CDC May Recommend Infant Circumcisions to Combat HIV

The Centers for Disease Control and Prevention (CDC) is weighing a recommendation that all newborn males be circumcised in an effort to curb HIV infections.

An Aug. 23 article at The New York Times noted that the CDC's recommendation is expected to be released in draft form by year's end, but that the issue of circumcision as a means to help prevent HIV transmission has already proved controversial--in part because of the varying results indicated by different studies.

Research indicates that circumcised men are less likely to be infected with HIV as a consequence of sex with HIV+ female partners. But men who sex with men (MSMs) have not been shown to have different rates of infection depending on whether or not they are circumcised, the article said.

An Oct. 8, 2008 Associated Press article also reported that no protective result had been found for circumcision among MSMs.

Because the recommendation would involve subjecting newborns to circumcision, opponents charge that it's tantamount to imposing a surgical procedure.

Despite objections, and despite a lack of evidence pointing to a comprehensive reduction in HIV transmission, some health authorities see circumcision as necessary in the fight against HIV and the disease that the virus leads to, AIDS.

The article quoted the CDC's Dr. Peter Kilmarx, in charge of epidemiology for the CDC's HIV/AIDS prevention department, who defended the recommendation, saying, "We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic.

"What we've heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks," added Dr. Kilmarx.

But the benefits in the United States might not be as dramatic as those observed in African countries where research into the issue has taken place.

The New York Times noted that the incidence of HIV transmission to heterosexual circumcised men in several African nations--Kenya, South Africa, and Uganda--was reduced by up to 60%, compared to uncircumcised men.

In Africa, the spread of HIV is much more prevalent in the heterosexual population.

Critics note that because circumcision has not been shown to reduce HIV transmission between MSMs in the United States, the recommendation may not be of any practical value. Moreover, the article said, more than three-quarters of American men are circumcised.

However, in a few decades, that proportion will shift, because circumcision for newborns is not as prevalent as it once was. Moreover, the article said, more Hispanics and African Americans are choosing not to have their make babies circumcised; those populations are harder hit by HIV and AIDS than are Caucasians.

The article noted that the trend may be about to reverse regardless of whether circumcision helps prevent HIV transmission: circumcision can also help prevent other health issues, the article cited American Academy of Pediatrics consultant Dr. Michael Brady as noting.

"We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are," the article quoted Dr. Brady as saying.

Moreover, there are indications that circumcised men may have lower rates of other diseases as well, such as syphilis and herpes, the article said.

Another study found that syphilis rates were not affected by circumcision, but that transmission of human papillomavirus (HPV), which can cause cervical cancer in women, was less likely to be passed on to a female sex partner by a circumcised man than by an uncircumcised man, a March 26 AP story reported.

That article noted that only about 30% of the world's male population is circumcised.

When it comes to circumcision and HIV, however, "Our biggest struggle is trying to figure out how to understand the true value for Americans," Dr. Brady said.

An anti-circumcision group, Intact America, is taking its message to Atlanta, where the CDC's National H.I.V. Prevention Conference convenes this week. The article said that Intact America has arranged for mobile billboards to circulate around the city with ads that say HIV rates will not be lowered through the circumcision of infants.

The head of Intact America, Georganne Chapin, was quoted in the article as noting that even heterosexual men gain some benefit in terms of HIV risk, circumcision in itself does not constitute safer sex.

Said Chapin, "Men still need to use condoms."

The article noted that the studies were ambiguous about whether sex with circumcised men was safer for women.

Though experts may be uncertain as yet how much good circumcision would actually do for Americans, in Botswana a program to circumcise up to half a million men by 2012 is already underway, according to a May 30 Associated Press article.