Two scenarios raise the question of whether male circumcision should be used in the U.K. as a means to decrease HIV transmission. Lack of circumcision has long been recognized as a risk factor for HIV acquisition in heterosexual men. This makes biological sense because superficial Langerhans cells, which express HIV-1 receptors, are more prevalent in the male foreskin than in the remainder of the penis. In addition, decreased keratinisation of the foreskin increases susceptibility to minor trauma during intercourse, potentially aiding the passage of HIV. Finally, ulcerative sexually transmitted infections, found more commonly in uncircumcised men, are associated with increased rates of HIV transmission.
The biological plausibility of adult male circumcision to reduce HIV transmission has now been shown to have clinical relevance in three recent large randomised controlled trials conducted in sub-Saharan Africa, in which male circumcision reduced the rate of female-to-male HIV transmission by at least 50%.[5-7] Overall, there was little evidence of increased risk taking behaviour in the circumcised men. Here we examine whether the results of the African trials are relevant in the U.K.
- HIV/AIDS prevention
- male circumcision
- public health
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