American Academy of Pediatrics to Review Policy on Male Circumcision After Studies Find Procedure Reduces Men's HIV Infection Risk

The American Academy of Pediatrics is reviewing its neutral policy on male circumcision following three recent studies in Kenya, Uganda and South Africa that found the procedure could reduce a man's risk of HIV infection, AAP President Jay Berkelhamer said recently, the AP/Fresno Bee reports (Konrad, AP/Fresno Bee, 6/18).

According to final data from two NIH-funded studies -- conducted in Uganda and Kenya and published in the Feb. 23 issue of the journal Lancet -- routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65%. In response to the findings, the World Health Organization and UNAIDS in March recommended the procedure as a way to help reduce the spread of HIV. The results of the Uganda and Kenya studies mirrored similar results of a study conducted in South Africa in 2005 (Kaiser Daily HIV/AIDS Report, 3/29).

The organization, which represents 60,000 pediatricians and helps set pediatric policy for the American Medical Association, has "never strongly endorsed or repudiated" male circumcision, according to the AP/Fresno Bee. In a statement released in 1999, the group noted that the procedure, particularly when performed without painkillers, could result in "pain and physiologic stress," the AP/Fresno Bee reports. "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision," the 1999 statement said, adding, "However, these data are not sufficient to recommend routine neonatal circumcision."

"We believe when there's this kind of information coming into play -- more and more evidence in various journals -- we need to go back carefully and review our policies," Berkelhamer said about the new data on HIV and circumcision, adding, "We recommend things for all children when medical evidence is overwhelming compelling." Berkelhamer said the organization's researchers are in the "literature review" phase and are expected to issue a new policy statement in six months to one year. He added that it is too early to tell if the group plans to endorse routine male circumcision and that he would not recommend the procedure to new or expectant parents. Berkelhamer said that he is "not terribly uncomfortable with policy as currently written."

According to the AP/Fresno Bee, the AAP policy statement on circumcision "carr[ies] weight" with insurers and Medicaid. Health care experts said Medicaid programs in several states began restricting coverage of routine, nontherapeutic circumcision follow the group's 1999 statement, which is one of the several factors that has led to decreasing circumcision rates in the U.S. (AP/Fresno Bee, 6/18). According to data from the National Health and Social Life Survey, the U.S. circumcision rate peaked at nearly 90% of male infants in the early 1960s and began falling in the 1970s. Government figures for 2004, the most recent year for which data is available, show that about 57% of all male infants delivered in hospitals were circumcised. The circumcision rate in some states is well below 50%, the AP/Houston Chronicle reports. Some experts attribute to the decreasing rate to immigration patterns, particularly among populations from Asian and Latin American countries where circumcision is uncommon. The trend also has accompanied a shift in U.S. residents' attitudes toward medicine and their bodies, the AP/Chronicle reports. Circumcision still remains the most common surgery in the country, and the U.S. is one of the few developed nations where a majority of male infants are circumcised (Konrad, AP/Houston Chronicle, 6/18).

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