It has long been noted that circumcised men appear to be less likely to become infected with HIV, but whether there's a benefit to actively circumcising adults for this purpose has been an open question.

Now, investigators in France and South Africa report that circumcising men does afford them some protection against HIV.

Dr. Bertran Auvert, from Hopital Ambroise-Pare in Boulogne, France, and colleagues conducted a clinical study to test this prevention strategy. They randomly assigned 1,546 uncircumcised, HIV-negative men ages 18 to 24 years residing in South Africa to be circumcised and 1,582 to a wait "control" group.

Those who underwent circumcision were instructed to abstain from sex for 6 weeks after the procedure.

During 21 months of follow-up, 20 cases of HIV infection occurred in the circumcision group and 49 in the control group, the team reports in the medical journal PLoS Medicine

The researchers suggest several possible ways that circumcision may protect to some extent against HIV infection: "keratinization of the glans when not protected by the foreskin, short drying after sexual contact, reducing the life expectancy of HIV on the penis after sexual contact with an HIV-positive partner, reduction of the total surface of the skin of the penis, and reduction of target cells, which are numerous on the foreskin."

Auvert's group recommends male circumcision for reducing the risk of HIV infection in areas where the disease is rampant. However, they also caution men not to think circumcision gives them total protection. "If perceived as full protection, it could lead to reduction of protection of men who, for example, decrease their condom use or otherwise engage in riskier behavior."

SOURCE: PLoS Medicine, November 2005.

HIV prevention programs that involve more of a teenager's everyday world may have a particularly strong influence over behavior down the road, researchers have found.

Their study, of 12- to 17-year-olds living in low-income housing developments, found that a "community-level" HIV prevention program was especially effective at keeping kids from having sex, as well as encouraging condom use among those who did.

The program included two workshops on HIV prevention held in the housing development, for both teenagers and parents, followed by ongoing projects meant to reinforce the prevention message.

Eighteen months after the study's start, teenagers in the program were more likely than those who received other forms of HIV education to still be virgins, or to have used a condom the last time they had sex.

Dr. Kathleen J. Sikkema and her colleagues reported the findings in a recent issue of the medical journal AIDS.

The point of involving teenagers' communities was to "empower" kids and create an environment that would encourage them to avoid risky behavior, according to Sikkema, an associate professor at the Yale University School of Public Health in New Haven, Connecticut.

The age at which kids start having sex is related to a number of health and social concerns -- including unwanted teen pregnancy and the risk of sexually transmitted diseases other than HIV, according to Sikkema. So, she told Reuters Health, community-based programs aimed at HIV could have additional benefits.

The study included teenagers at 15 housing developments in five U.S. cities. Some developments served as the "control" group, with residents being invited to a standard HIV education meeting. Another group was offered two workshops on cutting HIV risk through abstinence or condom use.

A third group received the community-level program. After attending the workshops, teenagers in this group nominated peers who then helped coordinate ongoing projects in the housing development -- including community activities and "small media" projects, like newsletters that reinforced the HIV prevention message.

Eighteen months into the study, teenagers in the community program were more likely to have remained abstinent or to use condoms than those in the control group. Teens in both groups that attended the workshops reported higher condom use than their peers in the control group -- about 77 percent in each workshop group, versus 62 percent in the control group.

The findings, Sikkema and her colleagues conclude, point to the value of extending HIV prevention efforts over time, as well as involving teenagers' larger social environment.

This may take more time and resources, Sikkema said, but it could also offer a "broader benefit."

SOURCE: AIDS, September 23, 2005.

An initiative to expand testing and treatment of HIV-infected workers in mid-sized companies in South Africa was launched on Friday, to help fight a disease affecting one in nine people in the country.

Big companies, which run successful in-house HIV/AIDS testing and treatment facilities and pay for their workers' life-prolonging drugs, have teamed up with the World Economic Forum (WEF) to try to offer similar care to smaller businesses.

