The Unkindest Cut? Gay Men vs. Male Circumcision

via edge, by Peter Cassels

In what will be a first for the nation, San Francisco voters will consider a controversial ballot measure to ban circumcision for males under the age of 18 in the November election.

Each violation would result in a $1,000 fine and there’s no religious exemption.

If voters approve, a ban would certainly face court challenges from the city’s large and politically powerful (Diane Feinstein, e.g.) Jewish community, not to mention Muslims. Both religions trace the practice to the biblical injunction God gave Abraham in the Book of Genesis and have been practicing infant circumcision as a religious rite for thousands of years.

Groups opposing the ban are already lining up against it, but supporters passionately assert that circumcision is medically unnecessary and nothing more than genital mutilation.

One only has to visit websites whenever the subject is discussed to see how many readers ardently condemn the practice. They have been doing so for years.

For most, the controversy has been under the radar until widespread news coverage of the San Francisco ballot measure. Santa Monica voters may consider a similar referendum in November 2012.

Because California is often the trendsetter in American culture, there may be similar moves to ban circumcision elsewhere, unless such efforts are quashed by court rulings that it’s unconstitutional.

"Intactivists," as those opposing circumcision call themselves, offer a litany of reasons why it’s wrong.

They are men and women, gay and straight, who have formed organizations with members in all 50 states and some foreign countries. For several years, intactivist contingents have marched in gay pride parades in San Francisco, New York, Chicago and Vancouver, Canada.

Intactivists say circumcision traumatizes infants, sometimes results in their deaths, suppresses feelings in the penis and interferes with sexual pleasure and performance. They also point out that the vast majority (perhaps 85 percent) of males in other countries are uncut.

They dismiss out of hand contentions by the medical community that circumcision helps prevent STDs, as well as HIV.

Medical experts beg to differ, however.

Read the rest.

SF to Ban Circumcision?

via Joe.My.God


Next year San Francisco's voters may see a ballot question that would ban the circumcision of males under 18 years old.

Read it all.

The unkindest cut of all for the gays (ineffective too)

Circumcision may not cut HIV spread among gay men

via Reuters

Although studies in Africa have shown that circumcision can lower the spread of HIV among heterosexuals, it may not do much to prevent infections among gay and bisexual men in Western countries, a new study suggests.

A number of studies in African nations have found that circumcised heterosexual men were up to 60 percent less likely than uncircumcised men to contract HIV during the study periods.

But it is unclear whether circumcision could have an impact on HIV transmission in the U.S. or other Western countries, where much of the transmission is among men who have sex with men. There has so far been no good evidence that circumcision lowers HIV risk among these men.

In the new study, researchers at the U.S. Centers for Disease Control and Prevention (CDC) looked at HIV infection rates among nearly 4,900 men in the U.S., Canada and the Netherlands who took part in a clinical trial of an HIV vaccine.

They found that circumcised and uncircumcised men showed no difference in the risk of HIV infection over three years.

Moreover, while having unprotected sex with an HIV-positive partner increased a man's risk of infection, there was no evidence that circumcision altered that risk.

Read the rest.

Me and my foreskin: About HIV prevention, circumcision & anal sex

via Fridae, by Jan Wijngaarden

Does this technology work for us, gay men? Is there a protective effect of circumcision during anal sex, or only in vaginal intercourse? Do we all have to line up at the circumcision clinics, and say goodbye to our Holy Prepuce?

The foreskin, for those of you who don't have one (or, worse, have never seen or tasted one), is a retractable double-layered fold of skin and mucous membrane that covers the glans penis and covers the mouth of the urinary tract when the penis is not erect. This is supposed to protect the urinary tract, but there has been some evidence that infections of the penile glans and urinary tract are more common in uncicrumcised men than in their circumcised brothers. Indeed, the most-often quoted reason for circumcision is for both cultural/religious and for hygienic reasons. All Jews and Muslims and some groups of Christians cirumcise their boys, often following quite detailed rituals.

Read the rest.

Circumcision may protect HIV-negative gay men from syphilis

via Aidsmap, by Michael Carter

Circumcision protects HIV-negative gay men from infection with syphilis, Australian investigators report in the December 15th edition of the Journal of Infectious Diseases. However, circumcision did not affect the risk of acquiring any other sexually transmitted infection.

