CDC Considers “Universal Circumcision” to Fight HIV Cases

This week at the CDC’s National HIV Prevention Conference in Atlanta, the government agency will discuss whether to recommend routine circumcision for all baby boys to protect them from the disease.

Research is split on whether routinely cutting boys at birth will protect them from sexually transmitted diseases, including AIDs and HIV. Most research points to a decrease in diseases only in high-risk populations where such diseases are prevalent.

One of the groups lobbying against such a blanket recommendation is Intact America, a newly-formed group in the U.S. with the aim of lowering the circumcision rate.

But those who state simply that “circumcision prevents STDs” may need to get their facts straight.

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In a recent comprehensive study, circumcision indeed appeared to lower the risk for those repeatedly exposed to HIV.

Possible induced mucosal immunity following repeated subinfectious HIV antigen stimulation of urethral mucosa

The same research also points out that such research can be difficult to control for, because circumcision can be tied to religion, or are often “highly selected”.

Religion (Islam, Judaism):

• May be correlated with lower risk behaviors, less alcohol use, genital hygiene, etc.
• Mainly neonatal

Traditional / tribal

• Behavioral differences
• Younger age (puberty rituals)

Medical indications (phimosis, GUD)

• correlated with higher risk behaviors

In other words, we can’t force the social structure under which babies and men are circumcised, and other factors may play as large a part in exposure to STDs as their behavior. Also, a study cited in this research suggests that it is the number of sex workers in a population that better determines the number of males infected with HIV.

And lets focus on that: males. Male circumcision does not lower the risk to women. While that may not factor into your family’s decision, let’s look at it from a community perspective, which is how the CDC should view it.

A Ugandan study performed by Johns Hopkins School of Public Health found that circumcised men were a bit more likely to transmit HIV to their partners. This study involved 922 HIV-infected men randomly chosen to be circumcised. Researchers provided the couples with HIV information and condoms. The partners in this study were previously free of HIV.

After two years, 18 percent of the women in the circumcised group had become infected with HIV, compared with 12 percent in the uncircumcised group. Cumulative probability of HIV infection at 24 months was 22 percent among women in the circumcised group and 13 percent among those in the uncircumcised group.

Overall, these are studies–including those the CDC is aware of and cites–that play to both sides of the debate. Only one study that the CDC cites claims that the HIV risk is lower for circumcised men. The CDC points out that all the studies are performed in Africa, most in high-risk populations.

Currently, they are operating under the theory that the foreskin holds and breeds diseases. And this is only for female to male infection. HIV rates for homosexuals is not decreased dependent on circumcision.

For its part, the American Academy of Pediatrics (AAP) says that although there may be “potential” medical benefits,

data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child.

So let me ask: Is it in the “best interest” of your son to remove his foreskin, a part of his body?

And if these studies are as of yet “inconclusive,” might we hold off on the recommendation that all boys be snipped at birth?

Image: Ted Drake on Flickr under a Creative Commons License.

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