The circumcision debate -- next in intensity only to, say, breast-feeding as far as our readers are concerned -- has gotten an injection of controversy from a recent report linking the (arguably not so) "simple snip" with a large decrease in HIV transmission. Now comes news from the New York Times that New York City's Department of Health and Mental Hygiene is planning to urge men at high risk for contracting the virus to get circumcised.
Recent clinical trials in Africa found that circumcision reduces men's chance of contracting HIV through heterosexual sex by a whopping 60 percent. As a result, the World Health Organization decided to promote circumcision as a means of slowing the disease's spread and now New York is planning to jump aboard. Some are skeptical, though, that a study of heterosexual men in sub-Saharan Africa will translate to New York's highest-risk individuals: gay men and injection drug users.
But anal sex and vaginal sex present similar risk factors for men, according to city health commissioner Thomas R. Frieden. So he believes the circumcision benefit demonstrated in the African studies should also apply to the subgroups he plans to target in New York. The idea is that in New York, the "epicenter of the AIDS epidemic," even convincing as few as 1,000 men in the right groups to get circumcised could make a world of difference. He also notes that reducing the virus' reach among bisexual men will also protect women (who are sometimes unaware that their partner has sex with men).
I'll admit to some ambivalence about the circumcision crusade -- in part because a lot of questions remain unanswered. A somewhat sketchy report recently suggested that circumcision might -- but, uh, also might not -- increase women's risk for contracting HIV. And a recent study documented that directly following circumcision, transmission rates were (understandably) raised. But it seems New York health officials have come to a conclusion about the trickiest question of all: Whether promoting circumcision as a means of reducing HIV's reach undercuts safe-sex initiatives.
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