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CDC Weighs Consideration of Male Circumcision as an HIV Prevention Tool

The Centers for Disease Control and Prevention (CDC) is considering whether or not to recommend male circumcision as an HIV prevention strategy after a new study released by the agency suggests that the procedure does not reduce the risk of contracting HIV among men who have sex with men.[i] The new guidelines, which are still being written, will be released later this year for public comment before being finalized in 2010.[ii]

UNAIDS and other international health groups have endorsed male circumcision worldwide in light of clinical trials that show it can reduce HIV transmission by up to 60%. These results have led to male circumcision being deemed an “important intervention” in the global fight against the HIV/AIDS epidemic.[iii]
 
However, many question how applicable those trials are to the United States and whether increasing male circumcision will have as much of an impact domestically.[iv] The studies cited by UNAIDS were completed in African nations, where HIV prevalence is high, male circumcision rates are low, and the primary mode of transmission is heterosexual intercourse.[v] In the United States, however, half of all new infections occur in men who have sex with men, a mode of transmission that is not appreciably reduced by circumcision.[vi] Others question whether the practice should be endorsed based on the ethical and moral issue of mandating a medically unnecessary procedure without the child's consent.[vii] Until now, medical groups have avoided making a statement on the procedure, saying that it should be left up to the cultural and personal preferences of the parents.[viii]
 
But some public health officials believe it is important to consider any tool in the fight against HIV/AIDS, even if adherence to it is voluntary.[ix] Approximately 79% of American males are circumcised; however, these numbers are lower in communities of color, which are hardest hit by the HIV/AIDS epidemic. And without guidelines from the CDC, many state Medicaid programs will not pay for the procedure.[x] “We have a significant H.I.V. 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,” said Dr. Peter Kilmarx, chief epidemiologist for the Division of HIV/AIDS Prevention at the CDC.[xi]
 
The CDC has released a statement on its website stating that it has made “no determination at this time about the final content [of the guidelines].”[xii] And, while it is considering recommendations for both male infants and heterosexual men who are at high risk, the statement declares that whatever the content, “CDC’s final circumcision recommendations will be completely voluntary.”[xiii]
 
 


[i] Roni Caryn Rabin, “Officials Weigh Circumcision to Fight HIV Risk,” New York Times, 24 August 2009, accessed 16 September 2009. <http://www.nytimes.com/2009/08/24/health/policy/24circumcision.html?_r=3&hp=&pagewanted=print>.
[ii] Rabin, “Officials Weigh Circumcision.”
[iii] UNAIDS, “Male Circumcision,” accessed 16 September 2009, <http://www.unaids.org/en/PolicyAndPractice/Prevention/MaleCircumcision/>.
[iv] Rabin, “Officials Weigh Circumcision.”
[v] Rabin, “Officials Weigh Circumcision.”
[vi] Mike Stobbe, “Circumcision Doesn’t Protect Gays for AIDS Virus,” Associated Press, 25 August 2009, accessed 16 September 2009, <http://www.google.com/hostednews/ap/article/ALeqM5jIzjzyhnJn4ttGInSaFzYthkIIygD9AA47CG>.
[vii] Rabin, “Officials Weigh Circumcision.”
[viii] Ibid.
[ix] Deborah L. Shelton, “Circumcision: Change in Medical option Possible,” Chicago Tribune, 27 August 2009, accessed 19 September 2009,
[x] Ibid.
[xi] Rabin, “Officials Weigh Circumcision.”
[xii] Centers for Disease Control and Prevention, “Status of CDC Male Circumcision Recommendations,” 27 August 2009, accessed 16 September 2009, <http://www.cdc.gov/hiv/topics/research/male-circumcision.htm>.
[xiii] Ibid.

 

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