I was shocked, surprised, and flabbergasted to hear it. I’m sure that you'll never believe it, either. The federal government is – get this, readers – butting into your most personal and private business.
OK, you’ve caught me in a rare moment of sarcasm. Maybe I wasn't really that surprised. After all, government bureaucrats attempt to control what types of substances you put into your body, what kind of work you do with your body, and even how you can legally dispose of your body after death; it makes perfect sense that they would also scramble for power over what parts of your body should remain attached. Yes, that’s right. The CDC is now considering a campaign for universal circumcision in the US.
The reason for pushing this one-size-fits-all policy stems from the results of several studies, all done in Africa, which have demonstrated the benefits of male circumcision for reducing the transmission of HIV.
The studies on circumcision and HIV transmission are very interesting. They are large, randomized, controlled trials; the methodology is solid. They show, on average, a 40–60% reduction in the risk of a circumcised, HIV negative man contracting the virus from an HIV positive woman, as compared to an uncircumcised man. The precise mechanism of circumcision’s protective effect is unknown. There are many potential explanations, none of which are mutually exclusive. First, the foreskin has a relatively high population of cells that are receptive to being infected by HIV. Second, it acts as a reservoir which may trap infected secretions. Third, the foreskin has a higher propensity to ulcerate (become scraped) and become infected with other sexually transmitted infections that cause open sores. It seems that removing the foreskin also removes several potential avenues for HIV entry into the body.
However, when considering the benefits of circumcision, there are some significant caveats. For one, circumcision is not a panacea; it does not completely prevent transmission of HIV, it just lowers the probability that a man will contract the virus during any given sexual encounter with an HIV positive woman. It should be noted that these studies only examined the effect of circumcision on transmission of the virus from an HIV positive woman to an HIV negative man. While this is a relatively common scenario in Sub-Saharan Africa, HIV epidemiology in the US is different. Overall rates of infection are lower. Also, HIV in the US is relatively more common among men who have sex with men (MSM). There is no evidence that circumcision protects against HIV acquisition in MSM. Circumcision also does nothing to protect anyone against acquiring HIV via bloodborne routes, such as sharing needles with an HIV positive person. It should go without saying that men can protect themselves from acquiring HIV in other ways besides getting circumcised, such as practicing safe(r) sex and avoiding intravenous drug use. These methods are much more reliable than the 40 – 60% risk reduction conferred by circumcision.
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