The study was conducted by investigators from the Health in Men (HIM) study. This is the same group of investigators who recently reported that circumcision may protect gay men with a “preference” for insertive anal sex from HIV.

Gay men are disproportionately affected by sexually transmitted infections and new methods of preventing them are required.

Observational studies conducted in heterosexuals have suggested that circumcision is protective against ulcerative sexually transmitted infections, including genital herpes and syphilis. In addition, the Rakai randomised controlled trial showed that circumcision protected against genital herpes, but not syphilis.

Read the rest.

The Latest Fight Over the Foreskin

via New York Times, by Roni Caryn Rabin

In the late 19th century, Victorian-era doctors described the male foreskin as a “source of serious mischief.”

Convinced that masturbation led to insanity, and that it was the sensitive, responsive foreskin that stimulated masturbation, surgeons started promoting therapeutic circumcision to cure young men of the “sin” of excessive indulgence and prevent its corollary, “masturbatory insanity,” a catchall phrase for various psychiatric and physical disorders that perplexed physicians.

Now, in the 21st century, the foreskin has been exonerated as far as masturbation and mental illness go. But public health experts are making a pretty strong scientific case that cells in the foreskin act as a magnet for H.I.V. and, as such, may increase a man’s risk of acquiring the virus from an infected woman if he is uncircumcised.

Read the rest.

Circumcision doesn't protect gays from AIDS virus

Previous research has suggested circumcision doesn't make a difference when anal sex is involved. The latest study, by CDC researchers, looked at nearly 4,900 men who had anal sex with an HIV-infected partner and found the infection rate, about 3.5 percent, was approximately the same whether the men were circumcised or not.

via AP, by Mike Stobbe

Circumcision, which has helped prevent AIDS among heterosexual men in Africa, doesn't help protect gay men from the virus, according to the largest U.S. study to look at the question.

The research, presented at a conference Tuesday, is expected to influence the government's first guidance on circumcision.

Circumcision "is not considered beneficial" in stopping the spread of HIV through gay sex, said Dr. Peter Kilmarx, of the U.S. Centers for Disease Control and Prevention.

Read the rest.

Little HIV protection from circumcision for gay sex: study

[source]

Circumcision, which has been found to reduce by about one-half the transmission of HIV between heterosexuals, appears to offer far less protection for men engaging in homosexual intercourse, according to a study released Tuesday.

The research published in the October 8 issue of The Journal of the American Medical Association compiled 15 discrete studies of more than 50,000 male subjects in Africa.

The report by the US Centers for Disease Control and Prevention noted that male circumcision appears to reduce by between 50 and 60 percent the likelihood of female-to-male transmission of the potentially deadly AIDS virus.

But among men who report having male sexual partners, researchers found little difference in the rate of HIV infection between those who were circumcised and those who were not.

Of 53,567 subjects in the study, 52 percent were circumcised, meaning that they had had all or some of the foreskin removed from the penis.

The study's authors wrote that circumcision appears to provide "not statistically significant" protection from HIV in men who engage in anal sex with other men. The researchers said however that more research may be necessary to quantify the amount of protection -- or lack thereof -- provided by circumcision.

That view was echoed in an editorial that accompanied the article. A team of peer reviewers from Vanderbilt University concluded that "circumcision would likely be insufficiently efficient to be universally effective in reducing HIV risk, and will have to be combined with other prevention modalities to have a substantial and sustained prevention effect."

The findings did suggest however, that male circumcision may offer men engaging in heterosexual intercourse some protection against sexually-transmitted infections, such as syphilis or chlamydia.

Snip protects FEW gays from HIV

via tvnz.co.nz

Circumcision can help protect gay men from contracting HIV depending on their sex habits, landmark Australian research has found.

But the controversial findings have sparked alarm among HIV educators concerned that homosexual men will throw out their condoms if they've had the snip, wrongly believing they are naturally protected.

"We have shown for the first time that men who predominantly take on the insertive role in sex are less likely to contract HIV if they've been circumcised," said Dr David Templeton, from the National Centre in HIV Epidemiology and Clinical Research in Sydney.

