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[MollyBloom]

http://www.nytimes.com/2009/08/24/health/policy/24circumcision.html?_r=1&hp

Officials Weigh Circumcision to Fight H.I.V. Risk


By RONI CARYN RABIN
Published: August 23, 2009

Public health officials are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., 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 H.I.V. 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.

But Dr. Peter Kilmarx, chief of epidemiology for the division of H.I.V./AIDS prevention at the C.D.C., said that any step that could thwart the spread of H.I.V. must be given serious consideration.

�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,� Dr. Kilmarx said. �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.�

He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, because it spreads through different routes and because the health systems are so disparate as to be incomparable.

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 H.I.V. over the course of the trials than those who were not circumcised.

There is little to no evidence that circumcision protects men who have sex with men from infection.

Another reason circumcision would have less of an impact in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.

But newborn circumcision rates have dropped in recent decades, to about 65 percent of newborns in 1999 from a high of about 80 percent after World War II, according to C.D.C. figures. And blacks and Hispanics, who have been affected disproportionately by AIDS, are less likely than whites to circumcise their baby boys, according to the agency.

Circumcision rates have fallen in part because the American Academy of Pediatrics, which sets the guidelines for infant care, does not endorse routine circumcision. Its policy says that circumcision is �not essential to the child�s current well-being,� and as a result, many state Medicaid programs do not cover the operation.

The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics.

He said the academy would probably stop short of recommending routine surgery, however. �We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,� he said. But, he said, the value of circumcision for H.I.V. protection in the United States is difficult to assess, adding, �Our biggest struggle is trying to figure out how to understand the true value for Americans.�

Circumcision will be discussed this week at the C.D.C.�s National H.I.V. Prevention Conference in Atlanta, which will be attended by thousands of health professionals and H.I.V. service providers.

Among the speakers is a physician from Operation Abraham, an organization based in Israel and named after the biblical figure who was circumcised at an advanced age, according to the book of Genesis. The group trains doctors in Africa to perform circumcisions on adult men to reduce the spread of H.I.V.

Members of Intact America, a group that opposes newborn circumcision, have rented mobile billboards that will drive around Atlanta carrying their message that �circumcising babies doesn�t prevent H.I.V.,� said Georganne Chapin, who leads the organization.

Although the group�s members oppose circumcision on broad philosophical and medical grounds, Ms. Chapin argued that the studies in Africa found only that circumcision reduces H.I.V. 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 H.I.V., 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 H.I.V. 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 H.I.V. and can be an entry portal for the virus. Observational studies have found that uncircumcised men have higher rates of other sexually transmitted diseases like herpes and syphilis, and a recent study in Baltimore found that heterosexual men were less likely to have become infected with H.I.V. from infected partners if they were circumcised.

[Kuros]

Opposed.

I'd be interested to see Big Bird's opinion on this. Genuinely, of course.

[cwflaneur]

Mandatory? Right. Not a chance.

Others want it banned:
http://mgmbill.org/

Sadly, they won't win either, will they.

[Hater Depot]

Very misleading thread title.

[bacasper]

What a bunch of hogwash!

Now the justification for circumcision is the prevention of AIDS. Odd how they were promoting it even before AIDS existed. In fact, the history of circumcision is just a trail of justifications du jour.

In the early 19th Century, it was done to prevent wet dreams. Next, the pretext was to stop masturbation, then it was to prevent syphilis, cure epilepsy, spinal paralysis, bedwetting, clubfoot, curvature of the spine, eye problems, and more.

In 1888, John Harvey Kellogg promoted circumcision to prevent boys from masturbating, as his corn flakes allegedly did.

And circumcising blacks would stop them from raping white women.

Around the turn of the 20th Century, some doctors promoted it for permanent desensitization of the penis which IS true.

It would cure epilepsy, TB, and cancer (even of the tongue and cervical cancer in women!), in fact, nearly all physical and mental illness.

[Moldy Rutabaga]

But allow me to make the old joke: I asked my wife if she thought I should get circumcised. She said it was a big flap over nothing.

Ken:>

[Pluto]

[caniff]

One of my good friends is nicknamed "Foreskin" because it is believed he is akin to the worthless flap of skin on the end of a pecker (his laziness knows no bounds).

In light of all the evidence bacasper and others have provided on this forum, we may now have to reconsider whether or not his handle is actually suitable.

[bacasper]

[RufusW]

[Fox]

After reading bacasper's last post, I feel incredibly sick to my stomache. What's worse, someone at my school was just talking to Korean Center for Disease Control about the H1N1 flu virus as I was reading the post, so when she saw my reaction she freaked out.

You, sir, are a terrorist. If I get stuck in quarantine or something because if your post, it's going to be fisticuffs between us.

Regarding circumcision preventing AIDS: in any situation circumcision might prevent HIV infection, the individual in question could prevent it just as easily while uncircumcised by simply being more careful about their sexual partners.

Contracting AIDS through intentional sexual contact or needle sharing is utterly avoidable.

[RufusW]

[Fox]

[RufusW]

Well you could certainly rid the world of Aids if everyone got screened for it and everyone decided not to sleep with an infected person.... but that's a while off..

[bacasper]