Circumcision and HIV: If it can make it there, it can make it anywhere

I know that this blog has discussed male circumcision and HIV prevention before. But now that the World Health Organization has endorsed the use of male circumcision to reduce risk of HIV transmission, the issue has really gone global. News items are everywhere. And Americans can no longer think it is something that just Africans, living in high HIV prevalence countries, have to contend with. No, the debate has arrived, like many a new immigrant to these shores, in New York.

The Department of Health and Mental Hygiene in New York City is planning a promotion campaign for male circumcision among populations deemed to be at risk for acquiring HIV. The Department has started asking some community groups and gay rights organizations to discuss circumcision with their members. Health and Hospitals Corporation, a company that operates city hospitals and clinics, is being asked to perform the procedure at no charge for men without health insurance. As usual, New York is being avant guard, since the Centers for Disease Control and Prevention have not formulated national guidelines yet. The Department of Health and Mental Hygiene is so proactive that it seems to have even caught New York City Mayor Michael Bloomberg off-guard.

There are a lot of unknowns and issues raised by the use of male circumcision as HIV prevention strategy in a place like New York. One is that the African studies were about the reduction of HIV risk among circumcised men in hetrosexual relations. The high-risk groups in the US are mostly injection-drug users and men who have sex with men, and the studies say little to nothing about that. New York City's Health Commissioner, Thomas Frieden, claims that if a man's risk from penetrative anal sex with an HIV positive man is about the same as the risk from sex with an HIV positive woman, then the African studies should mean that gay men who are circumcised are at lower risk for HIV acquisition too. Of course, that is not how science works. You are supposed to run a study with the population in question. But apparently the city that doesn't sleep doesn't have time for that.

The comments (85 and counting) about this possible new initiative in one of the New York Times' articles are well worth reading. Besides interesting insights -- such as the possibility that uncircumcised men in the gay community could become stigmatized analogously to injection drug users -- you have the whole gamut: conspiracy theories, non sequiturs, accusations of distorting scientific facts, libertarians in favor of adult circumcision, human rights activists against infant circumcision as 'genital mutilation', as well as those who are absolutely convinced that the retention of a foreskin is a condition sine qua non of sexual joy.

New York City is apparently poised to undertake a massive social and epidemiological experiment; the rest of us will just have to watch and wonder.