The smaller firms, which supply them with various services and products, have been found to have little if any formal ways of coping with AIDS, yet they employ the bulk of workers in Africa's biggest economy, officials said.

South African unit of carmaker Volkswagen, Unilever and state power utility Eskom are among the companies working with WEF's Global Health Initiative to try to expand HIV/AIDS care to their suppliers.

"Without our suppliers, we simply wouldn't be able to function," said Penny Mkalipe, Eskom's Health & Wellness head.

The project, which will see the big companies finance AIDS testing, counseling, awareness campaigns and treatment of infected workers in the smaller businesses, would be assessed in early 2006 to determine its impact, said Francesca Boldrini, Director of the WEF's Global Health Initiative.

Small and medium-sized firms provide more than 55 percent of all South African jobs, the African Development Bank has said.

The country struggles with the world's biggest caseload of HIV/AIDS in the world with about 6.5 million out of a population of around 47 million people infected.

Only half of small business owners in the country had a formal strategy to tackle AIDS, and over a third of those had no one to oversee the policy, the Grant Thornton 2005 Business Owners Survey issued in April showed.

Researchers in Africa have started what they describe as the largest trials ever held of a vaginal gel that could help women protect themselves against HIV in countries where men are notoriously reluctant to use condoms.

About 10,000 women in South Africa, Uganda, Tanzania and Zambia. are expected to take part in the trial of PRO 2000, which could provide a physical barrier that prevents HIV from reaching target cells during sexual intercourse. It is one of a number of microbicide products in various stages of clinical development around the world. The first nine volunteers were enrolled in Johannesburg this week, said Sibongile Walaza of the University of Witwatersrand Reproductive Health Research Unit.

HIV infection is rising more rapidly among women than men in many parts of the world. Half of all adults living with the virus that causes AIDS are female, according to U.N. figures.

In sub-Saharan Africa, home to more than 25 million of the nearly 40 million people infected globally, the figure is nearly 60 percent, with most new infections acquired through heterosexual intercourse. Yet strong taboos exist on the continent against the use of condoms.

"If there is any other mechanism for women to protect themselves using their own power, then that is absolutely critical," Health Minister Manto Tshabalala-Msimang said at a news briefing Thursday.

Other microbicides under development enhance the natural vaginal defense mechanisms by maintaining an acidic pH, kill pathogens by stripping them of their outer covering, or prevent replication of the virus after it has entered the cell.

PRO 2000 has already been tested on small numbers of women to rule out serious side effects. Clinical trials funded by the British government and coordinated by the Clinical Trials Unit of the British Medical Research Council will take place over three to four years in South Africa, Uganda, Tanzania and Zambia.

Researchers hope to enroll 50 new HIV-free participants a month and ensure that all receive proper counseling and clinical monitoring.

The women will be assigned at random to receive a placebo or the microbicide. They will be asked to use it for one year but can drop out at any time if they are unhappy, Walaza said.

The volunteers will all be counseled to continue using a condom during intercourse, she added. But past experience has shown this advice is frequently ignored, so the trial has been designed to determine whether the gel offers additional protection.

UNAIDS welcomed the microbicide trials, which officials said offer some of the best hope of curbing the deadly pandemic in the absence of a vaccine.

The London School of Hygiene and Tropical Medicine has calculated that a microbicide that is 60 percent effective against HIV and used by only 20 percent of women in 73 developing countries over three years could prevent 2.5 million infections.

"We are very much in favor of this research going forward and it is good to test the product in a real world setting where it is likely to have most application," said UNAIDS' chief scientific adviser, Catherine Hankins.

Researchers hope the first generation of microbicides with 50 percent to 60 percent effectiveness will be available over the counter in five years. By 2012, second generation microbicides that are between 70 percent to 90 percent effective could be on the market, the University of Witwatersrand Reproductive Health Unit said.

Male condoms, if used correctly, can reduce the risk of HIV infection to less than 1 percent.