Statement on Findings that Adult Male Circumcision Significantly Reduces Risk of Acquiring HIV

Trials in Kenya and Uganda Stopped Early

Dr. Zeda Rosenberg, CEO, The International Partnership for Microbicides

(15 December 2006) –The announcement from the National Institutes of Health that the Data and Safety Monitoring Board has halted male circumcision trials in Kenya and Uganda represents an historic breakthrough in the field of HIV prevention research. As these trials have demonstrated, male circumcision has the potential to become an important new tool in the fight against HIV/AIDS. We are inspired to learn about these results, and we encourage the global community to begin to undertake the practical steps required, including the provision of technical support, to make this intervention accessible to the millions of people who stand to benefit.

Everyone working to address this epidemic recognizes that a range of new prevention options is urgently needed. The global public health community can now begin to add medical circumcision into the broader array of HIV prevention strategies, including condom use, behavior change education and safer sex practices.

The National Institute of Allergy and Infectious Diseases (NIAID) trials studied whether male circumcision reduces female-to-male transmission. In addition, an important trial funded by the Gates Foundation is ongoing to determine if male circumcision reduces male-to-female HIV transmission, and is scheduled for completion in 2007.

Women and girls make up 60 percent of HIV infections in Africa, and worldwide, 75 percent of young people infected with HIV are women and girls. There remains an enormous need for HIV prevention tools like microbicides that women can initiate to protect themselves.

Background
On December 13, 2006, the National Institute of Allergy and Infectious Diseases (NIAID) announced an early end to two clinical trials of adult male circumcision because an interim review of trial data revealed that medically performed circumcision significantly reduces a man’s risk of acquiring HIV through heterosexual intercourse. The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.

In addition, in 2005 results of the first randomized clinical trial assessing the protective value of male circumcision against HIV infection, conducted by a team of French and South African researchers in South Africa, were reported. That trial of more than 3,000 HIV-negative men showed that circumcision reduced the risk of acquiring HIV by 60 percent. The trial was funded by the French Agence Nationale de Recherches sur le Sida (ANRS) (see http://www.anrs.fr/).

For more information on the Kenyan and Ugandan trials of adult male circumcision, see the NIAID Questions and Answers document at http://www3.niaid.nih.gov/news/QA/AMC12_QA.htm.

A press statement by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its cosponsors, the World Health Organization (WHO), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF) and the World Bank, in response to the NIAID DSMB recommendation is available on the WHO website: www.who.int/hiv.