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Friday February 22, 2008

Scientist’s circumcision research hailed as breakthrough

by joe eskenazi
staff writer

What a difference a decade makes.

When Dr. Daniel Halperin first publicly made his case that male circumcision was a huge factor in combating the spread of HIV and AIDS, he was subjected to bitter ridicule.

“Seven years ago, I gave a talk here about this and they said, ‘Get this guy to Langley Porter,’” he said, referring to UCSF’s psychiatric hospital.

But at a late January speech at UCSF, when the Jewish Harvard researcher asked a roomful of top AIDS researchers, doctors and medical students to name the most effective method of curtailing HIV, he was greeted with a unified shout of “male circumcision!” that resembled a campfire sing-along.

The San Francisco born-and-raised scientist has been working to fight AIDS in Africa since the 1990s. In that time, his most fervent assertion — that male circumcision is the single largest factor combating the spread of the disease — has been promoted from the outhouse to the penthouse of scientific thought, largely through his efforts and those of a like-minded “cabal, a mafia of nerds obsessed with HIV epidemiology.”

Indeed, the work Halperin contributed to proving the efficacy of male circumcision was named the top scientific breakthrough of 2007 by Time magazine. The foreskin, research has shown, is the most susceptible part of the body to the HIV virus. For one thing, foreskin is teeming with Langerhans cells, which act as a magnet for the virus. For another, foreskins tend to suffer frequent micro abrasions during sex, further heightening susceptibility.

Even the U.S. government has taken notice of the findings. And it’s a good thing, quips a frustrated Halperin, because the expensive HIV-prevention strategies employed in the United States, Africa and elsewhere have barely made a dent in the epidemic.

So far, efforts have focused on condom use and abstinence. The former longtime UCSF researcher notes that when he was working in Swaziland in 2005 and ’06, condoms were dropped from helicopters, literally blanketing villages with prophylactics. But this alone has not prevented AIDS.

Halperin spoke of a “lethal cocktail” of uncircumcised males and practices prevalent in stretches of Africa in which men and women carry on open relationships with multiple sex partners. In this way, the HIV virus — which is most contagious when first contracted — hops through populations like “a hot potato,” he said. Circumcision can make a critical difference, largely because Africans in these open marriages rarely wear condoms.

In Botswana, for example, only an estimated 15 percent of men are circumcised, while 65 percent report engaging in high-risk, multiple sexual partnerships. The percentage of AIDS infection among Botswana’s adults is 25 percent. By contrast, in Ethiopia, 75 percent of men are circumcised and only 21 percent report engaging in high-risk partnerships. There, the nation’s AIDS rate is 2 percent.

It’s problematic for a doctor to tell a patient to “cut back on your risky behavior” rather than “cut out your risky behavior.” But, Halperin notes, if Africans cut back on their sexual partnerships and used condoms, it would make a huge difference.

It would make an even more potent difference if added to circumcision. Men may forget or ignore a condom, but circumcision offers permanent protection.

In a recent paper, Halperin and others postulated that male circumcision may be “as good as the HIV vaccine we’ve been waiting for.” Separate trials have shown that circumcision reduces the risk of heterosexual HIV infection by 60 percent. The minimum threshold for a future vaccine — which isn’t coming anytime soon — is 30 percent, he said.

While some anti-circumcision extremists have highlighted the Semitic monikers of Halperin and other Jewish researchers and claimed this is some sort of Jewish plot, the scientist sees it differently.

“It’s nice. It’s the one issue that brings Muslims and Jews together, right?”

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