Poll: If you had an infant son, would you have him circumcised as a preventive measure against HIV? [January 2009]
Clinical trials in Africa have shown that circumcision can reduce the risk of HIV infection in heterosexual men. A recent U.S. study of heterosexual African-American men exposed to an HIV-infected female partner appears to confirm the protective effects of circumcision.
“Circumcision was associated with substantially reduced HIV risk in patients with known HIV exposure, suggesting that results of other studies demonstrating reduced HIV risk for circumcision among heterosexual men likely can be generalized to the U.S. context,” wrote researcher Lee Warner, Ph.D., M.P.H., and colleagues at the Centers for Disease Control and Prevention and the Johns Hopkins University School of Medicine.
The study determined that circumcision was associated with a 51 percent reduction in HIV prevalence.
Warner reviewed the records of more than 26,000 African-American men who had been tested for HIV at two Baltimore, Maryland, sexually transmitted infection clinics between 1993 and 2000, with a focus on those who said that they did not inject drugs and had sex only with women. Overall, 394 of these men were also identified as having had sexual contact with HIV-infected women within the past year. Analyzing this smaller group of men with known HIV exposure, the study determined that circumcision was associated with a 51 percent reduction in HIV prevalence.
By focusing on patients who had documented exposure to an HIV-infected female partner, Warner’s study revealed that there was a protective effect to circumcision. This approach, investigators said, “represents a significant methodological advancement over most previous observational studies.”
In a related editorial, Ronald Gray, M.B.B.S., M.Sc., and colleagues at Johns Hopkins University noted that in the U.S., circumcision is less common among blacks and Hispanics—two groups most at risk of contracting HIV. “Thus, circumcision may afford an additional means of protection from HIV in these at-risk minorities,” they wrote.
But Gray also noted that the American Academy of Pediatrics does not recommend routine neonatal circumcision and that Medicaid does not cover the procedure, presenting a major barrier to those who might benefit most from this procedure.
Gray Ronald H., Wawer Maria J., Serwadda David, and Kigozi Godfrey. “The Role of Male Circumcision in the Prevention of Human Papillomavirus and HIV Infection.” Journal of Infectious Diseases 2009; 199:1–3.
Warner Lee, Ghanem Khalil G., Newman Daniel R., Macaluso Maurizio, et. al. “Male Circumcision and Risk of HIV Infection Among Heterosexual African American Men Attending Baltimore Sexually Transmitted Disease Clinics.” Journal of Infectious Diseases 2009; 199:59–65.