Los Angeles Times Examines Male Circumcision in the U.S.
The Los Angeles Times on Monday examined male circumcision in the U.S. and factors that some parents consider when deciding whether to have their infant boys circumcised, including a reduced risk of HIV. According to the Agency for Healthcare Research and Quality, 56% of infant boys in the U.S. were circumcised in 2005, compared with 85% in 1965. Worldwide, about 25% of men are circumcised, the Times reports.
Some experts say factors influencing the decline in male circumcision in the U.S. include immigration from Latin America and other countries where the procedure is less common, as well as declining insurance coverage and a tendency for parents to opt for decreased medical interventions. Doug Diekema, chair of the academic committee on bioethics at Seattle Children's Hospital, said, "The fact that circumcision is an even split these days is not a bad thing." He added, "If there are not religious beliefs, then parents really are left with the primary question of whether circumcision offers another benefit. The data are not compelling in either direction." According to Diekema, "The social pressure parents faced before to circumcise their sons was not the best reason to do it."
According to the Times, although the American Academy of Pediatrics and the American Urological Association "offer little guidance" in terms of the advantages and disadvantages of the procedure, both associations and CDC are re-evaluating their positions in light of data from recent studies conducted in Africa that found routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex. Peter Kilmarx, chief of epidemiology at CDC's Division of Sexually Transmitted Diseases Prevention, said the agency is looking at how the findings apply. "The early opinion from the consultants ... is that, given all the previous data on circumcision plus the recent HIV African studies, the medical benefits of male infant circumcision outweigh the risks and that any financial burden barring parents from making this decision should be lifted."
Some physicians say that findings from the African studies cannot be applied in the U.S., the Times reports. Andrew Freedman, a pediatric urologist at Cedars-Sinai Medical Center, said, "The HIV data is the most compelling to date that circumcision can help prevent the transmission of the virus in male-female sex." He added, "While this is important to sub-Saharan Africa, the question is how many infant boys need to be circumcised in the United States to prevent one case of HIV transmission 25 years from now?" Freedman said that "[f]actoring in even the rare complication that can occur with circumcision may render this study insignificant." Freedman and Diekema, who also sit on AAP's task force to study the matter, said AAP's revised guidelines on male infant circumcision should be released next year (Jameson, Los Angeles Times, 3/31).