"That's very interesting, but most HIV infections are contracted in the receptive role, so what we're talking about is a risk reduction for a small group of men who didn't have a huge risk in the first place."

University of NSW researchers recruited 1,400 HIV-negative men, two-thirds of whom were circumcised, and tracked them over four years to analyse patterns in HIV infection. Over that time, 53 developed HIV.

Results presented at an HIV conference in Perth showed no evidence that circumcision reduced HIV risk among gay men in general.

However, men who predominantly opted for the insertive role had an 85% reduced risk of getting HIV if they were circumcised.

Circumcision is believed to be protective because the operation removes part of the foreskin that is more prone to lesions, allowing the virus to enter the body thorough the penis.

Dr Templeton said while the statistic looked impressive, it was relatively difficult to catch HIV through this kind of sexual activity anyway.

The receptive role was the most common means of infection.

Just seven of the 53 cases were among insertive partners, with study modelling showing five could have been avoided had the man been circumcised.

"That's only nine percent of all HIV infections overall that can be attributed to being uncircumcised, not enough to advocate throwing out condoms or advocating widespread circumcision," he said.

Stevie Clayton, chief executive of the AIDS Council of NSW said it was very important gay men did not see circumcision as a magic bullet.

"And in a public health sense, a mass circumcision program is very unlikely to be an effective or cost-effective way to go," Clayton said.

Mathematical modelling presented to the conference suggested she was correct.

Circumcision of all gay Australian men would cost $196 million in the first two years and would prevent 37 infections a year in the next decade and 57 per year by 2030, according to the projection.

Circumcision No Benefit to the Ladies - Study

[via aidsmap]

There is evidence that men who are circumcised are less likely to become infected with HIV.

But results from a study presented to CROI [Conference on Retroviruses and Opportunistic Infections] show that circumcision is not HIV prevention’s “silver bullet.” The study found that far from being protective, circumcision might actually be associated with an increased risk of HIV transmission. The wives of HIV-positive men who are circumcised being slightly more likely to become infected with HIV than the wives of uncircumcised HIV-positive men.

The study was conducted in Rakai, Uganda and involved over 1000 HIV-positive men. Annual HIV incidence was 14% amongst the wives of circumcised men and 9% amongst the wives of uncircumcised men.

Investigators described these results as “unexpected and disappointing.”

But HIV-positive circumcised men were a third less likely to have genital ulcer disease. This infection has been associated with an increased risk of HIV transmission.

Data split on benefits of circumcision

Conflicting studies on HIV protection for gay men

Via the Washington Blade

ATLANTA — College years are filled with memories, none more exciting for Louis Rahim than the first time he laid eyes on an uncircumcised penis while attending one of the schools that make up the Atlanta University Center.

He remembers every detail of the encounter, from the screen name of the guy he hooked up with, to the animal Rahim thought of when he first saw what was in his pants.

“The skin covered the head, and it reminded me of an elephant trunk,” Rahim said.

More skin is almost a deal-breaker for D.J. Levi, 26, who has a “strong preference” for circumcised men.

“If it’s big enough, I can overlook it,” joked Levi, who added that “my reasons are dumb” for being biased against uncut penises.

“I think circumcised looks better, and it’s more hygienic,” Levi said. “Guys have to be taught the proper way to clean uncircumcised foreskin, and everyone isn’t taught that.

“I’ve actually known guys to have to get circumcision done because they got an infection from improper cleaning,” Levi said.

Despite their differing tastes when it comes to their partners’ phallus, Rahim and Levi share the perception that uncircumcised men are more prone to hygiene-related infections and STDs.

“I’ve read about uncut men being more susceptible to STDs, but that’s if they aren’t being clean,” said Rahim, who added that despite his preference for uncut men, he is glad to be circumcised.

Whether or not circumcision status plays a role in the spread or prevention of STDs is an ongoing topic debated by scientists, with several recent studies coming to dramatically conflicting conclusions. Two separate studies conducted by the Centers for Disease Control and Prevention appear to show that circumcision profoundly reduces the risk for heterosexual men in Africa to contract HIV, while having “absolutely no effect” on whether gay and bisexual men in the U.S. contract the disease.

