Male circumcision and HIV prevention.
BACKGROUND
Growing evidence has linked circumcision with some protection against HIV infection. Should nations with a high HIV infection rate encourage male circumcision?


METHODS
Four people with expertise and/or interest in the area of circumcision and HIV were asked to contribute their opinions.


METHODS
To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine.


RESULTS
Three clinical trials in Africa showed the benefit of circumcision in reducing HIV incidence in men. Sadeghi-Nejad cites these, but balances this with the pandemic in India, and the cultural implications of circumcision. Pollack cites these studies as well, but reinforces the World Health Organization and UNAIDS recommendations that male circumcision should not replace safe sex. As a Nigerian, Aisuodionoe-Shadrach discusses the indirect ways in which circumcision can reduce the spread of HIV, and advocates the surgery, although he proposes infant circumcision may be wiser. Ira Sharlip, President of the International Society for Sexual Medicine, explains some of the physiology involved while again citing the three recent African studies. He questions who would be circumcised and who would perform the procedure if pro-circumcision policies were adopted.


CONCLUSIONS
While three clinical trials in Africa were halted after it became evident that circumcision was beneficial in protecting against HIV, further information on the health risks and benefits of male circumcision is needed. Ethical decisions need to be made and medical recommendations developed before circumcision can be considered for HIV prevention.
Vardi
Yoram
Y
Department of Neuro-Urology, Rambam Medical Center, Haifa, Israel.
Sadeghi-Nejad
Hossein
H
Pollack
Shimon
S
Aisuodionoe-Shadrach
Oseremen I
OI
Sharlip
Ira D
ID
D002944:Circumcision, Male; D002986:Clinical Trials as Topic; D003906:Developing Countries; D004196:Disease Outbreaks / Q000517:prevention & control*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D020010:Heterosexuality; D006801:Humans; D008297:Male; D012107:Research Design