Male circumcision involves the surgical removal of the foreskin, the tissue covering
the head of the penis. When circumcision is performed for babies it mainly
takes a period of one week to heal whereas in adult men, a four to six week
period is required for the wound to heal fully.
A randomized controlled trial conducted in 2005 among uncircumcised men aged
between 18 and 24 years in South Africa showed that male circumcision reduced
the risk of acquiring HIV infection by 60%.
Another trial concentrated on a larger cross-section of rural men (aged 15 to 49) in Uganda. Over 11,000 men volunteered for the trials with one group receiving circumcision on enrolment and a control group delaying surgery until the end of the study.
By tracking newly acquired infections in both groups, investigators discovered that circumcision cut HIV transmission rates by 55 to 65 percent. In fact, three trials were stopped early due to the overwhelming evidence of circumcision’s protective effect.
“It was striking that the trials were in very different settings, but yielded consistent results,” says Ronald Gray, study leader for the Uganda trial and epidemiologist at Johns Hopkins Bloomberg School of Public Health in Baltimore. “This was the largest protective effect ever
seen next to condom use,” added Sten Vermund, director of the Institute for Global Health at Vanderbilt University School of Medicine in Nashville, Tenn. But the question remained: Why?
Microscopic examination of the foreskin yielded important clues for unravelling the benefits of circumcision. Normally, the skin provides a thick protective barrier produced from keratin; a tough structural protein also found in hair and fingernails. But on the inner surface of the foreskin, the keratin layer is much thinner, more like the inner lining of the mouth or eyelid than the skin on the palm of the hand.
There are several biological explanations why male circumcision may reduce the risk
of HIV infection for men. By removing the foreskin, circumcision reduces the ability of HIV to penetrate the skin of the penis due to toughening of the inner aspect of the remaining
foreskin.
The inner part of the foreskin contains many special cells with protective properties such as Langherhans cells that are prime targets for HIV. Some of these are removed with the foreskin, while the remaining cells become less prone HIV virus due to the toughening of the remaining foreskin.
By removing the foreskin, the likelihood and probability of acquiring HIV virus is also reduced because ulcers, which are characteristic of some sexually transmitted infections and can facilitate HIV transmission, often occur on the foreskin.
International Hospital Kampala (IHK) has partnered with the Infectious Disease Institute (IDI) to provide free circumcision at the Namuwongo facility. They currently run male circumcision camps on Saturdays that started in April 2011, and are set to continue till the programme goals are achieved. By task sharing with qualified doctors and nurses, the surgeons have steadily increased the number of circumcision procedures by more than 250% since the camps started.
The outcomes so far have been very successful and more than 2,000 male adults have benefited from this free programme over a four month period. One of the beneficiaries, Samuel Kasule, 29, feels that the camp could not have happened at a better time.
“I wanted it [circumcision] a long time back but I was told I would take long to heal. Now that I’ve done it, I am pleased that I resumed work by the third day and I am now healed after 10 days.”
Dr Moses Galukande, the Programme Director for these camps explains: “There has been an overwhelming response which is very pleasing and, hopefully, people fully understand the benefits and the limitations of safe male circumcision.”
However, what everybody must know is that circumcision, just like many other prevention methods, is not 100% guarantee against HIV infection. Safe male circumcision (SMC) reduces the probability of getting an infection and has other health benefits. Male circumcision must not be promoted alone, but alongside other methods to reduce the risk of HIV infection. Avoidance of unsafe sexual practices, reduction in the number of sexual
partners and correct and consistent condom use should be emphasized.