While trying to figure out why black and Latino gay and bisexual men have higher rates of HIV even though they engage in less risky behavior than their white counterparts, CDC researchers looked at data from more than 2,000 black and Latino gay men to see if being uncircumcised increased their probability of being HIV-positive. About 74 percent of black men in the study — which was unveiled at the CDC’s National HIV Prevention conference last month — were circumcised, compared to 33 percent of Latinos.

“We found no overall association between circumcision status and HIV-infection status among black or Latino [gay and bisexual men],” said CDC epidemiologist Greg Millet (pictured above), the study’s author. “We also found no protective benefit of circumcision among those men reporting recent unprotected sex with a male partner in which they were exclusively the insertive male partner.”

Read the rest.

[Greg Millet was in Chicago this past October. Check out his presentation "HIV Infection Among Black and Latino Men" here. This presentation, and so many other great things, can be found on LifeLube.org - papa to this lil blog.]

The Ole Snip Snip Not Effective HIV Prevention for Black, Latino MSM

The following article abstract adds to other data published this year from Australia, for example, that circumcision is not a useful prevention method in most MSM populations

Circumcision Status and HIV Infection Among Black and Latino Men Who Have Sex With Men in 3 US Cities.

Epidemiology and Social Science

JAIDS Journal of Acquired Immune Deficiency Syndromes. 46(5):643-650, December 15, 2007.
Millett, Gregorio A MPH *; Ding, Helen MD, MS, MSPH *; Lauby, Jennifer PhD +; Flores, Stephen PhD *; Stueve, Ann PhD ++; Bingham, Trista MPH, MS [S]; Carballo-Dieguez, Alex PhD [//]; Murrill, Chris PhD, MPH [P]; Liu, Kai-Lih PhD, MPH [P]; Wheeler, Darrell PhD, MPH #; Liau, Adrian PhD *; Marks, Gary PhD *

Abstract:
Objective: To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection.

Methods: Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. A 45-minute computer-assisted interview and a rapid oral fluid HIV antibody test (OraSure Technologies, Bethlehem, PA) were administered to participants.

Results: Circumcision prevalence was higher among black MSM than among Latino MSM (74% vs. 33%; P < 0.0001). Circumcised MSM in both racial/ethnic groups were more likely than uncircumcised MSM to be born in the United States or to have a US-born parent. Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex.

Conclusions: In these cross-sectional data, there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM.

(C) 2007 Lippincott Williams & Wilkins, Inc.

Circumcision may cut HIV risk among some groups of US men

Circumcision could cut the risk of heterosexual HIV transmission in the United States- especially in some groups such as black and Hispanic men, according to a new evidence review.

But any man considering circumcision needs to discuss the possibility - and the risks associated with the procedure - carefully with their doctor.

Researchers at the US Centers for Disease Control and Prevention have analysed three randomised controlled trials of circumcision as a HIV prevention measure in Africa to find out if any recommendations for the US can be made on their basis.

In each trial - carried out in South Africa, Kenya and Uganda - men who had been randomly assigned to be circumcised were significantly less likely to become infected with HIV up to two years after, compared to a group of men who remained uncircumcised. The risk was cut by between 51 and 60%.

But the potential impact of adult male circumcision on HIV transmission rates in the US is hard to predict, say the researchers writing in PLoS Medicine.

Read the rest on aidsmap.

PEPFAR To Begin Providing Funds for Male Circumcision Programs in Some African Countries, Officials Say

[courtesy of the Kaiser HIV/AIDS Daily Report]

The President's Emergency Plan for AIDS Relief will begin providing money for male circumcision programs in some African countries in an effort to reduce the spread of HIV, a delegation of U.S. health officials led by HHS Secretary Mike Leavitt announced on Sunday while in Johannesburg, South Africa, the Washington Post reports. According to the Post, PEPFAR focus countries have been invited to request program funding to increase access to the procedure (Timberg, Washington Post, 8/20). Leavitt and the officials are on a 10-day tour of four African countries to highlight programs funded by PEPFAR and the President's Malaria Initiative. They will visit Mozambique, Rwanda and Tanzania after their stop in South Africa (Kaiser Daily HIV/AIDS Report, 8/17).

