Uncircumcised men are eight times as likely to become infected with HIV than circumcised men, according to a study of nearly 2,300 men in India released on Thursday.
A researcher at Baltimore’s Johns Hopkins University School of Medicine suggested that the inner surface of the foreskin does not have the same protective layer as the outside, and is potentially more vulnerable to HIV.
Male circumcision is common in North America and elsewhere for religious and cultural reasons and to help prevent urinary tract infections and penile cancer.
The procedure involves removal of the foreskin, which covers the tip of the penis, and is typically done shortly after birth.
In the United States, some two-thirds of male infants are circumcised annually. Worldwide, the rates vary widely, depending on culture and religion. In many countries, including India, circumcision is uncommon.
“It’s important that we offer measures to help curb the spread of AIDS, particularly in developing countries, where it continues to grow at an alarming rate,” Dr. Steven Reynolds, post-doctoral fellow in the division of infectious diseases at Johns Hopkins and a study investigator said in a statement.
The American Academy of Pediatrics has said it no longer recommends routine circumcision because — despite some medical benefit — there can be complications.
Johns Hopkins also studied the risk of other sexually transmitted diseases among circumcised and uncircumcised men. Although the incidence of diseases like syphilis, gonorrhea and genital herpes was slightly higher among uncircumcised men, the difference was not statistically significant.
The research was part of a larger study investigating risk factors for HIV infection based on men attending one of three sexually transmitted disease clinics in Pune, India between 1993 and 2000.
Demographics, sexual risk behaviors — including having sex with a prostitute — and condom use were similar between both groups, Reynolds said.
He added that there are methods uncircumcised men may be able to use to protect themselves against HIV, including condoms and, in the future, a potential topical microbicide product that might be applied to the foreskin before sex.
“Circumcision as a potential prevention strategy requires confirmation by randomized clinical trials,” Reynolds said. There currently are clinical trials underway in Uganda, Kenya and South Africa.
Results of the study were presented at a San Diego meeting of the Infectious Diseases Society of America.