New York Health Department Plans To Promote Male Circumcision To Help Reduce Spread of HIV
The New York City Department of Health and Mental Hygiene plans to launch a campaign promoting male circumcision after the World Health Organization and UNAIDS last month recommended the procedure as a way to help reduce the spread of HIV, the New York Times reports (McNeil, New York Times, 4/5). UNAIDS and WHO released the recommendations in response to growing evidence that routine male circumcision could reduce a man's risk of contracting HIV through heterosexual sex. According to final data from two NIH-funded studies conducted in Uganda and Kenya published in the Feb. 23 issue of the journal Lancet, routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65% (Kaiser Daily HIV/AIDS Report, 3/29). New York's health department has begun asking community organizations and gay advocacy groups to discuss male circumcision with members and has requested that the Health and Hospitals Corporation, which runs hospitals and clinics in the city, provide circumcisions at no cost for men who lack health insurance. City Health Commissioner Thomas Frieden said he believes health insurers might agree to cover preventive circumcisions because they already cover them as treatments for infections and urinary blockage. According to Frieden, even 1,000 circumcisions performed in certain populations could curb the spread of HIV in the city. In Manhattan, 20% of black men between ages 40 and 50 are HIV-positive, the Times reports. In addition, about 10% of men who have sex with men in the city are HIV-positive, and the figure is as high as 25% in the Chelsea neighborhood, the Times reports. Black, Hispanic and foreign-born men are less likely to be circumcised that white U.S. men, and the proportion is lower among men who have lower incomes, according to the Times. In addition, a large percentage of men who seek treatment for sexually transmitted infections in New York's clinics are uncircumcised, Frieden said. The studies in Africa were conducted among heterosexual men, and men who are most at risk of contracting HIV in New York are MSM, injection drug users and their sexual partners. Frieden said circumcision likely will offer some protection to MSM only in the case of penetrative sex because penetrative anal sex and vaginal sex carry about the same HIV infection risk. He added that curbing the spread of HIV among bisexual men would protect women because some bisexual men do not reveal their sexual activity with men to their female partners.
Ana Marengo, a spokesperson for HHC, said that the group is "having conversations" with the health department but has not come to a decision. HIV/AIDS advocate Peter Staley said that although he is "intrigued" by the idea of offering male circumcisions, he is concerned that the populations in the African studies are not similar to New York's vulnerable populations. "Should we proceed when we don't have hard data yet on the population here?" Staley asked, adding, "On the other hand, if we wait the three years it would take to answer that question, how many will be infected in the meantime?" In addition, Staley said that based on postings he has read on Web sites about the studies, he is concerned about a possible backlash among black and Hispanic men against white public health officials and advocates promoting circumcision. "It's going to sound like white guys telling black and Hispanic guys to do something that would affect their manhood," he said. Tokes Osubu, executive director of Gay Men of African Descent, said that circumcision is "not the answer to our problems" and that the procedure is unlikely to curb the spread of the virus because of the discrimination and stigma that black MSM already face. Bric Bernas, manager of information and counseling for the Asian and Pacific Islander Coalition on HIV/AIDS, said his group would like to see studies conducted in the U.S. among MSM before taking a position on circumcision. The procedure is rare among Asian men who are not from Muslim countries and the Philippines, and "there might be cultural sensitivities around it," Bernas said (New York Times, 4/5).