Benefits of Male Circumcision Over HIV/AIDS is Significant
In some faiths, including Judaism and Islam, circumcisions are performed on all baby boys as a religious rite. In some parts of the world, including Europe, Asia, and South and Central America, circumcision is rare among the general population.
Opinions vary among physicians regarding the need for circumcision in healthy boys. Some place great value on the benefits of an intact foreskin, including a more natural sexual response during adulthood.
Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common in the United States, but is it right for your son? Here's help making an informed decision.Other studies show correlations between being uncircumcised and an increased risk of developing penile cancer, some sexually transmitted diseases including HIV, infections of the penis, and phimosis (tightness of the foreskin, not allowing it to retract over the glans penis). The overall increased risk for these conditions is thought to be relatively small.
Circumcision may have health benefits, including:
- Easier hygiene. Circumcision makes it easy to wash the penis — although it's simple to clean an uncircumcised penis, too.
- Decreased risk of urinary tract infections. The risk of urinary tract infections in the first year is low, but these infections may be up to 10 times as common in uncircumcised baby boys. Severe infections early in life can lead to kidney problems later on.
- Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may narrow so much that it's difficult or impossible to retract. This can also lead to inflammation of the head of the penis.
- Decreased risk of penile cancer. Although cancer of the penis is very rare, it's less common in circumcised men.
- Decreased risk of sexually transmitted diseases. Safe sexual practices remain essential, but circumcised men may have a slightly lower risk of certain sexually transmitted diseases — including HIV, the virus that causes AIDS, and human papillomavirus (HPV), which causes genital warts. Some strains of HPV also cause cervical cancer.
The most recent data indicate that circumcision is correlated with significantly reduced risks of HIV transfer during heterosexual intercourse (a between 48% and 53% reduction, although the topic remains the subject of ongoing research and debate in the medical community. There are also fears that some may mistakenly believe they will be protected against HIV through circumcision and see circumcision as a safe alternative to other forms of protection, such as condoms.
Research by the World Health Organization published in the US Public Library of Science Medicine journal in July, 2006, showed that men who had been circumcised had a significantly lower risk of infection with the AIDS virus, and calculated that if all men were circumcised over the next 10 years, some two million new infections could be avoided.
In March 2005, a Cochrane review of the medical evidence concluded that, “Although the positive results of these observational studies suggest that circumcision is an intervention worth evaluating in randomised controlled trials, the current quality of evidence is insufficient to consider implementation of circumcision as a public-health intervention.” Initial population based studies suggesting that circumcision might play a protective role were criticised because confounding factors such as religion may have skewed the results; the reviewers therefore commented that the results of randomised controlled trials then underway would be critical.
The results of the first randomised controlled trial was published in November 2005. It found a 60% reduction in the rate of new HIV infection (from 2.1 per 100 to 0.85 per 100 in the intervention group and claimed that male circumcision provided a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.
Two further randomised trials of the effect of circumcision on HIV infections conducted in Uganda and Kenya were originally scheduled to be concluded in 2007. However, the US National Institutes of Health (NIH) stated on December 13, 2006 that they had stopped the trials early citing that circumcision was so effective that it would be unethical to continue the experiment and not offer circumcision in the uncircumcised men who were acting as controls. The results showed that circumcised males in Uganda were 53% less likely to get infected and circumcised males in Kenya were 48% less likely to get infected.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), announced an early end to two clinical trials of adult male circumcision because an interim review of trial data revealed that medically performed circumcision significantly reduces a man's risk of acquiring HIV through heterosexual intercourse. The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.
"These findings are of great interest to public health policy makers who are developing and implementing comprehensive HIV prevention programs,"says NIH Director Elias A. Zerhouni, M.D. "Male circumcision performed safely in a medical environment complements other HIV prevention strategies and could lessen the burden of HIV/AIDS, especially in countries in sub-Saharan Africa where, according to the 2006 estimates from UNAIDS, 2.8 million new infections occurred in a single year."
"Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition," notes NIAID Director Anthony S. Fauci, M.D. "We now have confirmation — from large, carefully controlled, randomized clinical trials — showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse. 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."
The findings from the African studies may have less impact on the epidemic in the United States for several reasons. In the United States, most men have been circumcised. Also, there is a lower prevalence of HIV. Moreover, most infections among men in the United States are in men who have sex with men, for whom the amount of benefit provided by circumcision is unknown.
Nonetheless, the overall findings of the African studies are likely to be broadly relevant regardless of geographic location: a man at sexual risk who is uncircumcised is more likely than a man who is circumcised to become infected with HIV. Still, circumcision is only part of a broader HIV prevention strategy that includes limiting the number of sexual partners and using condoms during intercourse.