Kent Hill, an assistant administrator for USAID, said recent research indicating that routine male circumcision could reduce significantly a man's risk of HIV infection has demonstrated that the procedure is "going to be one of the major interventions in the international arsenal" against HIV/AIDS, the Post reports. According to Hill, initial investment in circumcision services would be a small portion of program budgets, with funding in the hundreds of thousands of dollars for individual countries. He added that funding likely would increase to be "an important part" of PEPFAR programs in coming months and years, the Post reports (Washington Post, 8/20).

U.S. Officials Praise South Africa's HIV/AIDS Program
The delegation on Sunday also praised South Africa's new five-year plan that aims by 2011 to reduce the number of new HIV cases in the country by 50% and to provide at least 80% of HIV-positive people with access to antiretroviral treatment, the AP/Washington Post reports. South Africa has "constructed a good plan," Leavitt said, adding, "Now it must be executed in a way that makes good on the prospects it offers and the hope it can provide" (Jacobson, AP/Washington Post, 8/20).

Victoria to Scrap Public Hospital Circumcision

Australian Associated Press (08.12.07)

Beginning in September, public hospitals in Victoria will perform male circumcisions only when the operation is medically necessary. Victoria is the fourth Australian state to announce such a decision.

Recent studies in Africa have found that circumcision reduces rates of female-to-male HIV transmission. The Victorian government, however, cited a World Health Organization report indicating that routine circumcision would have limited benefits in countries that, like Australia, have a low prevalence of HIV.

"Both nationally and overseas, doctors agree there is no medical benefit to routine circumcision, and studies show the complication rate is around 5 percent," said Daniel Andrews, Victoria's health minister. Now only 10-20 percent of baby boys are routinely circumcised in Australia and New Zealand, he said.

The approximately 2,000 circumcisions performed at Victorian hospitals in 2005-06 cost about $2 million (US $1.7 million). This money could better be spent on more urgent elective surgery, Andrews said: "It is important to ensure hospital services are prioritized towards treating patients who have a clinical need for surgery to improve their health." He said parents who wish to have their sons circumcised for religious reasons can have the operation done in private hospitals.

Senegal: Circumcision Message Could Confuse Gay Community

Posted to the web 8 August 2007
Dakar

Experts are warning Senegalese men who have sex with men not to get caught up in the hype about male circumcision after recent research indicated that the procedure could offer some protection against HIV, and are urging them to keep using other means of protection.

In 2006, the results of three studies, one each in South Africa, Kenya and Uganda, showed that the risk of HIV infection was up to 60 percent lower among circumcised men. However, these studies were specific to heterosexual interaction.

The HIV prevalence among men who have sex with men (MSM) in Senegal is an estimated 21.5 percent, according to the French Institute for Applied Medicine and Epidemiology (IMEA), compared to a national average of 0.7 percent. AIDS campaigners worry that the preliminary data on male circumcision could lead to reckless sex and an even higher HIV prevalence.

In a 2003 study on stigma, violence and HIV among MSM by Dr Cheikh Niang of the Cheikh Anta Diop University in Dakar, the Senegalese capital, only 23 percent of MSM said they had used a condom during their last sexual encounter.

"Within Senegal's cultural context ... where homosexuality remains a taboo subject, we do not want to encourage people to hide behind the idea that circumcision completely prevents the transmission of HIV," Jean-Louis Rodriguez, former executive secretary of And Ligeey, a Senegalese association working to protect the rights of gay men, told IRIN/PlusNews.

He said the hidden nature of homosexuality in Senegal meant gay men often married or had girlfriends in order to fit into society, but still engaged in clandestine homosexual activity, putting many people at risk. In the IMEA study, 94 percent of participants also had sexual relations with women.

The results of observational research, published in the Journal of Infectious Diseases in 1993, suggested that the risk of circumcised homosexuals contracting HIV during sex could be halved; another study in 2005 in the United States reached the same conclusion.

However, neither of these was as extensive as the three African studies that prompted the United Nations World Health Organization (WHO) to recommend male circumcision as a tool in the fight against the AIDS pandemic.

