Tuesday, October 27, 2009

The Greater the Foreskin, the Higher the HIV Risk

This study did not get quite the play in the media that other health-related circumcision studies have attracted, but it deserves mention on this blog. Still another African study has found that the more foreskin an individual has, the greater his risk of getting HIV.

Perhaps the media didn't report this widely because it's so obvious. The foreskin is a "portal of entry" for deadly diseases, so obviously the more foreskin you have the more portals and the greater the risk. Pretty simple.

As reported in "AIDS Map," here's the gist of the study: "Larger foreskin size is associated with an increased risk of becoming infected with HIV, investigators from the Rakai circumcision study report in the October edition of AIDS. “Larger foreskin size is a risk factor for HIV acquisition in uncircumcised men,” comment the investigators."

"Investigators from the Rakai circumcision study hypothesised that the size of an individual's foreskin may be associated with an increased risk of HIV infection, due to the larger surface area containing cells vulnerable to HIV infection. They therefore analysed men in the clinical trial who had previously taken part in a cohort study to see if they could find an association between the size of the foreskin measured at the time of circumcision and the risk of HIV acquisition in uncircumcised men prior to the removal of their foreskin. They conducted the retrospective analysis in men who had initially been recruited to the Rakai community cohort study, tested for HIV at baseline and followed for a median of four years prior to enrolling in the clinical trial and undergoing medical circumcision. A total of 965 men were included in the study."

"There were 48 new HIV infections. The median foreskin area was larger in those who became infected with HIV compared with those who did not (41.5 vs 35 cm2). Furthermore, the mean foreskin area was significantly higher among those who seroconverted than those who did not (43.3 vs 36.8 cm2). . . . HIV incidence was lowest amongst men with foreskin surface areas in the lowest quartile (0.8 per 100 person years), and incidence increased with foreskin surface area, being 2.48 per 100 person years amongst individuals in the upper quartile (p < 0.01 for the trend). After adjustment for possible confounding factors, the investigators found that individuals with a foreskin area above 45.6 cm2 had a significantly increased risk of becoming infected with HIV compared to men with the smallest foreskin surface area."

The obvious thing about this study is that it confirms that the presence of ANY foreskin carries a risk, but the risk increases as the foreskin grows larger. To me, it suggests that the removal of all foreskin as quickly as possible after birth is most desirable. Why should anyone run the risk of growing a large foreskin later in life? Most importantly, it once again links the foreskin to HIV risk, clarifying that the more you have of a bad thing the greater your chances of getting hurt.


  1. Huh. My risk of getting HIV is zero, and you could double my foreskin without changing that risk. At least in industrialized countries, getting HIV is a choice. Circumcision to prevent HIV is like playing russian roulette with 3 bullets instead of 5. If you play repeatedly, you will lose either way. This article makes it sound like get HIV like you catch a cold.

  2. Hey, Anonymous. Please read the study. You write, "You could double my foreskin without changing that risk....getting HIV is a choice." Both statements have no basis in medical science.

    First, the longer the foreskin, the greater the risk precisely because you have more excess skin that acts as a portal for HIV. That's what science says, not me. Second, you say getting HIV is a choice? Dude, nobody chooses to get AIDs. If you're saying that a person by his conduct becomes more susceptible, yes, I agree. Not using a condom, not getting circumcised, not being faithful -- yes, those personal failures can increase your risk of getting HIV.

    But the whole point of the United Nations, World Health Organization, the Gates Foundation, USAID, and other efforts to promote universal circumcision in Africa is to reduce the risk of getting HIV. True, if a person "chooses" to remain celebate all his life, I suppose that will greatly reduce his chance of HIV. But let's get real.

  3. Invoking "medical science" doesn't make you right, and I stand by my statement that my risk is zero, and I'm not celibate. A long foreskin isn't a portal for HIV any more than your mouth is a portal for cyanide. Unless you are raped, deceived, or you don't know about the risk factors for HIV, your probability of getting HIV is your choice: you can set it from 0 to 1. It's amazing that in this day and age people like you actually believe that getting HIV is some random event outside of your control with a single probability. Among the idiot crowd that does get HIV, I suppose that various things modulate their probabilities by small amounts, but the millions of circumcised men who have HIV prove that circumcision not an effective strategy for avoiding HIV.

  4. Millions of uncircumcised men who have HIV prove that denial of risk is not an effective strategy for avoiding HIV. Good luck with your "only idiots get HIV" view.

  5. No luck needed, R. That's your mistake.

  6. Millions of circumcised men who have HIV prove that relying on circumcision is not an effective strategy for avoiding HIV. Good luck with your "just get cut" view.

  7. Millions of circumcised men who have HIV prove that relying on circumcision is not an effective strategy for avoiding HIV. Good luck with your "just get cut" view.

    Has anyone claimed otherwise? Circumcision doesn't guarantee safety from HIV. Nor does using condoms. And, for that matter, there are plenty of men who use condoms most (or even all) of the time, and yet who have become HIV positive. Does that mean that using condoms is a waste of time? Of course not: they reduce the risk, and that reduction is valuable even though it is not absolute protection.