Soon to disappear along with the white rhino: the African foreskin
Potentially. Research is one thing, implementation of research findings into real world situations is another, as one of the researchers in the Ugandan trial soberly points out. If men come to believe that circumcision offers them immunity, and they engage in more unsafe sex, then the protective effect will be lessened. It will also be lessened if men and boys have sex too soon after the operation, or if the operation is performed in unhygienic circumstances by under-skilled practitioners. There are many unknowns, such as unknowns about the acceptability of male circumcision or its wider cultural impact among traditionally uncircumcising groups, or the acceptability of circumcising at early ages among traditionally circumcising groups. The underlying biological mechanisms to explain how male circumcision prevents transmission of the virus are not entirely clear. But the Ugandan and Kenyan studies should greatly increase confidence in the idea that being circumcised helps protect a man somewhat from getting the virus from an HIV positive woman.
It is strange to see how many news reports make reference to what the findings mean for the USA, as if the story that male circumcision could save millions of African (or Asian) lives is not interesting enough. Given that most men and boys (some 77%) in the US are circumcised already, the effect of male circumcision on male to male transmission is unknown, that it does nothing for injection drug users, the new findings won't help the US epidemic much. But there are still some fascinating twists. These results are yet another blow to the 'intactivists', those who regard male circumcision as genital mutilation, something only permissable (but still frowned upon as irrational) when an adult male consents to it. Until last year, the intactivists were helping to slowly roll back the practice of routinely circumcising infants in the United States. Now they are on the ropes. Given that the rate of new HIV infections has not dropped in the US over the last years, it is possible that the American Academic of Pediatrics could start recommending routine neonatal circumcision again, and insurers start covering the operation again. It is amazing how many effects this faintly comical flap of skin is capable of producing.