Wawer's earlier studies of male circumcision in Uganda — like other studies in Kenya — showed unequivocally that male circumcision could reduce female-to-male transmission rates. As nearly 3 decades of dealing with HIV-AIDS as an international public health crisis has shown, simply educating people about barrier contraception and making contraception more readily and inexpensively available — both difficult endeavors in developing countries, for a variety of reasons — are simply not having the same effect in some countries on reducing HIV transmission rates that developed countries like the U.S. experienced (let alone that such efforts seem to plateau when the perception of immediate danger declines and rates go up again). It's entirely possible (and somewhat unsurprising) that education and contraception access simply don't trump human sexual urges, culture and tradition, which is why scientists think adult male circumcision programs could provide a necessary addition to the HIV-AIDS reduction arsenal.

Wawer and her team were hopeful that male circumcision could reduce male-to-female transmission rates as well, given that in many places, women don't have access to barrier contraception or the power in sexual relationships to demand its use even if their partner's HIV status is known. Unfortunately, their hypothesis was incorrect.

Wawer's team recruited 922 uncircumcised, HIV-infected, men aged 15 to 49 years. Some were immediately circumcised and some had the procedure delayed for two years.

The researchers also followed 163 wives or female sex partners of these men.

"Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed," Wawer's team wrote.

"Condom use after male circumcision is essential for HIV prevention."

Wawer and her colleagues do point to one positive benefit of a widescale adult male circumcision program, though.

"However, the efficacy of male circumcision for prevention of HIV in uninfected men is clear, and reductions in male acquisition of HIV attributable to circumcision are likely to reduce women's exposure to HIV-infected men. Male circumcision programs are thus likely to confer an overall benefit to women," the researchers concluded.

Unfortunately, this is one of at least 3 promising studies conducted in Africa over the last decade — the other two being with carageenan and nonoxynol-9 — that attempted to find a method for women to protect themselves against HIV transmission when they couldn't implement ongoing, external protection themselves. Luckily, scientists plan to keep trying.

Circumcision Helps Protect Men, Not Women From AIDS [Reuters]

Related: Male Circumcision For HIV Prevention In Men In Rakai, Uganda: A Randomised Trial. [NIH]
Male Circumcision For HIV Prevention In Young Men In Kisumu, Kenya: A Randomised Controlled Trial. [NIH]
HIV Transmission Rates in the United States [CDC]
HIV Transmission Rate Declines in United States, Study Finds [Johns Hopkins]
Experimental Microbicide Carraguard Does Not Provide Protection Against HIV, Study Finds [Kaiser Network]
Nonoxynol-9 For Preventing Vaginal Acquisition Of HIV Infection By Women From Men [WHO]

First off, John McCain supports the so-called Mexico City Policy, also known as the "global gag rule", which prevents international organizations that talk about or perform abortions from receiving family planning or population funds from the U.S. government. Although the Bush Administration was initially going to extend its global gag rule to its HIV/AIDS program (PEPFAR) in 2003, it eventually relented in the face of fierce public opposition. Despite the fact that PEPFAR funds may go to groups which also provide abortion services, the evidence shows that the gag rule as applied to family planning organizations in Africa, has had significantly detrimental effects on women's access to HIV/AIDS prevention and treatment. It also doesn't help matters that a significant portion of the money in the President's HIV/AIDS program goes towards treatment, not prevention, and what prevention money is available is heavily weight in favor of — you guessed it — abstinence-only education.

When asked last year about funding contraception programs to stop the spread of HIV/AIDS in Africa, McCain hemmed, hawed, admitted he didn't "know" his position on the issue and finally admitted that he deferred to Senator Tom Coburn of Oklahoma on such issues. Oh, you mean the Tom Coburn who is fighting to tell everyone how "ineffective" condoms are to promote his abstinence-only-for-life agenda? The one who calls "the 'safe' sex myth" a "lie", even when all research shows that proper condom usage can help stem the transmission of disease? The one who led a Senate fight to hold up funding the President's HIV/AIDS program this year because it was expensive and didn't focus enough on treatment instead of prevention — after the Democrats coincidentally adjusted the formula to give more money to non-abstinence prevention program? That Tom Coburn? Now I feel totally better about what McCain will do when it comes to HIV/AIDS prevention programs here and abroad.

Study Pushes Back Origins of AIDS Pandemic [Reuters]
Philadelphia Inquirer: McCain Is A Good Friend To The Unborn [McCain-Palin]
USAID's Family Planning Guiding Principles and U.S. Legislative and Policy Requirements [USAID]
Bush Administration "Breaks the Promise" by Expanding Global Gag Rule to HIV Funding On Eve of World AIDS Day [Africa Focus]
The "Mexico City Policy" And Its Effects On HIV/AIDS Services in Sub-Saharan Africa [Boston College]
How Bush's AIDS Program is Failing Africans [The American Prospect]
McCain Stumbles on H.I.V. Prevention [NY Times]
Bush's Abstinence Man [The Advocate]
Public Health Advocates Say Campaign to Disparage Condoms Threatens STD Prevention Efforts [The Guttmacher Institute]
Coburn Places A Hold On HIV/AIDS Prevention Bill [Think Progress]