December 5, 2014
Earlier this week, the US Centers for Disease Control and Prevention (CDC) released draft recommendations on male circumcision, stating that men of all ages (and parents of male minors) should be counseled on the health benefits of voluntary medical male circumcision. The recommendations do not call for universal male circumcision but recognize its power to prevent sexually transmitted infections and suggest a discussion about male circumcision with providers:
These recommendations are intended to assist health care providers in the United States who are counseling men and parents of male infants in decision making about male circumcision conducted by health care providers (i.e. medically performed) as it relates to the prevention of human immunodeficiency virus (HIV) infection, sexually transmitted infections (STIs), and other health outcomes. Such decision making is made in the context of not only health considerations, but also other social, cultural, ethical, and religious factors.
The document—Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and other Health Outcomes—reflects the data that show in heterosexual men that medical male circumcision can reduce risk of HIV infection by around 60 percent and reduce risk of other sexually transmitted infections such as HPV and herpes. These data are the basis for voluntary adult male circumcision programs implemented as a primary strategy to prevent HIV in 14 priority countries in East and Southern Africa, where HIV rates are high and circumcision rates are low.
Acknowledging the different epidemics between the US and countries in Africa, the CDC notes that some subpopulations in the US where HIV continues to rage could benefit from male circumcision—in particular heterosexual men at higher risk including African-American and Hispanic men, traditionally living in communities with higher rates of HIV and lower rates of male circumcision.
There are little data on male circumcision’s effect on risk reduction in gay men and other men who have sex with men whose risk for HIV exposure is primarily via anal sex, although there is a biological rationale for a potential protective effect for the insertive partner (or “top”) in anal sex. But data on effect are not available.
In 2012, the American Academy of Pediatrics updated its position on male circumcision noting that the benefits of newborn male circumcision outweigh the risks and that those families interested should have access to it.
For more on medical male circumcision, visit AVAC’s webpage on the topic.