CDC Drafting Recommendation Of Routine Circumcision For Male Infants To Prevent Spread Of HIV

Main Category: HIV / AIDS
Also Included In: Pediatrics / Children's Health;  Men's health
Article Date: 26 Aug 2009 - 2:00 PDT

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The Centers for Disease Control and Prevention is drafting a formal recommendation that all male infants born in the U.S. be circumcised as a way to reduce the spread of HIV/AIDS, the New York Times reports. Recent studies have shown that in African countries circumcision reduces a man's risk of infection by 50%; however, those studies focused on heterosexual men who are at a high risk of contracting HIV from female partners. The procedure does not seem to protect men who have sex with men -- the population at greatest risk of infection in the U.S. It is unclear whether male circumcision reduces the risk for women, experts say. "There's mixed data on that," according to Peter Kilmarx, chief of epidemiology for the division of HIV/AIDS prevention at CDC. He added, "If we have a partially successful intervention for men, it will ultimately lower the prevalence of HIV in the population, and ultimately lower the risk to women."

The recommendation is expected to be released by the end of the year, but the issue already has generated controversy. Critics contend that the procedure subjects male infants to medically unnecessary surgery without their consent, while proponents argue that any measure that can reduce HIV infection rates should be taken under consideration. About 79% of adult men in the U.S. are circumcised. The Times reports that rates have fallen in recent years in part because the American Academy of Pediatrics does not endorse routine circumcision. AAP's policy states that circumcision is "not essential to the child's current well-being." As a result, many state Medicaid programs do not cover the operation, the Times reports. However, AAP is revising its guidelines and is expected to replace the neutral tone with a policy stating that circumcision has health benefits even beyond HIV prevention, such as reducing urinary tract infections in infants, according to Michael Brady, an AAP consultant.

Kilmarx said, "We have a significant HIV epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic." He added, "What we've heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks." Still, according to Kilmarx and other public health officials, the benefits of such preventive measures would be muted in the U.S. compared with Africa because HIV is less prevalent here, spreads through different routes and because circumcision already is highly common (Rabin, New York Times, 8/24).

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