Circumcision Promotion Divides AIDS Activists

Article excerpt

THE LAST TIME circumcision made headlines in New York City, the city Department of Health and Mental Hygiene was objecting to an ultra-Orthodox Jewish practice in which mohels-professional circumcisers-sucked blood out of the wounds of newly cut infants. After three babies contracted herpes, the city tried to ban the obscure ritual in 2005, provoking an angry response from the Orthodox community and a media dust-up.

Now circumcision is news again in New York, but this time the city is promoting the practice. The April 5 New York Times reported that the city health department has decided to encourage male circumcision as an HIV-prevention method among at-risk populations, particularly gay and African-American men. The move comes after several clinical studies in Africa showed that circumcision of an adult male can decrease his likelihood of infection by as much as 60 percent.

But New York's campaign brings up thorny questions for AIDS researchers and activists. Many are concerned about extrapolating prevention methods for American high-risk men, many of whom are bisexual or gay, from the African circumcision studies, which were conducted primarily among heterosexual groups. Meanwhile, others question how a male partners circumcision affects a woman's susceptibility to HIV.

Two decades of research show women are less likely to contract a variety of sexually transmitted infections when their male partners are circumcised. But a recent Johns Hopkins University study examining 997 men in Uganda found that their female partners were more likely to contract HIV following a circumcision if the men ignored doctors' orders to abstain from sex until their wounds were fully healed, which usually takes about a month. And with the continued lack of a female-controlled HIV-prevention method-microbicide gels have yet to advance out of the trial phase-any HIV education effort must include a heavy emphasis on condom use. Spokespeople for the New York City Department of Health and Mental Hygiene and the Health and Hospital Corporation, which operates public clinics and hospitals in the city, say the city hasn't established any formal procedures for encouraging HIV-testing prior to circumcision in light of women's increased risk, but stress that any public circumcision efforts will be just one part of a multi-pronged HIV-prevention program.

Cultural stigma against circumcision also remains, especially among immigrant groups like Caribbean Americans. Though about 60 percent of American men are circumcised, the practice is relatively rare worldwide. …