US health officials are considering whether to promote routine circumcision for all baby boys born in the country as a way to reduce the spread of HIV; a topic that is giving rise to considerable debate in anticipation of the Centers for Disease Control and Prevention's official draft recommendations on the subject that are due out at the end of the year.

The New York Times reported online yesterday, in an article that will appear in today's print edition, that experts are also considering whether circumcision should also be offered to adult heterosexual men whose sexual behaviour puts them at higher risk of infection.

The reasons behind the consideration stem from several studies in support of male circumcision as a way to reduce HIV spread.

Trials in Africa, where there are several countries with severe AIDS and HIV epidemics, have shown that male circumcision reduced HIV infection risk by 50 per cent in heterosexual men who were at high risk of infection from women with HIV.

And earlier this year, an Australian study suggested that the inner foreskin has the largest concentration of Langerhans' cells, which are the initial cellular targets in the sexual transmission of HIV. The researchers suggested that removing the skin surface which is most susceptible to the virus would reduce the risk of contracting HIV.

However, there is also a strong opinion that large scale male circumcision will not make a big difference in the US where the group at highest risk is men who have sex with men, and there is no evidence that circumcision prevents the spread of HIV among this group.

Another reason that the measure might have less impact in the US is because health officials there suggest that nearly 80 per cent of adult American males are already circumcised, although this is likely to go down in the future because there is less routine circumcision of newborns nowadays, reports the New York Times.

Another argument that is being put against the idea of promoting male circumcision in newborn boys is that it subjects them to a medical procedure of questionable health value without their permission.

However, the CDC HIV/AIDS Division's chief epidemiologist, Dr Peter Kilmarx said every potential step that could prevent the spread of HIV should be seriously considered. He said there is a significant HIV epidemic in the US and every opportunity to add another "tool in the toolbox" should be examined.

"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," he told the New York Times.

However, he did acknowledge that the situation in Africa was different to the US and the effect of male circumcision was likely to be less dramatic both because the disease was not so prevalent in the US and because the routes of infections were also different. Another consideration was the difference in health care infrastructures.

Circumcision will be a discussion topic at the CDC's National HIV Prevention Conference which takes place this week in Atlanta and is expected to be attended by thousands of HIV health professionals.

Intact America, a group that is against the idea of routine circumcision for newborns is holding a protest in the city to coincide with the conference.

They will be arguing that the facts show that circumcision only reduces the risk of HIV infection, it does not eliminate it, and circumcised men still have to wear condoms.

Sources: New York Times, MNT archives

Written by: Catharine Paddock, PhD