A piece called AIDS prevention: Africa’s circumcision challenge just appeared in Nature. I thought it was a great update on where we stand as far as using circumcision to prevent HIV infections in Africa. At this point, four randomized controlled trials have shown that it reduces the odds of transmission for men. So big circumcision campaigns are now being rolled out. One of the big worries is that circumcision will change people’s sexual practices, lulling them into a false security so that they forgo condoms. Based on this article, it seems as though many of the men getting circumcised and their partners aren’t sure what protection is actually being offered. That’s not a good sign. Critics have also pointed out that if men were planning on using condoms, they probably wouldn’t sign up to be circumcised. If there is core population of guys who just aren’t going to use condoms no matter what, though, it seems like circumcision would be a good (though far from perfect) mitigation strategy.
Time will tell, but maybe this will be one more piece in the puzzle.
One thing I’ve heard a lot in debates about male circumcision in the US that kind of surprises me is that people don’t think the trials in Africa are relevant to men in the United States. That is, they don’t believe that circumcision will protect against HIV transmission here. I’m still not sure what the reasoning is. Yes, HIV is less prevalent here (well, depending on who your partners are). But for a given risky heterosexual interaction, is there a good reason to believe that the African RCT results wouldn’t transfer? I’d be curious to hear from someone who takes this position! The decision to circumcise obviously depends on lots of different factors, and I don’t think that protection from HIV is at the forefront of most new parents’ minds. That makes sense. But it does seem probable that circumcision would offer a little protection against HIV transmission.