To Circumcise Or Not? - The Matter of AIDS

AIDS Retrospective Slideshow

Berkeley, California, June 12, 2000 -- For some time, circumcision has been a matter of debate in the world at large and within our family which is large enough to contain some differing opinions and both circumcised and uncircumcised males.

The National Organization of Circumcision Information Resource Centers (NOCIRC) states that it is "dedicated to making a safer world" and "committed to securing the birthright of male and female children and babies to keep their sexual organs intact."

Not everyone equates male and female circumcision. No health rationale can be conjured up to defend female circumcision. But there are some health reasons for male circumcision.

The Protective Effect of Circumcision Against HIV

Among the foremost factors favoring male circumcision today is its protective effect against HIV (the human immunodeficiency virus), the agent of AIDS.

Uncircumcised men are known to be at much greater risk of becoming infected with HIV than circumcised men. Over 40 studies have found that men who are circumcised have a lower risk of becoming infected with HIV from an infected sexual partner than uncircumcised men. Circumcised men are two to eight times less likely to contract HIV and other sexually transmitted diseases (STDs) than uncircumcised men.

Perhaps the most dramatic evidence for this protective effect has just appeared in a new study published in the British Medical Journal (BMJ). The study was of couples in Uganda where each woman was HIV positive and her male partner was not. Over a period of 30 months, no new infections occurred among 50 circumcised men, whereas 40 of 137 (29.2%) of the uncircumcised men became infected -- even though all couples were given advice about preventing infection and free condoms were available to them.

Why Circumcision Protects Against HIV and AIDS?

The explanation for this remarkable effect seems logical. The HIV virus targets certain cells called Langerhans cells that are present in abundance on the inner surface of the foreskin. These cells are likely "the primary point of viral entry into the penis of an uncircumcised man." Langerhans cells possess HIV receptors, making them particularly susceptible to infection. Male circumcision may act to provide significant protection against HIV infection by removing most of the receptors.

Whether to Circumcise or Not?

In light of the available evidence, male circumcision should clearly be considered as a measure to prevent HIV in countries with a high level of infection. Should the matter of AIDS (and other STDs) figure into the decision whether or not to circumcise a boy here?

References:

1. Robert Szabo and Roger V Short. How does male circumcision protect against HIV infection? British Medical Journal 2000;320:1592-1594.
2. The MedicineNet Focus on Circumcision - The Surgical Procedure
3. The MedicineNet Focus on Circumcision - The Medical Pros and Cons