- Ronald H Gray: Johns Hopkins University, Bloomberg School of Public Health, E4132, 615 North Wolfe Street, Baltimore, MD 21215, USA. rgray@jhsph.edu
Three randomized trials in Africa have shown that adult male circumcision reduces HIV acquisition in men by approximately 60%. It is biologically plausible that circumcision reduces HIV risk in men because the inner mucosa of the foreskin is lightly keratinized and has a high density of dendritic cells and other HIV target cells, making it vulnerable to HIV infection. Also, the foreskin is retracted over the shaft during intercourse, exposing the inner mucosa to vaginal secretions; the prepuce is vulnerable to trauma during coitus, providing a portal for HIV entry. In addition, circumcision reduces the rate of reported genital ulceration, which is a cofactor for HIV acquisition. Male circumcision may also reduce some other sexually transmitted infections in men and their female partners. For these reasons, male circumcision should be promoted as a component of HIV prevention strategies.