Saturday, November 10, 2007

AIDS & CIRCUMCISION: Snip, Snip, Oh What a Relief It Is

Phill WilsonĀ 

This summer, the Bush administration revealed that it will use part of its $15 billion a year global AIDS program to promote male circumcision in sub-Saharan Africa as an HIV prevention tool. The news is a welcome development that, for once, puts science at the forefront of the administration's response to this epidemic.

However, both abroad and here at home, educating people about circumcision as a way to slow HIV's spread is a necessarily sensitive endeavor. Everybody involved will have to abandon old bad habits if we are to have a sober dialogue about reducing risk for HIV. Public health must respect communities' traditions and individuals' choices; communities and individuals must discard reflexive distrust of public health.

The facts today are hard to dismiss. Study after study has found that HIV transmits far less easily through the skin of a circumcised penis than it does when the foreskin is still intact. Circumcision is a procedure in which the foreskin covering the tip of the penis is removed.

The most widely reported studies establishing the prevention benefits of circumcision come from Kenya, South Africa and Uganda, completed in 2005 and 2006. Researchers tracking groups of circumcised and uncircumcised men in those countries found the rate of HIV infection among men who had their foreskins removed to be anywhere from 51 percent to 76 percent lower. Those are big numbers, and they're just the latest studies to come up with such striking results.

Why does circumcision make such a difference?

Laboratory studies have established that the foreskin's inner lining has a high density of the cells that HIV targets. Researchers also believe foreskin is more likely to tear during intercourse, allowing openings for the virus. More studies should pursue the question.

Meanwhile, public health must begin to make people aware of the dramatic difference circumcision appears to make in HIV risk. In doing so, however, the scientific community must respect the justified concerns both communities and individuals may present-too many years of abuse at the hands of pseudoscience have left communities of color around the world distrustful of health officials. Any outsider-driven, top-down campaign urging men to have skin removed from their penises will no doubt deepen that skepticism. I'm sure every man reading this column is crossing his legs right now.

So as public health officials gear up their response to the compelling data on circumcision, it is important that our leaders do the leading, including investing in raising the HIV science literacy among local leaders and supporting culturally appropriate venues where local communities can develop the tools needed to interpret the science.

At the same time, people of color around the world no longer have the luxury of allowing other folks' mistakes to hold us captive. If we're going to survive this epidemic, we must begin taking responsibility for our own lives. That means, no matter what the scientific community does, and no matter what any local health department does here in the U.S., we must learn the facts about circumcision and HIV.