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PUBLIC HEALTH & EDUCATION | Routine Circumcision Does Not Protect Against HIV for Men Who Have Sex With Men, CDC Study Finds

PUBLIC HEALTH & EDUCATION | Routine Circumcision Does Not Protect Against HIV for Men Who Have Sex With Men, CDC Study Finds
[Aug. 27, 2009]

Although previous research in African countries has shown that circumcision helps reduce a man's risk of contracting HIV through heterosexual intercourse, a new study from the Centers for Disease Control and Prevention suggests the procedure does not provide protection for men who have sex with men -- one of the groups most at risk for the virus in the U.S. -- the AP/Miami Herald reports. According to the AP/Herald, the study -- presented Tuesday at an HIV/AIDS conference in Atlanta -- likely will influence new government recommendations on male circumcision, which currently are being developed and will not be finalized until 2010 following a public comment period.

For the study, CDC researchers surveyed about 4,900 men who had anal sex with HIV-positive men. The study found that the infection rate among the men was about 3.5% in both the men who were circumcised and those who were not. Although the study found that circumcision "is not considered beneficial" in preventing the spread of HIV among MSM, CDC still might recommend the procedure for other groups, including male infants and high-risk heterosexual men, according to Peter Kilmarx, chief of epidemiology for CDC's division of HIV/AIDS Prevention.

Kilmarx noted that the definition of high risk is still being discussed. He added that circumcision is "seen by many as more than just a medical procedure" because of the procedure's cultural and religious associations. He added that CDC might just recommend improved education for doctors and parents about the risks and benefits associated with male circumcision.

According to the AP/Herald, various global health organizations like UNAIDS have been promoting male circumcision as a way to reduce the spread of HIV/AIDS in other countries. However, the same level of promotion has been largely absent in the U.S., where nearly 80% of men already are circumcised. More than half of new HIV cases in the U.S. each year occur among MSM, who account for about 4% of the U.S. male population (Stobbe, AP/Miami Herald, 8/25).

Editorial Calls for Clear CDC Recommendations

"Three large studies in Africa have shown that male circumcision can reduce the transmission of HIV/AIDS from women to men by up to 60%," a Boston Globe editorial states, adding that this has prompted CDC "to consider promoting circumcision of infant boys in this country. Such a tactic makes sense against a virus that infects more than 50,000 Americans each year."

The protection provided by male circumcision "is not complete, however, and the organizers of the African studies still advised all participants, circumcised or uncircumcised, to use condoms," the editorial continues. In addition, although there is no "evidence that circumcision protects against male-to-male transmission of the virus, or from men to women," a "technique that reduces the prevalence of the disease will ultimately benefit all groups," according to the editorial.

"While a majority of U.S. parents already circumcise their babies, rates are lower among two groups that suffer disproportionately from HIV/AIDS: African-Americans and Hispanics," according to the editorial. "No one should be forced to circumcise a son," but "where the health benefits are clear, the CDC should be equally clear in its recommendations. Circumcision is no panacea, but it deserves the CDC’s support," the editorial concludes (Boston Globe, 8/26).