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Prevention of HIV Transmission in the United Kingdom: What is the Role of Male Circumcision?
  1. Abigail MacDonald (abigail.macdonald{at}wadh.ox.ac.uk)
  1. University of Oxford, United Kingdom
    1. Joanna Humphreys (joanna.humphreys{at}medschool.ox.ac.uk)
    1. University of Oxford, United Kingdom
      1. Harold W Jaffe (harold.jaffe{at}dphpc.ox.ac.uk)
      1. University of Oxford, United Kingdom

        Abstract

        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.[1] 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.[2] In addition, decreased keratinisation of the foreskin increases susceptibility to minor trauma during intercourse, potentially aiding the passage of HIV.[3] Finally, ulcerative sexually transmitted infections, found more commonly in uncircumcised men, are associated with increased rates of HIV transmission.[4]

        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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