Circumcision

The risk of getting infected with HIV decreased by half with the use of circumcision in NIAID research with 4,996 Ugandan men and 2,784 Kenyan men. “Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition,” Anthony S. Fauci, M.D., director of NIAID (National Institute of Allergy and Infectious Disease), said in a press release. “We now have confirmation—from large, carefully controlled, randomized clinical trials—showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse.” Because the results clearly favored circumcision, NIAID stopped the research early and will offer circumcision to all men enrolled in the study. A French study in South Africa had previously shown that circumcision decreases the risk of infection. That study showed a 60% reduction in risk. Research has also found that the foreskin is rich in a type of cell that is very vulnerable to the virus. NIAID noted that the use of condoms and safer sex counseling is still important to slowing the epidemic. The World Health Organization (WHO) agreed with that concept in a statement, “emphasizing” that circumcision is not the complete answer. WHO said that it would look into the use of circumcision, but among its concerns, WHO noted that “the ideal and well-resourced conditions of a randomized trial” are not always available to men around the globe, including sanitary conditions. The epidemic in sub-Saharan Africa is driven primarily by heterosexual contact, and WHO noted that the rate of circumcision there is low. For extensive information on circumcision and HIV, visit www.aidsvaccineclearinghouse.org.

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Prisons and HIV

An article in the January 11 issue of the prestigious New England Journal of Medicine explored HIV prevention in prisons. Author Susan Okie, M.D., noted that the World Health Organization (WHO) and UNAIDS (a program of the United Nations) have for more than 10 years recommended condoms in prisons. The agencies also recommend drug treatment, methadone, and bleach for cleaning injection supplies, plus having syringe exchange be considered. But the U.S. rarely makes those resources available to prisoners. Dr. Okie reported that in terms of harm reduction:

• prisons in several Western European countries and in Australia, Canada, Kyrgyzstan, Belarus, Moldova, Indonesia, and Iran have adopted some or all of these recommendations
• clean needles and syringes are available in approximately 50 prisons in eight countries
• evaluations of such programs in Switzerland, Spain, and Germany found no increase in drug use, a dramatic decrease in needle sharing, no new cases of infection with HIV or hepatitis B or C, and no reported instances of needles being used as weapons
• condoms are provided on a limited basis in two state prison systems in the U.S. (Vermont and Mississippi) and five county jail systems (New York, Philadelphia, San Francisco, Los Angeles, and Washington, D.C.)
• methadone maintenance programs are even more rare, available in a few jails and prisons, including those in New York City, Albuquerque, and San Juan, Puerto Rico
• no U.S. prison has provided a needle-exchange program
Dr. Okie also reported that:
• there were more than 2.2 million U.S. prisoners at the end of 2005, a record high
• drug-related offenses were a major reason for the increase in prisoners, responsible for half of the new numbers between 1995 and 2003
• more than half of all inmates had a mental health problem in 2005, and Dr. Okie wrote that “doctors who treat prisoners say that many have used illicit drugs as self-medication for untreated mental disorders”

• in 2004, 1.8% of prison inmates were HIV-positive, more than four times the estimated rate in the general population
• the rate of confirmed AIDS cases was also substantially higher
• it has been estimated that each year, about 25% (one out of four) of all HIV-positive persons in the U.S. spend time in a correctional facility, as do 33% of persons with hepatitis C and 40% of those with active TB
• between 1988—when the Georgia Department of Corrections began mandatory HIV testing of all inmates on entry to prison and voluntary testing thereafter—and 2005, HIV occurred in 88 male inmates in Georgia prisons; transmission resulted from men having sex with other men or getting a tattoo
• in another study in a southeastern state, HIV transmission while in prison was documented in 33 of 5,265 male inmates (0.63%)

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