Growing evidence has linked circumcision with some protection against HIV infection, Dr. Kawango E. Agot of Moi University in Kenya and colleagues note in the medical journal Epidemiology. "Some have recommended male circumcision as one possible strategy to control the rapid spread of HIV in Africa."

However, cultural and religious differences between circumcised and uncircumcised men have made it difficult to be sure that circumcision itself reduces the risk of HIV transmission, Agot's group notes.

To investigate further, the researchers studied 845 men from the Luo ethnic community, a population with a high prevalence of HIV. Many members of this community are Christians from African-instituted churches, and although circumcision practices differ among denominations, other risk factors "might be expected to be rather similar," the researchers point out,

Overall, 398 of the men were circumcised and the remaining 447 were not. The proportion infected with HIV was 30 percent in the uncircumcised group and 20 percent in the circumcised group.

In an accompanying editorial, Dr. Eduardo L. Franco of McGill University in Montreal comments that this observational study certainly does not end debate on the matter.

However, he praises the investigators' ingenuity and notes that "the quality of the science informing that debate has just moved up a notch."

SOURCE: Epidemiology, March 2004.

WASHINGTON (Reuters) - Americans may say they know a lot about sexually transmitted diseases but they do not practice what they preach when it comes to defending against them, according to a survey published on Tuesday.

While one in four Americans will be infected with an STD -- and up to half of younger adults will be -- most of those surveyed believed they were not personally at risk.

This is precisely why STDs spread so easily and so pervasively in society, said the American Social Health Association, which published the survey.

"The findings in our survey are quite disturbing. Despite the fact that STDs are extremely widespread and have severe consequences, it is troubling that there is such a large portion of people who still feel invincible," said Dr. James Allen, president and chief executive officer of the ASHA.

"In addition, people's lack of awareness about the various STDs only underscores the need for continued education to prevent the spread of these serious diseases," Allen added in a statement.

STDs cause a range of long-term problems. Human wart virus or HPV is the main cause of cervical cancer, while bacterial infections such as gonorrhea or chlamydia can cause infertility in women.

They often have no symptoms and people are often unaware they are infected.

The non-profit group, which promotes awareness about sexually transmitted diseases, published a poll of 1,155 adults aged 18 to 35 interviewed by Harris Interactive. It had a margin of error of plus or minus three points.

Despite not knowing whether their partner had been tested, 93 percent said they were sure their partner did not have an STD, the survey found.

Just over one-third of those surveyed felt "very knowledgeable" about STDs, compared to 22 percent who felt they knew a lot about diabetes, asthma or migraines.

FEELING INVINCIBLE

Sixty-three percent said they were well-informed about the risks associated with sex and 84 percent said they felt they took the right precautions.

But 82 percent of those who said they were sexually active said they never used protection against STDs for oral sex, 64 percent never used protection for anal sex and 47 percent never used protection for vaginal sex.

Even among single adults, 71 percent used no protection when having oral sex, 42 percent never protected against an STD when having anal sex and 23 percent always had unprotected vaginal sex.

STDs including the AIDS virus, gonorrhea, syphilis and chlamydia are transmitted orally, anally and vaginally. In the United States, heterosexual contact is the primary means by which HIV is transmitted now.

The survey also found Americans ignorant of the risks of hepatitis A, B and C, all of which can be transmitted sexually. he group said hepatitis A and B cause more than 170,000 infections each year in the United States alone, killing 5,000 people a year.

"One in every four Americans will contract an STD sometime in their lifetime," the group said.

In February, Advocates for Youth -- a nonprofit group advocating sex education -- and the sexual health-oriented Alan Guttmacher Institute published a report that said 27 million young Americans under the age of 25 were sexually active.

The Centers for Disease Control and Prevention says there were 18.9 million new cases of STDs in 2000, of which 9.1 million or 48 percent were among teens and adults aged 15 to 24. That means one-third of all sexually active young adults and teens contracted an STD in 2000 alone.

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