Last week, while looking for something else, I ran across a report that has big implications for HIV/AIDS prevention in Africa: Almost five years ago, a trial of circumcision to protect men in Rakai, Uganda, reported that intact (uncircumcised) men who waited at least 10 minutes after sex before cleaning their penis were at less risk to get HIV than men who had been circumcised: intact men who waited to clean got HIV at the rate of 0.39% per year compared to 0.66% per year for circumcised men. Although the study team reported these results to an international AIDS conference in 2007, and several newspapers wrote about it at the time, the report has dropped out of view. That is a big mistake.
Why is this report important? Here are three reasons.
First, if you are intact, this report says you don’t need to get circumcised to reduce your risk to get HIV. Use a condom, of course, if your partner has or might have HIV. But if that fails, this report says you are as safe with a foreskin as you would be without one. Just don’t clean your penis for at least 10 minutes after sex, and then wipe it with a dry cloth, without water. A later report from the Uganda study team suggests waiting to clean is good for all men, both circumcised and intact: men who didn’t “wash genitals after sexual intercourse” got HIV less than 1/3rd as fast as men who did.
Second, if you are a politician or public health official who is considering whether to go along with the largely US-promoted program to circumcise 20 million African men by 2015, you can take another close look at the evidence and options. The evidence that advocates use to promote circumcision comes from three studies (in South Africa, Kenya, and Uganda during 2002-06) that recruited thousands of intact, HIV-negative men, circumcised some and not others, and then followed and retested them to see who got HIV. All three studies reported that circumcised men got less HIV. But the study team for at least one of those trials – the trial in Uganda – has data showing that intact men who waited to clean after sex got less HIV than circumcised men.
Circumcision is expensive and dangerous and takes doctors and nurses away from other tasks. Why put scarce public resources into campaigns to circumcise millions of men if you can get the same results by advising men to use condoms, and if that fails to wait least 10 minutes after sex before wiping their penis with a dry cloth?
Third, this is another example of people reporting important evidence that contradicts well-funded misinformation about HIV risks. WHO, USAID, and other organizations pay for a lot of messages – some are true and helpful, but some are at best only partial truths. It’s important for people to speak up when they have good information about how to avoid HIV risks, even though what they say disagrees with the official “line” at the time.