Studies Examine Effect Of Male Circumcision On Sexual Behavior, Breast-Feeding Interventions For HIV-Positive Women

The following highlights recently released journal articles on HIV/AIDS.

Male Circumcision in Siaya and Bondo Districts, Kenya: Prospective Cohort Study To Assess Behavioral Disinhibition Following Circumcision," Journal of Acquired Immune Deficiency Syndromes: Kawango Agot -- project coordinator of a collaborative research project among the University of Nairobi, University of Illinois and the University of Manitoba -- and colleagues conducted the study among 324 recently circumcised men and 324 uncircumcised men to determine the effect of circumcision on sexual behavior. The researchers compared the two groups' sexual behaviors at one, three, six, nine and 12 months following circumcision or study enrollment. They found that during the first month following circumcision, men were 63% less likely to report having 0 to 0.5 risky sexual acts weekly than uncircumcised men. The researchers also found that during the first month following circumcision, men were 61% less likely to report having more than 0.5 risky sexual acts weekly than uncircumcised men. The differences in sexual behavior disappeared during the remainder of the follow-up period, and similar results were seen for risky unprotected sexual acts, number of at-risk sexual partners and condom use, according to the researchers. The researchers concluded that during the first year following circumcision, men did not report an increased number of risky sexual acts compared with uncircumcised men -- indicating that "any protective effect of male circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral impact" (Kawango et al., Journal of Acquired Immune Deficiency Syndromes, 1/1).

Two-Year Morbidity-Mortality and Alternatives to Prolonged Breast-Feeding Among Children Born to HIV-Infected Mothers in Cote d'Ivoire," PLoS Medicine: Renaud Becquet of the Institut National de la Sante et de la Recherche Medicale Unite in France and colleagues conducted the study from 2001 through 2005 among 557 infants born to HIV-positive women in Abidjan, Cote d'Ivoire. After their infants were born, the women, who underwent prenatal antiretroviral prophylaxis, either received breastmilk substitutes or exclusively breast-fed for four months. Nutritional counseling and clinical management were provided for two years, and breastmilk substitutes were provided at no cost. Thirty-four percent of the 262 infants who were breast-fed for an average of four months during the two-year follow-up period did not experience any adverse health outcomes -- which the researchers defined as diarrhea, acute respiratory infections or malnutrition -- compared with 37% of the infants who received breastmilk substitutes. The two-year probability of presenting with a severe health event -- which the researchers defined as hospitalization or death -- was 14% among the breastmilk substitute group, compared with 15% among the breast-fed infants. The researchers concluded that breastmilk substitutes and short-term breast-feeding can be safe interventions aimed at preventing mother-to-child HIV transmission in urban African settings where adequate nutritional counseling and care, access to clean water and breastmilk substitutes are available (Becquet et al., PLoS Medicine, January 2007). In a related opinion piece, Grace John-Stewart of the University of Washington writes that the researchers "provide good data to suggest that with appropriate provisos, replacement feeding can be a safe option to consider" for HIV-positive women in urban African settings (John-Stewart, PLoS Medicine, January 2007).

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