Abstract

Two scenarios raise the question of whether male circumcision should be used in the U.K. as a means to decrease HIV transmission. Lack of circumcision has long been recognized as a risk factor for HIV acquisition in heterosexual men.[1] This makes biological sense because superficial Langerhans cells, which express HIV-1 receptors, are more prevalent in the male foreskin than in the remainder of the penis.[2] In addition, decreased keratinisation of the foreskin increases susceptibility to minor trauma during intercourse, potentially aiding the passage of HIV.[3] Finally, ulcerative sexually transmitted infections, found more commonly in uncircumcised men, are associated with increased rates of HIV transmission.[4]

The biological plausibility of adult male circumcision to reduce HIV transmission has now been shown to have clinical relevance in three recent large randomised controlled trials conducted in sub-Saharan Africa, in which male circumcision reduced the rate of female-to-male HIV transmission by at least 50%.[5-7] Overall, there was little evidence of increased risk taking behaviour in the circumcised men. Here we examine whether the results of the African trials are relevant in the U.K.