Thursday, April 05, 2007

Circumcision For Men At Risk For HIV/AIDS?

[Posted by reader_iam]

It's been my impression--though it's not a subject I've actually researched--that male circumcision had fallen out of favor, that it was being discouraged in many quarters, that it even was spawning increasing activism against the practice. I think the first serious article that I ever encountered on the topic was this one, which appeared in the February 2000 issue of GQ magazine, but which I didn't read until quite a bit later.

But now, it appears that NYC is considering not just promoting andt possibly funding the procedure for men who are at risk of HIV/AIDS, based on a World Health Organization (WHO) recommendation of the procedure to slow the spread of AIDS via heterosexual sex, based on three clinical trials in Africa.
New York City’s Department of Health and Mental Hygiene is planning a campaign to encourage men at high risk of AIDS to get circumcised in light of the World Health Organization’s endorsement of the procedure as an effective way to prevent the disease.

While the Centers for Disease Control and Prevention in Atlanta is just beginning to convene meetings and design studies to help it formulate a national policy, New York City is moving ahead on its own.

In the United States, “New York City remains the epicenter of the AIDS epidemic,” Dr. Thomas R. Frieden, the city’s health commissioner, said in an interview. Referring to H.I.V., he said, “In some subpopulations, you have 10 to 20 percent prevalence rates, just as they do in parts of Africa.”

His department has started asking some community groups and gay rights organizations to discuss circumcision with their members, and has asked the Health and Hospitals Corporation, which runs city hospitals and clinics, to perform the procedure at no charge for men without health insurance.
For example, in Manhattan, 20 percent of all black men between 40 and 50 are infected with the virus that causes AIDS. About 10 percent of all gay men in the city are infected, and the rate rises to as high as 25 percent in the Chelsea neighborhood.
WHO's recommendation seems to contradict some of the ideas which sites such as the Circumcision Resource Center has been trying get across, which is that the procedure is genital mutilation, that there are not sound health reasons for it, and that it causes problems, physically, psychologically and otherwise. (To be fair, I suspect the site is especially concerned with the circumcision of infants, since they're not in a position to choose for themselves.)

Is a clash being born between those who believe the procedure is mutilation and those who think it can be a useful preventive tool in a life-and-death situation?

Like the blogger at QC Examiner (hat tip), I'm female. For that reason, I never gave male circumcision a whole lot of thought, though after a conversation last year with a male acquaintance, who's vehemently opposed to the procedure and challenged me when I went on a rant about female circumcision, I had to question why that was and wonder if and why I was applying a different standard.

I'd be interested in hearing that acquaintance's reaction to the WHO document, and to NYC's contemplated reaction to it.

Regardless of the clash issue, it seems to me there are some good reasons to be a bit cautious, as the NYT article notes:
Peter Staley, a longtime AIDS activist and co-founder of ACT-UP New York, the Treatment Action Group and, said he was “intrigued” by the idea of offering circumcisions but worried because those in the studies supporting it bore little relation to New York’s risk groups.

“Should we proceed when we don’t have hard data yet on the population here?” he asked. “On the other hand, if we wait the three years it would take to answer that question, how many will be infected in the meantime?”

Also, after reading many postings on gay Web sites about the Africa trials, he said he feared a backlash among black and Hispanic men to endorsements of circumcision from white public health officials or gay activists.
Since I have close gay male friends and know people living with HIV/AIDS (or who have died from the latter), my first instinct is to say: "If this can help, and it's voluntary, sure we should provide information, encourage insurance companies to underwrite the procedures and provide funds to pay for it for people without coverage."

But should we go all out and promote it right now, given the state of the research and the concerns about whether the results apply to the risk groups in our country? I don't know where to come down on that.


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