"We know nothing; [these] are observational studies; therefore, they prove nothing," Bertran Auvert, one of the authors of the South African study, said in an interview published on a gay rights website called 'The Warning'. "We can merely suppose that there is a certain level of protection."

The only thing the medical profession is sure of is that MSM run a considerable risk of HIV infection, especially since intercourse is often unprotected.

Vigilance in prevention must be maintained

"Prevention must always be targeted, so that the message can be better understood and conveyed in the correct manner. When I hear all the media hype about circumcision, I get scared that people will get confused," said Rodriguez.

"We have not yet worked on a specific statement to raise awareness, even if it were merely to tell people that condoms are the only thing that can offer protection."

Khoudia Sow, the HIV/AIDS focal point for the WHO in Senegal, commented that "It is certainly not a question of revising all our prevention techniques; circumcision could play a part in the range of existing measures, but in no instance would it substitute them."

The university's Dr Niang agreed. "MSM have to deal with many situations where they are excluded. Their lives are unstable, they are rejected by society and the health services, they do not have much control over negotiating their sexual relations, and drug use can also be an issue," he said. "These factors increase the risk of HIV infection a great deal more than whether or not they are circumcised."

Male circumcision for prevention of HIV transmission:

...what the new data mean for HIV prevention in the United States


Author(s): Sullivan PS, Kilmarx PH, Peterman TA, et al.

Reference: PLoS Med. 2007 Jul 24;4(7):e223.

Published Abstract:

Three randomized, controlled clinical trials in South Africa, Kenya, and Uganda were recently unblinded early because interim analyses concluded that circumcision of HIV-negative adult males reduced their risk for acquiring HIV infection through penile-vaginal sex [1-3]. In each trial, men who had been randomly assigned to an intervention group receiving circumcision had a lower incidence of HIV infection in up to two years of follow up, compared to men who were assigned to a control group not receiving circumcision. The estimated reduction in the risk of HIV infection ranged from 51% to 60%; per-protocol estimates of risk reduction ranged from 55% to 76%. It is now clear that male circumcision can be efficacious for men in reducing their risk of HIV acquisition through sex with women [4]. Some experts predict that the impact of male circumcision as a biomedical intervention for HIV prevention in Africa could be large [5,6], and preparatory work has been done to establish male circumcision programs in Africa. The implications of African trials on circumcision for HIV prevention programs in the United States are less clear-despite the interest of the popular press in the idea [7]. Here, we consider the differences between the HIV epidemics in Africa and the US, the current status of male circumcision in the US, and the knowledge gaps that will need to be addressed as we consider whether male circumcision should be evaluated or implemented as a biomedical intervention to reduce sexually acquired HIV infections domestically.

The full paper is available here.

IAS: Circumcision may be acceptable to some gay men, but study says no value for HIV prevention

by Michael Carter & David McLay for aidsmap

With male circumcision showing effectiveness in reducing female-to-male HIV transmission among African heterosexual men, some are questioning whether the tool might also be effective in other populations affected by HIV, including gay men and other groups of men who have sex with men (MSM).

Two contrasting studies examining this issue were presented on July 25^th to the 4^th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Sydney. The first conducted amongst MSM in South America found that circumcision would be acceptable as a method of HIV prevention. The second, however, found that circumcised and uncircumcised gay men in Sydney, Australia, had the same risk of becoming infected with HIV.

Read the rest on aidsmap.

MALE CIRCUMCISION, GENE THERAPY, AND POWERFUL NEW HIV TREATMENTS HEADLINE DAY THREE OF IAS CONFERENCE IN SYDNEY

Sydney, 24 July 2007

Research on novel prevention and treatment strategies, and the cutting-edge use of gene therapy to treat HIV disease was presented at today's plenary session at the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Sydney, Australia. Other session topics included female-initiated prevention technologies, provider-initiated HIV testing and the prevention of mother-to-child transmission. A special session explored the future of global financing of HIV prevention, care and treatment.

