September 6, 2009

Circumcision to fight HIV

Public health officials are considering promoting routine circumcision (surgical removal of the foreskin of the penis) for all baby boys born in the United States to reduce the spread of HIV, the virus that causes AIDS.

The topic is a delicate one that has already generated controversy, even though a formal draft of the proposed recommendations, due out from the Centers for Disease Control and Prevention by the end of the year, has yet to be released.

Experts are also considering whether the surgery should be offered to adult heterosexual men whose sexual practices put them at high risk of infection. But they acknowledge that a circumcision drive in the United States would be unlikely to have a drastic impact: the procedure does not seem to protect those at greatest risk here, men who have sex with men.

Recently, studies showed that in African countries hit hard by AIDS, men who were circumcised reduced their infection risk by half. But the clinical trials in Africa focused on heterosexual men who are at risk of getting HIV from infected female partners.

For now, the focus of public health officials in this country appears to be on making recommendations for newborns, a prevention strategy that would only pay off many years from now. Critics say it subjects baby boys to medically unnecessary surgery without their consent.

Clinical trials in Kenya, South Africa and Uganda found that heterosexual men who were circumcised were up to 60 percent less likely to become infected with HIV over the course of the trials than those who were not circumcised.

Members of Intact America oppose circumcision on broad philosophical and medical grounds, Ms. Chapin argued that the studies in Africa found only that circumcision reduces HIV infection risk, not that it prevents infection. “Men still need to use condoms,” Ms. Chapin said.

In fact, while the clinical trials in Africa found that circumcision reduced the risk of a man’s acquiring HIV, it was not clear whether it would reduce the risk to women from an infected man, several experts said.

“There’s mixed data on that,” Dr. Kilmarx said. But, he said, “If we have a partially successful intervention for men, it will ultimately lower the prevalence of HIV in the population, and ultimately lower the risk to women.”

Circumcision is believed to protect men from infection with H.I.V. because the mucosal tissue of the foreskin is more susceptible to HIV and can be an entry portal for the virus. Observational studies have found that uncircumcised men have higher rates of other sexually transmitted infections like herpes and syphilis, and a recent study in Baltimore found that heterosexual men were less likely to have become infected with HIV from infected partners if they were circumcised.

source: The New York Times

picture by S H HO urology and laparoscopy center


Mark Lyndon said...

In Europe, almost no-one circumcises unless they're Muslim or Jewish, and they have significantly lower rates of almost all STI's including HIV.

Even in Africa, there are six countries where men are more likely to be HIV+ if they've been circumcised: Rwanda, Cameroon, Ghana, Lesotho, Malawi, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Cameroon, the HIV rate is 4.1% among circumcised men, but only 1.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost lives, not save them.

PINK Armenia said...

agree, circumcision may reduces HIV infection risk, not that it prevents infection.

Hugh7 said...

"a recent study in Baltimore found that heterosexual men were less likely to have become infected with HIV from infected partners if they were circumcised."

This is wrong, and not surprisingly, it is wrong in a way that promotes circumcision.

The Baltimore study of 26,400 men showed no significant difference in the vast majority, only in a little subset of 385 men "at known risk", of whom only 50 were not circumcised, and of whom only 11 were infected. That's not a statistical landslide.

" was not clear whether [circumcision] would reduce the risk to women from an infected man..." The trial in Uganda was VERY clear that circumcision would NOT reduce the risk to women; what was not clear (because they cut the trial short) was whether it would increase the risk. In fact 18% of the women of circumcised partners were infected, compared to only 12% of the partners of non-circumcised men, but the numbers were too small to say it was not the result of chance.

We are being subjected to a sustained campaign to promote circumcision, and those promoting it are, to say the least, careless with their facts.