Male Circumcision & HIV: Still Lots More Questions
Headlines
The recent headlines about the potential role of male circumcision in stopping the HIV epidemic have been dramatic. “Circumcision ‘helps to halt HIV” (BBC, July 26, 2006); “Study Says Circumcision Reduces AIDS Risk by 70%” (Wall Street Journal, July, 2006); “AIDS Conference to Debate HIV, Circumcision Link” (NPR August 17., 2006); and most recently, “Male Circumcision is ‘Real-World Equivalent’ to AIDS Vaccine, Opinion Piece Says” (New York Times, Jan 16, 2007).
Geographic Differences
Yet few of these pronouncements have really clarified that while male circumcision may indeed play a vital role in reducing HIV transmission in the developing world, its potential to stem the relentless tide of HIV infections in the US is, at best, limited.
It is critical to understand how different the HIV epidemic in the US continues to be from the epidemic in the rest of the world. Heterosexual transmission and commercial sex worker transmission makes up a much more significant proportion of how men become infected with HIV outside of the US. Only 15% of men infected with HIV in the US report high-risk heterosexual sex as their likely route of infection. And, most men in the US are already circumcised — somewhere around 60% of newborn baby boys in the US are circumcised. The studies cited in the articles above that showed the most dramatic results in circumcision reducing HIV transmission for men were discovered where male circumcision is, to a large part, previously nonexistent. It’s possible that any protective factor male circumcision offers is already at work here in the US.
More Questions
Not enough is yet known or studied about the role of circumcision in male-to-male HIV transmission to determine if increasing circumcision among American men would make a difference. And, all the studies on circumcision continue to point to the role in reducing infection for the men themselves – no evidence is given about potential protective effects for their female partners. Given that 80% of women infected with HIV in the US cite heterosexual sex as the likely route of their infection, this is critical question that remain to date unanswered. Navigating critical differences in the HIV/AIDS epidemic across the world remains one of our greatest challenges in 2007.
