Question
What are the risks of catching HIV, if circumcised or from a tattoo needle?
12 March 2008. Related: All topics, HIV transmission.
Is it true that if you have had a circumsion that it is harder to catch HIV? Is it possible to catch it from a tattoo needle?
Answer
Thank you for your questions. I will start with answering your second question, as it is more straight forward. Yes, it is possible to get HIV from unsterilized instruments and that includes needles.
As far as your other question is concerned, there is evidence from studies (mostly done in Africa) that male circumcision may reduce men’s risk of being infected with HIV from women to men. The partial protection effect of male circumcision from the diverse studies is approximately 60% reduction risk of heterosexually acquired HIV infection.
There is still a lot of debate about the whole issue of circumcision and protection from HIV. Additional research is still needed especially to find out if there are any protective benefits of male circumcision in the case of men who have sex with men. At the 15th annual Conference on Retroviruses and Opportunistic infections, there were two studies that essentially concluded that male circumcision offered no benefits in case of insertive partners engaging in anal intercourse.
Lastly and most importantly, male circumcision does not offer complete protection against HIV. Correct and consistent use of condoms is still what many healthcare professionals recommend.
Circumcision trials by definition cannot be double-blind – because there is no placebo to having a circumcision. It is not like a drug trial where people can be randomised to a dummy pill or an active drug and not know which they get. If you’ve been circumcised, you know it.
The results were blinded to the researchers analysing rates of new HIV infections, which is why the study results are so important. On the basis of much higher infections in one group compared to another, the trials were stopped early. Only after the data was unblinded, was it found that the circumcised group had far fewer infections, and becasue it was a large randomised study, the link with circucision is real.
To discount research because it is performed by people interested in that aspect of research is also not very logical. Who would discount results of a new drug trial because the research is carried out by doctors interested in developing new drugs?
Circumcision is only one factor in the risk of transmission. By itself it doesn’t explain all infections, it is just part of the picture. If everyone used a condom every time this would stop HIV transmission, but in practice, for a number of reasons, this doesn’t happen in the ‘real world’.
Although you personally prefer other options, other people should be free to chose their own approach to their healthcare. Some of the recent circumcision studies also showed protective effects in terms of reducing some STIs.
The 3 large controlled trials done in Kenya, Uganda, and South Africa were all NOT double-blind. They all also were halted before the agreed-to protocol period had lapsed, while the rates among cut and uncut were still converging after the post-surgical period of abstinence for the cut. As they were all overseen by folks with a long history of promoting circumcision, they must be discounted.
As they hold no predictive power for the real world, they must be ignored. The studies can’t explain why the majority of AIDS-related deaths in the US were circumcised at birth. Nor can they explain how HIV rates are lower in many non-cutting countries – like Japan – than they are in many mostly-cut counties – like Israel.
This is not an obsession, it is now a proven option of reducing transmission. It is successful on a population level (ie reducing infections) but not on an individual level (ie the risk may be reduced but infection is still common so condoms are still important,
This research is in high prevalence countries, and community interest and acceptance of circumcision is very high.
ABC may be one approach that has been proposed but it has serious flaws. The majority of new infections in women occur within a relationship that they are faithful to. Marriage itself is an independent risk for women to become HIV-positive.
Abstinence doesn’t work on a population level in any society.
Condoms are expensive, difficult to access, or non-existent in many parts of the world.
In is wrong to think of Africa as one homogenous country. It is made up of many different countries, and each country often has many different cultures within it. There is a close relationship between between countries and cultures that practice circumcision and lower HIV infection rates.
This has been described in epidemiological studies for over 20 years, but only recently has this been shown in randomised, prospective, interventional studies. See this link and this link for study reports.
Circumcision can only possibly help men who have unsafe sex with HIV+ partners, so why this bizarre obsession with promoting genital surgery when we know that ABC works better than circumcision ever could? (ABC=Abstinence, Being Faithful, Condoms). The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Something is very wrong here. These people aren’t interesting in fighting HIV, but in promoting circumcision, and their actions will cost lives not save them.