Submitted 10/11/2003 9:29:33 AM
Below are critical comments from AIDS expert Dr Daniel Halperin on errors in recent article about foreskin as source of HIV infection during sexual intercourse (Dr Grulich's flawed commentary on recent research findings and the work of Prof Roger Short).
Dr Halperin is a leading researcher with USAID in Washington, DC, USA. Dr Halperin writes: There are a couple studies from the US showing increased risk of HIV infection in non-circumcised men. One was a prospective study in NY City among mainly heterosexuals, and there are three studies among gay men as well...
Also, one of Grulich's statements is incredibly inaccurate: "...one of the countries with the highest rates of circumcision in the world, the USA, has one of the highest rates of heterosexual transmission of HIV in the world." That is rather bizarre beyond belief. The large majority of HIV infection in the US is from needle sharing and anal sex among MSM.
Nearly all the heterosexual transmission that does exist (which is vastly lower level than in Africa) is male to female (i.e., some of the female partners of drug using or bisexual men are eventually infected as well...) This was discussed by Dr Bob Bailey (Chicago) and I in two paragraphs in the Lancet (
http://hivinsite.ucsf.edu/InSite.jsp?doc=2098.4613#cor):
Although he is incorrect in his assertion that North America has "one of the highest" HIV rates in the world (many of the Asian and all of the African countries cited in our article have much higher HIV rates than the 0·76% rate in the US), he is correct to point out that there are higher HIV rates in North America than in most European countries. It is important to recognize that in North America and Europe most HIV infections occur through receptive anal sex and injecting drug use, not through heterosexual transmission...
Lack of male circumcision is expected to contribute most to female-to-male HIV transmission, which is responsible for a very small proportion of infections in Europe and North America. Remarkably, there is consistent evidence that female-to-male HIV transmission, compared with male-to-female transmission, is much higher in Europe than in the USA, just as expected given the greater prevalence of uncircumcised men on that continent.
Data from the European Multicenter Partners Study and comparable research from the USA suggest that the ratio of female-to-male transmission (compared with male to female transmission) is about 10 fold higher in Europe. Although other factors may also be at work, lack of male circumcision is a logical co-factor accounting for such large differences in infectivity."