[Male circumcision and HIV/AIDS: convincing evidence and their implication for the state of Israel].
The results of recent controlled trials documenting the protective effect of male circumcision on HIV infection in young adults pose significant challenges to a country like Israel. Circumcision is performed in close to 100% of new born males, mostly as a religious act in Judaism and Islam. Christian Israelis follow societal norms suggesting that circumcision contributes to better hygiene and cleanliness. Complications in infant circumcision in Israel are rare, despite the surgery being preformed most often by nonmedical circumcisers (a "Mohel") on the eighth day of birth. Reported complication rates are between 0.34% and 2%, with bleeding and infections being the most common. In the last 10 years and due to massive migration of Eastern Europeans into Israel, impressive experience was gained in Israel with adults seeking male circumcision for various reasons including: religious, societal pressure, sexual and economical. Over 21,800 adult male circumcisions have been monitored between 1998 and 2006 alone. Complication rates (mostly bleeding) were 1.75% on an average. This review matches the new data emerging from the African controlled trials with previous observational studies and the Jewish and Israeli experience. We present three challenges to policy makers in Israel: (a) the need to intensify education and information sharing on male circumcision and HIV/AIDS among healthcare workers; (b) developing an information campaign for non-circumcised migrants and adequate service to scale up on potential demand; (c) developing intensified educational campaigns for circumcised males so that they do not abandon other protective interventions (e.g. condoms) when needed for HIV prevention.
Schenker
Inon
I
The Jerusalem AIDS Project, Hebrew University--Hadassah Medical Center, Ein Kerem, Jerusalem, Israel. inon_schenker@yahoo.com
Gross
Eitan
E
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology / Q000517:prevention & control*; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D018849:Controlled Clinical Trials as Topic; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D007557:Israel; D008297:Male