Circumcision Could Prevent Millions of HIV Infections

WESTPORT, January 10, 2001 (from Reuters Health) - Because uncircumcised men have an increased risk of HIV infection, this procedure should be added to the armamentarium of AIDS prevention, according to an article in the "Viewpoint" section of the November 20th issue of The Lancet.

The authors believe that the evidence linking male circumcision with regional discrepancies in the rates of HIV infection is now "compelling." Ten years ago, Cameron et al. reported that uncircumcised men have greater than 8-times the risk of HIV-infection, Drs. Daniel T. Halperin of the University of California in San Francisco and Robert C. Bailey of the University of Illinois at Chicago point out. Since then, the results of other studies have confirmed this association.

"However, the association between lack of male circumcision and HIV transmission has met with fierce resistance, cautious skepticism, or, more typically, utter silence," they write. Health professionals may be reluctant to make male circumcision a part of their HIV/AIDS prevention strategy because of "...deeply held cultural values and religious beliefs."

"By avoiding this issue altogether, medical professionals and public health authorities may inadvertently be harming the very individuals whom they are trying to help."

Drs. Halperin and Bailey believe that it is time to take several courses of action. Communities should be provided with information that allows for informed decisions about circumcision. Training and resources also need to be provided to make circumcision safe.

It is also time, according to the authors, to investigate the feasibility of introducing male circumcision to communities with a high HIV seroprevalence that do not traditionally participate in this practice.

The authors caution that it must be made clear that while circumcision can reduce the risk, it does not provide full protection against HIV infection. In addition, findings from one study cited by the clinicians suggested that circumcision performed after the age of 20 years did not reduce the risk of HIV transmission.
"Circumcision could have a huge impact on the HIV pandemic in many developing countries," Dr. Baily commented in a University of California San Francisco press release. "The number of infections probably caused by lack of male circumcision already reaches into the millions," Dr. Halperin added. "We would expect the international health community to at least consider some form of action, but male circumcision remains largely unexplored as a tool against AIDS."

SOURCE: Lancet 1999;354:1813-1815 -Westport Newsroom 203 319 2700