In my semi-silly, somewhat rambling post this summer about circumcision, “The Strangest Dream,” I mentioned in passing epidemiology indicating that the male chop reduces the incidence of heterosexual transmission of HIV between serodiscordant couples. The study I cited was conducted in Uganda between 1994 and 1998.
The New York Times is today reporting the results of a new study, just concluded by the National Institutes of Health, representing the first major clinical trial. In a study of nearly 3,000 men in South Africa, the study found that circumcision reduced the risk of HIV acquisition by 53 percent.
These findings indicate that circumcision can form one effective part of a comprehensive strategy to fight AIDS in Africa. It will have less impact in the United States, where most men have already been circumcised, there is a lower prevalence of HIV, and most infections among men in the United States are in men who have sex with men, for whom the amount of benefit provided by circumcision is unknown.
It is also not likely to be much help here in India, which is fast becoming the new epicenter of the epidemic, thanks to government ineptitude and the willful ignorance of right-wing Hindu nationalist politicians. Under the former BJP Government, Home Minister L.K. Advani declared, “We do not have an AIDS problem in India. We are a moral country.” In November of 2002, when the Gates Foundation pledged $100 million to fight HIV/AIDS in India, then Health Minister Shatrugan Sinha condemned the gift, stating that drawing attention to HIV/AIDS in India is “spreading panic among the general public.” More fundamentally, it is unlikely that India’s Hindus, which total 80 percent of the population, would consider circumcision, a custom strongly associated with Islam. Ignorance, denial of reality, and bigotry is often a fatal combination here, and the AIDS epidemic may be just another example.
Despite the limitations in translating the findings of the African studies across cultures, the overall message is broadly relevant: a man at sexual risk who is uncircumcised is more likely than a man who is circumcised to become infected with HIV. Nevertheless, the NIH correctly cautions that “circumcision is only part of a broader HIV prevention strategy that includes limiting the number of sexual partners and using condoms during intercourse.”
This is interesting stuff, though I do not generally write about health issues. I am posting this principally because it follows on my earlier commentary, which drew several reader responses (unfortunately lost when I moved my blog to its new WordPress server). I am not for a second suggesting that everyone — or anyone, for that matter — run out and get themselves chopped. In fact, it seems to me that the other two prongs of the NIH recipe for AIDS prevention probably work pretty well on their own, if followed. As anyone who reads this blog knows, I am not shy about making controversial statements. But advocating alteration of someone else’s equipment isn’t one of them.
Incidentally, there is no photo adorning this post because I didn’t want to shock all the Indian aunties who sometimes look to see the latest nonsense I’ve posted. A missed opportunity to get my blog noticed!