2009 New York Times News Service
Public health officials are considering promoting routine, universal circumcision for all baby boys born in the United States to reduce the spread of HIV, the virus that causes AIDS.
The topic is a delicate one that has already sparked controversy, even though a formal draft of the proposed recommendations, due out from the Centers for Disease Control by the end of the year, has yet to be released.
Experts are also mulling whether the surgery should be offered to adult heterosexual men whose sexual practices put them at high risk of infection. But they acknowledge that a circumcision drive in the United States would be unlikely to have a dramatic impact: The procedure does not seem to protect those at greatest risk here, men who have sex with men.
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Recently, studies showed that in African countries hard hit by AIDS, men who were circumcised reduced their infection risk by half. But the clinical trials in Africa focused on heterosexual men who are at risk of getting HIV from infected female partners.
For now, the focus of public health officials in this country appears to be on making recommendations for newborns, a prevention strategy that would only pay off many years from now. Critics say it subjects baby boys to medically unnecessary surgery without their consent. But Dr. Peter Kilmarx, chief of epidemiology for the Centers for Disease Control’s division of HIV/AIDS prevention, said that any step that could thwart the spread of HIV must be given serious consideration.
He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, spreads through different routes, and the health systems are so disparate as to be incomparable.
Clinical trials in Kenya, South Africa and Uganda found that heterosexual men who were circumcised were up to 60 percent less likely to become infected with HIV over the course of the trials than those who were not circumcised. There is little to no evidence that circumcision protects men who have sex with men from infection. Another reason circumcision would have less effect in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.
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