Should adult male circumcision be recommended for HIV prevention in the US?
Three clinical trials in Africa found that adult male circumcision reduced the risk of men acquiring HIV infection from heterosexual sex by 51-60%. While adult male circumcision may also have a role to play in preventing HIV transmission in the US, say scientists at the US Centers for Disease Control (CDC) in a paper in PLoS Medicine, "the extent of this role on a population basis is unknown."
Patrick Sullivan (Division of HIV/AIDS Prevention,CDC) and colleagues argue that the potential impact of adult male circumcision on HIV transmission rates in the US is hard to predict, given the many differences between the underlying HIV epidemics in Africa and the US, differences in the prevalence of male circumcision in Africa and the US, and the considerable gaps in knowledge that exist regarding the potential impact of circumcision on HIV transmission by male–male sex.
"The HIV epidemics in Africa are substantially different from the US epidemic," they say. The predominant mode of HIV transmission in Africa is heterosexual sex whereas the US has a concentrated HIV epidemic with most sexual transmission occurring among men who have sex with men (MSM). The African trials did not study MSM. While some observational studies have suggested that circumcised MSM in the US may have a decreased risk of HIV infection, say the authors, it is impossible to draw firm conclusions from such observational research, which is prone to bias.
Adult male circumcision will likely have the largest impact in populations where circumcision has been rare, they say. Yet in the US circumcision is already very common—hospital discharge data show that in 1999 around two thirds of all newborn boys were circumcised.
Nevertheless, based on the data from the three African clinical trials, Sullivan and colleagues conclude that "it is likely that circumcision will decrease the probability of a man acquiring HIV via penile–vaginal sex with an HIV-infected woman in the US." Until public health recommendations are available for the US, they say, "some sexually active men may consider circumcision as an additional HIV prevention measure, but should do so only in consultation with their physician or health care provider, and with a clear understanding of the costs and risks of circumcision and the need to continue use of other, proven prevention measures (e.g., reducing the numbers of sex partners and using condoms consistently and correctly). Men who choose to be circumcised should also be counseled about the importance of refraining from sexual intercourse following circumcision, until wound healing is complete. Men should also understand that male circumcision has only proven effective in reducing the risk of infection through insertive vaginal sex."
Citation: Sullivan PS, Kilmarx PH, Peterman TA, Taylor AW, Nakashima AK, et al. (2007) Male circumcision for prevention of HIV transmission: What the new data mean for HIV prevention in the United States. PLoS Med 4(7): e223.
IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER:: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040223
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-07-sullivan.pdf
Related image for press use: http://www.plos.org/press/plme-04-07-sullivan.jpg
- Caption: Painting from Sakkara Old Kingdom, 6th Dynasty, 2300 BC, depicting circumcision
CONTACT:
Patrick Sullivan
Centers for Disease Control and Prevention Division of HIV/AIDS Prevention 1600 Clifton Road NE MS E46 Atlanta, GA 30329
United States of America
+1 404-639-6110
+1 404-324-0903 (First Alternate Telephone)
pss0@cdc.gov
America's "anti-prostitution pledge" is hindering global HIV control efforts
In order to receive US funding for HIV prevention or control projects, recipient organizations must take a pledge that explicitly condemns prostitution. But such condemnation is not effective at helping to control the global HIV epidemic, say researchers in this week's PLoS Medicine.
Nicole Franck Masenior and Chris Beyrer (Johns Hopkins Bloomberg School of Public Health) reviewed the existing scientific evidence on strategies that effectively reduce rates of HIV among sex workers.
They found a substantial body of peer-reviewed published studies suggesting that the empowerment, organization, and unionization of sex workers can be an effective HIV prevention strategy and can reduce the other harms associated with sex work, including violence, police harassment, unwanted pregnancy, and the number of underage sex workers.
"While sex work may be exploitative," say Franck Masenior and Beyrer, "and is illegal in many jurisdictions, sex worker advocates and HIV prevention program leaders generally concur that sex workers themselves need services, protection, peer outreach, and support from health professionals to reduce their risk of HIV infection." The anti-prostitution pledge, they say, places funding restrictions on those HIV programs that have policies calling for decriminalization or legalization of sex work.
The breadth of the pledge, say the authors, and its application to privately funded activities have led to ongoing legal challenges of its constitutionality by a number of organizations involved in HIV prevention and treatment. The findings of Masenior and Beyrer’s scientific review were presented in a declaration for the court in the case of Alliance for Open Society International versus the US Agency for International Development.
Citation: Masenior NF, Beyrer C (2007) The US anti prostitution pledge: First Amendment challenges and public health priorities. PLoS Med 4(7): e207.
IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER:: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040207
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-07-masenior.pdf
CONTACT:
Nicole Franck Masenior
Johns Hopkins Bloomberg School of Public Health Department of Epidemiology
615 N. Wolfe St./ E 7144
Baltimore, MD 21205
United States of America
+1 410-502-0800
+1 410-614-8371 (fax)
nfranck@jhsph.edu
The role of student activism in the fight to control neglected tropical diseases
“University students are by no means passive players in the efforts to increase biomedical attention to the developing world,” argue two medical students in this week’s PLoS Medicine.
Sandeep Kishore and Prabhjot Dhadialla (Weill Cornell Medical College/ RockefellerUniversity/Memorial Sloan-Kettering Cancer Center Tri-Institutional Medical Scientist Training Program, New York) propose that innovative student-led campaigns to address neglected tropical diseases of the developing world “can and do make a practical difference.” The authors discuss one such campaign at their own university.
Citation: Kishore SP, Dhadialla PS (2007) A student led campaign to help tackle neglected tropical diseases. PLoS Med 4(7): e241.
IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER:: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040241
PRESS-ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plme-04-07-kishore.pdf
CONTACT:
Sandeep Kishore
Weill Cornell/ The Rockefeller University/ Memorial Sloan-Kettering Cancer Center Tri-Institutional Medical Scientist Training Program Universities Allied for Essential Medicines New York, New York 10021
United States of America
+1 917 733 1973
sunny.kishore@gmail.com
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