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West African HIV-2 prevalence associated with lower historical male circumcision rates

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According to a study published in the open-access journal PLOS ONE by João Sousa and colleagues from the University of Leuven, Belgium, in West African cities, male circumcision rates in 1950 were negatively correlated with Human Immuno-deficiency Virus type 2 (HIV-2) prevalence from 1985.

The HIV-2 virus likely emerged in humans around 1930-40 and is less widespread than the predominant HIV-1, remaining mostly within West Africa. Whilst male circumcision is known to be associated with reduced HIV-1 prevalence, because the foreskin is highly vulnerable to infection, the association between male circumcision and HIV-2 prevalence had not previously been examined.

The authors of the present study gathered the published results of large scale HIV-2 serosurveys, conducted from 1985 onwards, of the populations of 30 West African cities. They combined estimates of historical male circumcision frequency in 218 West African ethnic groups with demographic data to estimate male circumcision frequency for each West African city at various time points. The researchers then matched HIV-2 prevalence with the estimated male circumcision frequency in each city to identify any correlation.

The authors found that cities with higher male circumcision rates in 1950 generally tended to have lower HIV-2 prevalence at the time of the first serosurveys in 1985-91. Generally, male circumcision was far less common than it is today, and varied more by country. Cities in two countries, Guinea-Bissau and Côte d’Ivoire, which are thought to have acted as epicenters during the emergence of HIV-2, had particularly low male circumcision rates, reinforcing the negative correlation.

Whilst the data on male circumcision and HIV-2 prevalence were obtained in different years, making it difficult to link the two directly, the authors state that HIV-2 may only have been able to achieve high prevalence in West African cities where a substantial proportion of the population was uncircumcised.

“Lack of circumcision may have been a driving factor in initial HIV-2 emergence,” says Sousa.The research done by JDS and AMV in this study has been supported in part by grant G.0611.09N, funded by the Fonds voor Wetenschappelijk Onderzoek – Flanders, Belgium. MPT’s fieldwork in Guinea-Bissau was conducted within the framework of the project “The prophetess and the rice farmer: innovations in religion, agriculture and gender in Guinea-Bissau”, PTDC/AFR/111546/2009, funded by Fundação para a Ciência e Tecnologia, Portugal. VM is a Fellow of the Parmenides Center for the Conceptual Foundations of Science, part of Parmenides Foundation, Germany. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


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1 Comment
  • M Lyndon

    Male circumcision is a dangerous distraction in the fight against HIV/AIDS.

    From a USAID report:
    “There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
    http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
    (this will include men who were circumcised tribally rather than medically, but they and their partners may also believe themselves to be protected, and the whole rationale for the RCT’s into female-to-male transmission was a purported correlation between high rates of male circumcision and low rates of HIV)

    It seems highly unrealistic to expect that there will be no risk compensation. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”. This figure seems to have been unchanged in 2012.
    http://www.info.gov.za/issues/hiv/survey_2009.htm
    http://www.hst.org.za/sites/default/files/ZANationalHIVCommunicationSurvey2012.pdf
    http://jhhesa.org/sites/default/files/hiv_survey.pdf

    It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.