Unlocking An Immunity Mystery: Why Are HIV Rates Lower In Circumcised Men?

How men catch HIV during exposure through their penises is one of the least studied aspects of HIV transmission, but South African immunology researcher Dr Cosnet Lerato Rametse and her collaborators are looking for answers.

Rametse, who is currently a doctoral researcher at the University of Cape Town, Division of Immunology, says that her work aims to characterize the immune environment within the penis and whether these immune factors are impacted by circumcision.

According to the World Health Organization, about 38.4 million people were living with HIV at the end of 2021, which highlights why it is important to continue to delve into the disease.

Rametse is working to understand the biological mechanisms that underpin an interesting data point: according to the CDC, heterosexual male HIV risk is reduced by up to 60% in cases of voluntary medical male circumcision (VMMC).

“This is with the intention of using the findings as a stepping stone into deriving alternative HIV strategies in men,” Rametse says, explaining that the biggest challenge in the research was that men generally have “poor health-seeking behavior”, so getting them to enroll and to return for follow-up examination was difficult.

“Through this work I have ended up on multiple platforms at different levels (schools youth centers , social media platforms ) communicating science in HIV broadly,” she says.

Rural Roots

Rametse was born and raised in a rural area in a province in South Africa called Limpopo.

“Being exposed to rural and vulnerable communities in my upbringing, I have always been passionate about healthcare and disease knowledge and of course wanted to help and contribute,” she says, adding that she had childhood experiences of seeing men come back to her community from the cities with what would later become the hallmarks of HIV infection, like “the worst chest infections.”

When she finally got to medical school, Rametse says she always felt like there was not enough room to deeply explore the curriculum and to question and explore the deeper questions that scientific research is focused on.

“I realized soon into my medical degree that a lot of the work content was based largely on first-world populations derived data,” she says, “I wondered how I could position myself (career-wise) to be enabled to contribute to the understanding of healthcare and diseases in the context of our own community.”

Rametse says that the opportunity to partake in pursuing a PhD as a clinician, affords her the opportunity to acquire the skill-set needed to both translate research results into the clinical setting and to develop research questions based on clinical issues encountered in practice.

“For a long time science had a limited narrative and I believe that the more multiplied the narrative (science from all global regions), the more powerful it becomes and the more impactful it becomes because we get closer to ‘the truth’ in science,” Rametse says.

Another South African researcher working on ways to control HIV is Dr Edith Phalane.

Phalane is using big data to see which are the most effective HIV control programs in sub-Saharan Africa, with the goal of ending HIV/AIDS as an epidemic by 2030.