Los Angeles Times Examines How Evidence of Circumcision's Role in HIV Prevention Might Not Affect Declining Popularity

Circumcision once was a routine surgical procedure for newborn boys, but the practice's popularity in the U.S. is declining, despite evidence that it might reduce the risk of infection with HIV and other sexually transmitted diseases, the Los Angeles Times reports (Costello, Los Angeles Times, 11/28). According to a study published in the November issue of PLoS Medicine, male circumcision might reduce the risk of men contracting HIV through sexual intercourse with women by about 60% (Kaiser Daily HIV/AIDS Report, 10/26). Circumcision rates in the U.S. have fallen from 63.5% in 1993 to 55.9% in 2003, the lowest point in more than 50 years. Much of the decline is attributed to many doctors and medical organizations ceasing to recommend circumcision because they do not feel it is medically necessary. In addition, states have cut Medicaid funding for the procedure. Sixteen states, including California, Florida and Maine, no longer cover circumcision. On average, Medicaid pays for about one-third of all circumcisions in the U.S. annually. Some private insurers also have stopped covering the surgery. "For parents of newborn boys, the question ultimately comes down to one question: Do they believe their child will ever be at high enough risk of contracting a sexually transmitted disease to warrant having him circumcised?" the Times reports. "Other than condoms and antiretroviral drugs that block transmission during childbirth, circumcision is the next best tool we have to (slow) infections," Thomas Coates, a professor of infectious diseases at the UCLA David Geffen School of Medicine, said. However, Alan Fleischman, a member of the American Academy of Pediatrics task force that formulates recommendations on circumcision, said it is unlikely the group will change its guidelines that do not recommend the surgery because the HIV rate in the U.S. remains relatively low (Los Angeles Times, 11/28).

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