US/World

Should All Males be Circumcised? How Policy Could Control the HIV/AIDS Epidemic

Should All Males be Circumcised? How Policy Could Control the HIV/AIDS Epidemic
Following the recent study that found circumcision reduces risk of HIV transmission, another debate remains--whether the practice is recommended for all males, specifically for those living in HIV-prevalent regions.

When a recent study found a how circumcision could offer protection from HIV transmission by changing the microbiota, bacterial composition living on the penis, it prompted parents to give the ritual a second look.  Additionally, the debate could be wrung before public health officials looking to control the HIV/AIDS epidemic.

The study lead by the Translational Genomics Research Institute found that circumcision changes the ecology of the bacteria residing around and under the foreskin of the penis.  This could in turn influence the kinds of immune cells present in the area and reduce the number of targets HIV infects.

"I think that in certain regions of the world, in which HIV prevalence reaches a certain threshold level and the bulk of transmission is occurring through heterosexual contact then circumcision might be a policy recommendation that individuals can take," said Amesh Adalja MD, a board-certified infectious disease physician, at the University of Pittsburgh Medical Center.

"I don't think that this rises to a policy level recommendation for the United States."

According to the Centers for Disease Control and Prevention, more than 1.1 million people are living with HIV in the United States.  This number is significantly small compared to regions such as Sub-Saharan Africa where the number of adults and children living with HIV or AIDS is 22.9 million. 

Studies have shown that the prevalent needle exchange programs and practicing use of condoms have dramatically reduced the risk of HIV transmission in the United States, possibly a reason why it's not among the countries with high HIV prevalence rates.  Another reason why, which remains to be studied, is the number of men already circumcised in America is already high.

But for regions where needle exchanges or men who have sexual intercourse with other men are low, circumcisions would not have a strong impact on HIV transmission.

This benefits shown in the new study could be more beneficial for men in heterosexual relationships because it could prevent contracting HIV from their partner. 

In the United States, many children born in the 1970s and 80s were circumcised but the numbers have been on the decline since because the American Academy of Pediatrics advised there were no medical benefits for circumcision. But the tables turned last year when they published how the medical benefits of circumcising actually outweigh the risk

"I think the issue is being revisited because HIV, being such a major condition that is potentially preventable by circumcision, is shifting the balance on the risk benefit ratio," Adalja said, "Now with the HIV as a compelling case that circumcision should be recommended for certain areas in which the HIV epidemic has a certain prevalence level."

Reporting was contributed by Elijah Wolfson. 

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