Circumcision as Preventative Measure Against HIV Infection

In late March 2007, UNAIDS and the World Health Organization endorsed circumcision as a way of reducing heterosexual men’s vulnerability to HIV infection. Their endorsement was based in part on the findings of three recent studies which indicate that circumcised men are up to 60 per cent less likely to contract HIV from vaginal intercourse than uncircumcised men.

The studies looked at the vulnerability of heterosexual men in three high-prevalence, or HIV-endemic, countries: South Africa, Kenya, and Uganda.

The AIDS Committee of Toronto (ACT) recognizes the significance of these studies. Given, however, that the studies took place in social and epidemiological contexts different from those here in Toronto, ACT would like to clarify what the studies do and do not tell us.

What the current research tell us:

    • Uncircumcised men are more vulnerable to acquiring HIV during vaginal sex than circumcised men are. The foreskin is susceptible to nicks and tears during intercourse, which can act as entry points for the HIV virus. Compounding this vulnerability is the fact that the foreskin is rich in Langerhans cells, a target for the HIV virus.
    • While circumcision can reduce men’s vulnerability to getting HIV, it does not eliminate it.

What the current research does not tell us:
    • It is not clear whether uncircumcised men are more likely to pass on the HIV virus than circumcised men.
    • It is not clear whether circumcision significantly reduces the risk of HIV transmission to the insertive male partner (the ‘top’) during anal sex. It is possible to infer that the same factors that make uncircumcised men vulnerable to acquiring HIV during vaginal sex would make them vulnerable to HIV transmission during anal sex. However, the studies themselves did not look at this.
ACT would like to stress that while circumcision may reduce some men’s risk of HIV infection, it does not eliminate that risk.

Condoms are the most effective way to protect yourself and your partner from HIV transmission during sexual intercourse, whether you’re circumcised or uncircumcised, straight, gay, or bisexual.

Circumcision is a personal decision that may be made on religious, cultural or other grounds. As preventative measure against HIV, however, ACT cannot endorse circumcision based on the current research.