Male circumcision cuts HIV transmission

Should adult men in areas rife with unprotected sex and AIDS be encouraged to go under the knife?

By Tracy Clark-Flory
Published December 14, 2006 12:14AM (EST)

AIDS researchers in Africa have long observed that HIV spreads most quickly in areas where male circumcision is not common practice. Now, trials conducted by the National Institutes of Health in Uganda and Kenya confirm that circumcision can dramatically reduce a man's chance of contracting HIV through heterosexual sex. The trials followed nearly 8,000 men, half of whom underwent voluntary circumcision. Researchers were so floored by the preliminary results -- respectively, the circumcized Ugandan and Kenyan men were 53 and 48 percent less likely to become infected -- that they felt a moral obligation to put a halt to the study.

Responding to NIH's announcement of the findings today, Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, suggested that male circumcision could have far-reaching effects on the disease's spread: "While the initial benefit will be fewer HIV infections in men, ultimately adult male circumcision could lead to fewer infections in women in those areas of the world where HIV is spread primarily through heterosexual intercourse." A previous study estimated that roughly 6 million HIV infections could be prevented in sub-Saharan Africa through male circumcision, according to the BBC.

So the conundrum on everyone's minds is: Should circumcision be encouraged in areas where unsafe sex and HIV run rampant? Some would see it as an ethical no-brainer. It may be that, culturally, widespread circumcision is more easily adopted in sub-Saharan Africa than sweeping safe-sex practices. There's also an argument for spreading the word about the newfound benefits of circumcision in the name of comprehensive and honest sex ed.

But there are also arguments against it. For one, there's the risk that such a push would undercut safe-sex campaigns already scaling a cultural Everest. Should humanitarian efforts really be diverted to encouraging circumcision among African men when they might otherwise bolster safe-sex campaigns already under way? As Tom Elkins, senior policy officer at the National AIDS Trust, told the BBC: "There is a real danger in sending out a message that circumcision can protect against HIV. This is not the case and could lead to an increase in unprotected sex," he said. "There is still a long way to go in providing comprehensive prevention programs in many countries, and resources should go into normalizing the use of condoms, which are the most effective method currently available for preventing HIV."

And, of course, circumcision is a controversial topic -- almost any time we mention the practice, furious debates erupt over circumcision's cultural history and how it differs, if at all, from female genital mutilation. From our perspective, the practices have very distinct religious, medical and cultural histories. Male circumcision typically does not destroy sexual function -- it isn't designed to stamp out a man's sexual pleasure or identity. The same cannot be said for female circumcision, which, more often than not, is more accurately described as mutilation. And when it comes to the HIV-prevention debate, there's a dramatic difference between forcefully circumcising a young girl -- permanently flipping off the switch on her sexual self -- and offering an adult man the option to be circumcised. All that being said, both are surgical procedures that alter genitalia; plenty of people feel very strongly that male circumcision is an archaic practice and should be phased out; and the subject remains ripe for heated discussion.

Still, in light of this recent finding, advocating male circumcision in general seems different from advocating for the practice in a region rife with unsafe sex and AIDS. Even if we're able to set aside cultural debates about circumcision, though, we'll still be grappling with whether advocating for male circumcision in Africa is simply realistic broadening of the scope of the fight against AIDS or a dangerous endorsement of the idea that safe sex is as easy as a one-time snip.

Tracy Clark-Flory

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