In late August the New York Times reported that the Centers for Disease Control (CDC) were considering, for the first time, issuing a recommendation on male circumcision. Speculation abounded that they would recommend circumcision of boys (and in some high-risk cases, adult men) to help prevent STD transmission, in particular HIV. This was shortly followed by further research indicating that circumcision has little impact on HIV transmission for men who have sex with men (MSM). In the wake of this news, the already raging controversy over circumcision, and the CDC's role in promoting it, has deepened even further.
In recent years circumcision—particularly adult circumcision—has become an important element in HIV prevention in Africa. According to the World Health Organization, "There is now strong evidence from three randomized controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda and Orange Farm, South Africa that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%." Circumcision is relatively rare in Africa in comparison to the U.S., where circumcision rates in newborns are around 60 percent. A recommendation for circumcision for the U.S. would largely reaffirm a common cultural practice, though circumcisions have been in steady decline here as well over the last couple of decades.
But such a broad-based circumcision promotion does not appear to speak to the health needs of gay men, and could in fact lead to a false sense of security. AIDS in Africa is transmitted primarily through heterosexual contact; in the U.S., sex between men accounts for over half of new HIV cases each year, though gay men are only four percent of the population. And a CDC study presented at an HIV/AIDS conference in Atlanta in the same week as the recommendation controversy indicates that circumcision will do little to prevent those cases.
The CDC study surveyed roughly 4,900 men who had anal sex with HIV-positive male partners. The infection rate was about 3.5 percent whether the men were circumcised or not—there was no measurable difference. As the study concluded, circumcision "is not considered beneficial" in preventing the spread of HIV among MSM, meaning that the CDC is rethinking its guidelines. According to Peter Kilmarx, chief of epidemiology for CDC's division of HIV/AIDS Prevention, the CDC may still recommend circumcision for infants and high-risk heterosexual men, or may simply counsel improved education for doctors and parents about risks and benefits. Even so, the inapplicability of circumcision to the majority of HIV transmissions in the U.S. throws into doubt the wisdom of making a recommendation at all.
According to the CDC's website, "Whatever [their] content may include, CDC’s final circumcision recommendations will be completely voluntary. While CDC has not yet determined if male circumcision should be recommended for any population, ultimately the decision will rest with individuals and parents." No adult will be forced to undergo the procedure—though, of course, babies have little choice in the matter.