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THREE leading Australian health professionals are calling for a change in public health policy that would see male infants routinely circumcised to combat the rise in heterosexual HIV transmission.
In an editorial in the Medical Journal of Australia that is likely to reignite debate on the controversial topic, the authors cited research which they said showed that male circumcision substantially reduces female-to-male HIV transmission.(1)
Their editorial also questioned the influential anticircumcision position taken by the Royal Australasian College of Physicians. Last week the College approved an updated neonatal circumcision policy that it said takes into account the latest research.
However the College said its official stance remains the same: there is no medical indication for routine neonatal circumcision.
The authors have criticised this stance as scientifically flawed and the major barrier to boosting the rate of circumcision in Australia.
Elective circumcision was also officially discouraged by a low Medicare rebate and the fact that public hospitals in most states do not perform them, according to the MJA editorial.
In January a petition was sent to the College with 47 signatories from Australia, New Zealand, the United States and the United Kingdom, that expressed concerns that the policy was not evidence-based or “reflective of the considerable and rapidly growing medical literature supporting the circumcision of males”.
The World Health Organization and other global groups have agreed that male circumcision has been proven beyond reasonable doubt to reduce female to male transmission of the disease, according to the editorial’s authors, Professor David Cooper, Director of the National Centre in HIV Epidemiology and Clinical Research, Dr Alex Wodak, Director of Alcohol and Drug Service at St Vincent’s Hospital, and Professor Brian Morris, Professor of Molecular Medical Sciences at the University of Sydney.
“A wealth of research has shown that the foreskin is the entry point that allows HIV to infect men during intercourse with an infected female partner.”
Further, the authors said that circumcision of males is now referred to by many as a “surgical vaccine” against a wide variety of infections and adverse medical conditions over a lifetime.
Professor Morris noted that large randomised controlled trials had shown that male circumcision also protected against human papillomavirus, some common sexually transmitted infections, penile cancer, cervical cancer and genital herpes as well as HIV.
Dr George Williams, a New South Wales paediatrician and the head of the anticircumcision group, Circumcision Information Australia, however, said the evidence on circumcision and HIV had been conducted in Africa and the results could not be translated to Western populations.
Posted 20 September 2010
Australia has a low prevalence for heterosexual HIV transmission so there can be no justification for routine circumcision of male infants. This procedure is not only a human rights abuse but also has its own, not inconsiderable, morbidity and mortality. Even in Africa with high prevalence of heterosexual HIV I fear encouraging circumcision will create a false sense of security and lower condom use even more.
In Australia, all forms of female genital mutilation, no matter how minor, are illegal in the criminal code. This pro-male circumcision argument is severely gendered and I wonder how keen the supporters were be if the evidence showed male circumcision somehow protected women from acquiring HIV? Women remain the most vulnerable to HIV for a wide range of physical, social and cultural reasons. Let’s continue to work on promoting the things we know work well: education, condoms and reducing sexual partners.
There are other things that have to be considered to make the picture complete. The risk reduction in HIV transmission, although apparently statistically significant, is apparently also quite a modest one. That means it plays a much bigger relative role in high-prevalence settings than low-prevalence settings such as Australia. That has to be weighed carefully with the fact that infant circumcision is de facto a mild human rights violation: before someone can make their own decision (i.e. is of legal age), a body part is irrevocably taken away. I would certainly want the right to make my own conscious decision on that.
Let nature be! Save the foreskin! Surely natural evolution will win this one.
What can possibly be the difference between those circumsized and not: very probably nothing except hygiene and possibly temperature. In the absence of a proven and validated scientific rationale for carrying out circumcision, the default should surely remain for leaving the foreskin unmutilated.