New York Times Examines Concept of Circumcision To Reduce HIV Risk in U.S.

Even as recent clinical trials have shown that circumcision can reduce men's risk of contracting HIV and some groups have endorsed the procedure, the "difficult part [is] how to sell the idea," particularly to men in the U.S., the New York Times reports (McNeil, New York Times, 4/15). According to final data from two NIH-funded studies -- conducted in Uganda and Kenya and 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%. In response to the findings, the World Health Organization and UNAIDS in March recommended the procedure as a way to help reduce the spread of HIV (Kaiser Daily HIV/AIDS Report, 4/6). According to the Times, the data from the Africa circumcision trials "does not translate well" in the U.S., in large part because the continent and country have different HIV epidemics. In Africa, the circumcision trials were conducted among heterosexual men in countries with high HIV prevalence, little education about safe sex and resistance to condom use. In the U.S., sex education, abstinence, condom use, the availability of antiretroviral drugs and the "fear of death have concentrated [HIV] mostly in small pockets of the population," including men who have sex with men, injection drug users and women who have sex with high-risk men. For those groups, "circumcision probably won't do much good" because there are a lot of "unknowables" concerning who circumcision might protect, the Times reports. According to the Times, circumcision might help protect men who have penetrative anal sex with other men. The procedure also might protect women who have sex with circumcised men, though that was not proven in the Africa trials. Another issue is that "there hasn't been a groundswell of demand" for the procedure in the U.S., the Times reports. Until there is further research on the issue, that is not likely to change, according to the Times (New York Times, 4/15).