Why Male Circumcision Makes an Effectual Means of HIV Prevention? The Reasons Revealed.
Male circumcision has already proven its part as an effective prevention of HIV transmission together with other defined methods of prevention. Since sexual intercourse is accounted for highest way for HIV transmission, the preventative success brought by male circumcision is through scientific study of HIV target immune cells located on the foreskin and the proper dissemination of public information.
The Benefit of Male Circumcision
Male circumcision as revealed by many studies provides considerable benefits for men and women.Studies conducted by WHO and UNAIDS from three randomized controlled trials, show compelling evidences that male circumcision can lower the risk of HIV heterosexual transmission (penile-vaginal-intercourse) by 60%.
Which do you think is the best reason why male circumcision acts as a means of HIV prevention?
Other Benefits of Male Circumcision
- lowers the risk of acquiring urinary tract infections and sexually transmitted diseases (STDs).
- reduces the risk of developing penile cancer due to many cases of cancer cells progress in the foreskin; for female partners, male circumcision reduces the risk of acquiring cervical cancer caused by human papilloma virus (HPV), bacterial infection (bacterial vaginosis), and parasitic infection (trichomoniasis)
- lower down the chances of tears and breakages of vaginal and penile mucus membrane.
Reasons Why Male Circumcision Acts as a Substantial Intervention in HIV Prevention
Male circumcision is the removal of the foreskin in man. The foreskin is located on the top most part of the penis. Based on many studies and researches done, there are certain reasons why male circumcision is considered to be an effective intervention in HIV prevention.
Macrophage and Dendritic cell are called Antigen Presenting Cells
1. Lower down the number of HIV target cells and C-type lectin receptors
HIV target cells are specific immune cells necessary for HIV attachment. HIV does not bind to any kind of body cells. It requires specific receptors which are found on HIV target cells like T cells, Langerhans cells, macrophages, and sub-mucosal dendritic cells.
How Antigen Presenting Cell Works
HIV transmission through cell to cell interaction
Dendritic cells are numerously found in the genital and rectal sub-mucosa. Since the primary route of HIV transmission is through sexual contact, the dendritic cells and macrophages serve as the preliminary target cells of HIV.
Dendritic cells (DC) and macrophages highly express C-type lectin receptors (CLRs) on their surfaces. These receptors capture the glycoprotein 120 (part of HIV used for attachment to human immune cells). The DC with captured HIV migrates to other lymphoid organ where numerous T cells are present.
By cell to cell interaction, HIV will be presented by DC to the T cells which contain CD4 receptors and co-receptors necessary for HIV attachment in T cells. That's why DC and macrophages are called antigen presenting cells (APCs). In T cells, the primary virus replication and reproduction highly occur; and at the same time, the invasive destruction of the immune cells.
C-type lectin receptors expressed on antigen presenting cells
A study posted on The American Journal of Pathology reveals the abundance and presence of HIV target cells and C-type lectin receptors in the foreskin tissue of men. The study was conducted among young Kenyan men in high-risk groups. The sample tissue was taken at the time of circumcision and was frozen immediately to preserve the viability and suitability of the specimen. HIV target cells and CLRs were numerously found underneath the foreskin. Male circumcision which removes the foreskin will result in a reduction in the number of HIV target cells and C-type lectin receptors; thereby reducing the chances of HIV transmission.
2. Male Circumcision Makes the Skin Tougher from Breaks and Tears.
According to the study, in uncircumcised men, during intercourse, the foreskin is retracted over the shaft and the inner mucosa is greatly exposed to the partner's vaginal secretions. HIV viral load (number of virus presents in people living with HIV) when greatly increased in blood and in genital secretions can provide an increased risk of virus transmission. The foreskin, which is considered most sensitive part of all penile tissue, is very susceptible to breaks and traumatic epithelial disruptions that offer an accessible portal for HIV.
In the meantime, after intercourse, the unretracted foreskin provides a moist environment conducive for HIV survival. It offers a warm niche for HIV to grow and multiply. If the foreskin is removed, dry environment lessens HIV viability. HIV cannot survive when placed outside the body and in unfavorable temperature and condition.
The removal of the foreskin results to increased keratinization (deposition of highly-fibrous protein) which makes the skin tougher from breaks and tears; These makes another reason why male circumcision acts as an intervention for HIV prevention.
3. Alteration in Micro-biome
Another research study reported in Medical News Today reveals that in uncircumcised men, there is an increased probability for the presence of micro-biome (microorganisms living in a human body) underneath the foreskin. These microorganisms are primarily anaerobic or bacteria living without oxygen. Examples of these anaerobes in the foreskin are Prevotella and Fusobacterium which is similar to the inhabiting bacteria in the gut. Researchers believe that this kind of bacteria provides conduits for virus transmittance in a favorable environment.
The report explains that a large number of bacteria (anaerobes) can encourage the Langerhans cells (kind of dendritic cells mostly found in oral, anal and vaginal tissues) to present HIV directly to the T cells through sexual contact. The synergistic effects of anaerobic bacteria and dendritic cells faster the presentation of HIV to immune cells. This will lead to quicker destruction of the immune cells, and thus, will lower the capability of the body to fight infections.
The removal of the foreskin can alter the appearance or structure of the penis and can remarkably reduce the number of anaerobes which will be largely replaced by aerobes (bacteria living with oxygen). This condition is thought to be an aid in HIV prevention (but the complete and necessary evidences regarding this matter is not fully established).
Clear Communication and Messages
According to WHO, correct dissemination of messages and information to the public and high-risk group is highly necessary. These include:
1. Male circumcision does not give complete protection from sexually transmitted diseases. Circumcised men can still infect and be infected with HIV and other STD. According to WHO, this method only offers a partial protection and cannot replace other means or defined methods for HIV prevention. It only promotes an added strategy and will only serve as a part of HIV prevention packages like: abstinence; monogamy; provision of HIV testing and counseling services; treatment for sexually transmitted infections; promotion of safer sex practices; provision of male and female condoms and promotion of their correct and consistent use.
2. Furthermore, correct relaying of information regarding male circumcision is considered highly significant to prevent a false sense of security that can result to increased indulgence in sexual intercourse among high-risk groups. A substantial and balance information must be introduced to the community—circumcision does not provide 100% protection but only a complementary to the defined ways of HIV prevention.
3. Resume of sexual activity among high-risk group after circumcision and before wound healing will give a higher probability of acquiring HIV and other STDs.
4. It must also be emphasized that female circumcision is different compared to male circumcision. Female circumcision provides no medical benefits and presents hazards to women's health.
Synergistic Effect in HIV Prevention
WHO (World Health Organization) recommends male circumcision as an effective and effectual means of STD prevention, especially against HIV transmission.
Proper dissemination of correct information regarding male circumcision must be strictly professed to inhibit wrong connotation regarding male circumcision.
Together, these two factors both achieve a helpful intervention; and the omission of either of the two could, on the other hand, serve a conduit for HIV transmission.