Walking over to the AIDS 2012 meeting to pick up my badge yesterday afternoon, the first thing that I saw was the anti-circumcision activists. They were drawing attention to some of the methodological problems with the studies of circumcision and HIV, in an attempt to dissuade the American Academy of Pediatrics from moving towards a recommendation for universal circumcision in the U.S.
I definitely agree that such a recommendation is premature. To date, the research on circumcision as prevention has been mixed. While there has been a strong suggestion that circumcision may improve the health of the men themselves, information is more mixed with respect to how it affects the health of their partners - male and female alike. In addition, the circumcision activists drew my information to an interesting detail from the Rakai study, one which I had previously missed.
The study found that uncircumcised men who immediately (within 3 minutes) washed their foreskins with water after intercourse had a substantially higher risk of HIV than those who waited at least 10 minutes before cleaning. Those men had an HIV infection rate that was actually comparable to the circumcised group.
Although it's difficult to draw conclusions from this side data, which was not a question that the study was designed to address, it suggests that the circumcision data may not be as simple as people might like to think. This is a question that clearly needs to be addressed in future research -- possibly before we go overboard in recommending a surgery that can have significant effects on sexual function.
One of the most interesting things about chatting with the circumcision activists was chatting about the fact that another reason we might not want to focus so much on circumcision as prevention is that we have better options - such as condoms. Particularly in light of the current conversations about treatment as prevention, and the aftermath of the approval of Truvada for PrEP, this is a very timely way of looking at the issue. However, it worked against many of the themes of the opening night plenary, where circumcision was definitely one of the buzzwords of the day.
It will be interesting to see how conversations on circumcision and other controversial prevention issues evolve over the course of the conference. I think that this is going to be a fascinating six days.
Source: http://std.about.com/b/2012/07/23/circumcision-and-hiv.htm
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