The New York Times has an article today on the possibility the CDC
might recommend routine male circumcision in the US to prevent HIV
infection. Both sides in this argument fail to make their case.
Male circumcision is an effective prevention method- in areas with high seropravelence (lots of people with HIV) and high rates of heterosexual sex transmission. Data of this began emerging around a decade ago, and eventually randomized trials showed it to be effective.
So, if it has been show to work, why not do it here? Because there is little reason to think it would work.
To begin with, the US is not a high seroprevalence country. Nor do we have high rate of heterosexual sex transmission. And around 70% of boys already are circumcised.
The studies on male circumcision have looked exclusively at its effect on heterosexual transmission in areas of high seroprevalence. Extrapolating their findings to the US doesn't make much sense.
The opponents of circumcision don't manage to make much of a case themselves. They have rented mobile billboards to cruise around Atlanta during the ongoing HIV Prevention conference, simply saying- Circumcising Babies Doesn't Stop H.I.V." A spokes-person is quoted as saying that the studies done in Africa only found that circumcision reduced HIV infection risk, and that 'Men still need to use condoms.'
Sigh.
No prevention method is perfect- none works all the time. That is, simply put, irrelevant.
I honestly don't know where this debate will go. The prevention world is riddled with flimsy science and even flimsier extrapolation from that science. I am in favor of increased exploration of novel HIV prevention modalities, particularly biomedical ones. I think we have long since hit a wall on our behavioral interventions (not that they should be abandoned, but we are past the point of diminishing returns). As with questions of treatment, these examinaitons should be driven by good, solid science.If this is any indication- I am not hopeful.
Male circumcision is an effective prevention method- in areas with high seropravelence (lots of people with HIV) and high rates of heterosexual sex transmission. Data of this began emerging around a decade ago, and eventually randomized trials showed it to be effective.
So, if it has been show to work, why not do it here? Because there is little reason to think it would work.
To begin with, the US is not a high seroprevalence country. Nor do we have high rate of heterosexual sex transmission. And around 70% of boys already are circumcised.
The studies on male circumcision have looked exclusively at its effect on heterosexual transmission in areas of high seroprevalence. Extrapolating their findings to the US doesn't make much sense.
The opponents of circumcision don't manage to make much of a case themselves. They have rented mobile billboards to cruise around Atlanta during the ongoing HIV Prevention conference, simply saying- Circumcising Babies Doesn't Stop H.I.V." A spokes-person is quoted as saying that the studies done in Africa only found that circumcision reduced HIV infection risk, and that 'Men still need to use condoms.'
Sigh.
No prevention method is perfect- none works all the time. That is, simply put, irrelevant.
I honestly don't know where this debate will go. The prevention world is riddled with flimsy science and even flimsier extrapolation from that science. I am in favor of increased exploration of novel HIV prevention modalities, particularly biomedical ones. I think we have long since hit a wall on our behavioral interventions (not that they should be abandoned, but we are past the point of diminishing returns). As with questions of treatment, these examinaitons should be driven by good, solid science.If this is any indication- I am not hopeful.
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