=-=-=-=-= An Article From The Electronic Gay Community Magazine -=-=-=-=-=-=- =-= Copyright The Land Of Awes BBS (316)269-4208 Copied With Permission =-=- Subject: Are Uncircumcised Men at Higher Risk for HIV? By Alan G. Nyitray, MS, Public Health Educator HIV/STD Servic e Oklahoma State Department of Health Since HIV was discovered in 1984, public health officials have been trying to uncover factors that might promote HIV transmission. By identifying and publicizing such factors people at risk for HIV can take appropriate steps to reduce their risk. Research has clearly shown that sexually transmitted diseases (STDs) that cause sores in the genital area can put a person at higher risk for HIV. The sores give HIV another 'portal of entry' and allow the virus to find its way into a person's bloodstream more easily. STDs like syphilis, herpes, and chancroid cause sores that help HIV get into a person's bloodstream. It's unclear how other STDs (like gonorrhea or genital warts) might promote HIV transmission and continuing research is trying to clarify these issues. Only one other factor clearly promotes HIV transmission. Uncircumcised men having unsafe sex are at greater risk of getting HIV than circumcised men having unsafe sex. Circumcision is the practise of removing the foreskin of the penis. Just what makes circumcised men less likely to get HIV infection is unclear. It's important to understand that lack of circumcision increases a man's risk for HIV infection only if he is having unsafe sex. Circumcised and uncircumcised men who avoid unsafe sex are not at risk for getting HIV during sex. Unsafe sex is anal intercourse, vaginal intercourse, and oral intercourse when latex condoms aren't used. Uncircumcised men may be at greater risk for a variety of reasons. For instance, they may not have been told how to correctly use a condom. Because an uncircumcised man has a foreskin and a circumcised man doesn't have a foreskin, each has to put on a condom differently. Uncircumcised men must pull back on their foreskin before rolling on the condom. Neglecting to pull back the foreskin may make condom failure more likely, although no clear evidence supports this idea. Uncircumcised men having unsafe sex may be at greater risk if HIV infected fluid remains under the penis' foreskin for an extended period of time. the shelter afforded by foreskin may give HIV a more favorable environment in which to survive. The protected area under the foreskin might help shield HIV from air and keep it closer to body temperature. Although only speculation, foreskin might also somehow facilitate the entry of HIV infected fluid into the opening at the end of the penis. Calling the lack of circumcision a factor for HIV transmission can stir controversy. In recent years, many have questioned the need for male babies to be circumcised. Some say circumcision is a cultural tradition that no longer has any clear purpose. A January, 1993 issue of The Journal of the American Medical Association included reviews of books with the titles The Joy of Uncircumcising; Restore Your Birthright and Maximize Sexual Pleasure,m and Say No to Circumcision: 40 Compelling Reasons Why You Should Respect His Birthright and Keep Your Son Whole. Responding to changing mores about circumcision, some men have undergone foreskin reconstruction surgery. However, recent research provides compelling evidence that lack of circumcision puts men having unsafe sex at higher risk for HIV. Studies done by universities in the U.S., Canada and Africa point to increased risk for uncircumcised men. In one study, 413 men who came to an STD clinic in Nairobi, Kenya were tested for HIV infection and followed for a minimum of six weeks. All the men has chancroid a mainly tropical STD that causes a sore in the genital area. At the start of the study, 51% of the uncircumcised men were HIV infected while 16% of the circumcised men were HIV infected. As the HIV negative men were followed over time, 27% of the uncircumcised men because HIV positive, whole only 6% of the circumcised men became positive. This study seems to show that in a group of men with STD that causes ulcers, the uncircumcised men in the group are more likely to get HIV. Another study done with gay men in Seattle showed that uncircumcised gay men were twice as likely to be HIV infected as were circumcised gay men. This study asked 316 HIV+ gay men and 186 HIV- gay men if they were circumcised. While about 85% of them men were circumcised, those who were uncircumcised were significantly more likely to be HIV infected. These studies and evidence from other studies point to a greater risk for HIV infection in uncircumcised men who have unsafe sex. What should an uncircumcised man do with this information? The most important answer is the same answer given to all people regardless of circumcision status: Keep avoiding unsafe sex. Avoiding unsafe sex definitely helps protect a person. But are there other measures that uncircumcised men can take that might help protect them? Since warm water and soap create a hostile environment for HIV, washing after unsafe sex might give some protection from HIV. While this suggestion is based only on common sense and not research data, it seems possible that HIV infection might be less likely in uncircumcised men who, after unsafe sex, thoroughly clean their penis, especially under the foreskin. As a way to avoid HIV, medical authorities are not promoting circumcision surgery for adult men who still have a foreskin. There simply is no evidence leading researchers to feel this painful operation would provide a definite benefit to uncircumcised men. Remember; the circumcised man who has unsafe sex is at much greater risk for HIV than the uncircumcised man who has safe sex. Some health educators fear that people could use information like that contained in this report to unwisely discriminate against uncircumcised men. They use a familiar anology from health care to make their point: Since gay men are at higher risk for HIV, some hospital workers will use gloves and other protection when dealing with a gay man's body fluids, but not use adequate protection when dealing with other's body fluids. Would some people use a rubber with uncircumcised men but not with circumcised men? Once again, we have to remember the old adage: It's not who you are but what you do. We are not decreasing our risk for HIV if we have unsafe sex with circumcised men because we stereotype circumcised men as less risky than uncircumcised men. We, as gay and lesbian people, know how false and inaccurate stereotypes have distorted the truth about our own community. Let's now allow stereotypes and generalities to jeopardize our collective health. Alan G. Nyitray have been a health educator for the Oklahoma State Department of Health for almost five years. He currently acts as a liaison on HIV and STD issues to the gay and lesbian community in Oklahoma. For additional information on this topic and others, Mr. Nyitray can be reached at the HIV / STD Service; Oklahoma State Department of Health; Mail Drop 0308; 1000 NE 10th Street; Oklahoma City, OK 73117-1299; 405-271-4636 Voice; 405-271-5149 Fax.