% CI 12·7—33·4) in the intervention group and 13·4% (6·7—25·8) in the control group (adjusted hazard ratio 1·49, 95% CI 0·62—3·57; p=0·368).

Circumcision of HIV-infected men did not reduce HIV transmission to female partners; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.


(da TheLancet-National Institutes of Health)