I was at a medical conference last year when one of the male circumcision studies was presented, and the investigator showed a film of the surgery with an actual patient. It was easy to see everyone's face scrunch up and their legs close as they moaned softly in empathic agony with the patient.
Male circumcision cannot be confused with female circumcision, and this is a real danger as well. Female circumcision is a mutilating technique, forced on unwilling young women, and it involves cutting the labia and often the clitoris. It has no medical benefits whatsoever, and fortunately it is declining in many parts of the world in which it is practised, due to worldwide pressure and the women's movement.
Women bear the brunt of HIV infections in the world, but male circumcision can protect them as well. Women in subSaharan Africa are most likely to get infected with HIV between the ages of 14 and 25, while men get infected later, usually between the ages of 18 and 35. The women get their HIV infection from older men. Thus, women will benefit if we can prevent infections in men.
These include the use of the female diaphragm, acyclovir to suppress herpes (as herpes is highly associated with risk for HIV), and microbicides that can be placed in the vagina or rectum to kill HIV on contact.
Finally, there is pre-exposure prophylaxis so that people might be able to take a pill prior to sex to prevent HIV infection from occurring, much as we currently do with malaria.
There are two other clinical trials of male circumcision under way now, and they need to be examined to ensure that their findings are replicating, and not contradicting, this one. If the findings hold up, then studies need to start right away to determine the best ways to implement male circumcision on a broad scale without negative effects.
It might be interesting if relatively small countries highly affected by HIV, like Lesotho or Swaziland, would try male circumcision on a broad scale to see if they can reduce HIV infection among men and women.
The Botswana government has recently passed legislation indicating that all mothers need to be counselled on male circumcision for their male infants. It does not force circumcision on anyone - and that is important - but people need to be counselled about its potential benefits and disadvantages.
The American Academy of Paediatrics in 1975 issued a statement indicating that there are no medical reasons for male circumcision, and the procedure has been dropping in the US ever since. It may need to rethink its position as well.
This finding is good news in the fight against HIV. It will be controversial, and some individuals and countries may not want to do it. That is their choice, as no HIV prevention technique should be forced on anyone. But it does remind us that the pace of the fight against HIV is a hopeful one, and more good news is down the line.
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