"While resources for AIDS programming have grown substantially over the past five years, far greater commitments are required," said IAS President Dr. Pedro Cahn, International Conference Co-Chair and Director of Fundación Huesped in Argentina. "To achieve and sustain universal access to HIV prevention, treatment and care, all donors and governments in resource-limited countries must rise to the challenge of strengthening health systems throughout the world."

Regarding the availability of new treatment strategies, Prof. David Cooper, IAS 2007 Local Co-chair and Director of the National Centre in HIV Epidemiology and Clinical Research at University of New South Wales said: "It's an extremely exciting time in terms of drug development. We have better drugs in existing classes, as well as whole new classes of drugs. Patients and their clinicians now have a much wider choice of drug combinations than ever before."

Male Circumcision: From Research to Practice

Over 45 observational studies, three clinical trials and several biological studies all provide compelling evidence that male circumcision reduces HIV transmission from women to men by about 60 percent, according to the lead speaker on Tuesday's plenary panel, Professor Robert Bailey. Bailey is Professor of Epidemiology at the School of Public Health at the University of Illinois at Chicago and Research Associate at the Field Museum in Chicago. Since 1995, he has devoted most of his research activities to the issue of male circumcision as a possible HIV prevention strategy. He has conducted circumcision-related studies in varying communities in Uganda, Kenya, Malawi, Zambia, as well as in the US.

According to Bailey, male circumcision may be the oldest surgical procedure, dating back to at least 2300 BC in Egypt. Today, about 30% of men in the world are circumcised, and about 67% of men in Africa are circumcised. In his remarks, Bailey described modelling estimates that show that millions of new HIV infections could be averted in sub-Saharan Africa if substantial proportions of men were circumcised. In the highest prevalence areas, the impact of circumcision would be greatest, and the intervention would be highly cost-effective.

More on IAS later today.

Does Male Circumcision cut it for Gay Men?

By Jim Pickett

In the last couple of months, I have found myself in the middle, or on one side, of passionate debates with other gay men concerning the potential implementation of male circumcision as an HIV prevention intervention among gay and other men who have sex with men. These conversations have been marked by frustration, stridency for each position, and comparisons to female genital mutilation. More than once, they have devolved into yelling matches. I decided to take the gloves off and chat with a few folks in the community and learn their reactions.

“Wait, what about condoms?” asks Bill Stackhouse, Director of the Institute for Gay Men’s Health at Gay Men’s Health Crisis. “Have we done enough to support and encourage the use of condoms? Circumcision for adults is a serious, medically invasive procedure which does not eliminate the risk of HIV transmission. We clearly do not know how the research out of Africa is relevant to gay men,” he says, highlighting a chief concern among many in the community.

Can we interpret research done with African heterosexual men for gay guys in the Bronx, Berlin or Buenos Aires? While he has reservations and is not enthusiastic about the idea of male circumcision for gay men, Stackhouse would support a sufficiently powered multinational trial with sites in the West, Central and South America to determine if male circumcision would have an effect on the domestic and global HIV/AIDS epidemic.

Karl Grant is a party promoter and the Chair of the Chicago Black Gay Men’s Caucus. “If we had data to prove that this would be effective among the MSM population, and my partner of 10 years wanted to talk about it, I would definitely be willing to talk about it,” he says. “But I don’t like pain or anything associated with it. As an uncircumcised top man, I am used to being uncircumcised and understand the importance of hygiene.”

“I think some people in our community are excited about circumcision because they are grasping for the answer, the silver bullet,” says Simone Koehlinger, the Director of LGBT Health for the City of Chicago. “I would definitely like to have the question answered about its relevance for our community, but also want to remain mindful of the important cultural implications of such an intervention. And we must not dismiss the fact that removing the foreskin also removes a significant degree of sexual pleasure for men. That is not something to take lightly.”

Jim Pickett is the Director of Public Policy for the AIDS Foundation of Chicago

The Caucus for Evidence-Based Prevention is comprised of dozens of diverse organizations.The group monitors HIV prevention programs and policies, reports on HIV prevention-related conference proceedings to a wide audience, and alerts the community when ideology, prejudice, or opinion interferes with evidence-based approaches to reducing the further spread of HIV/AIDS. The article above was published in a newsletter that was distributed May 22, 2007 at the HIV Prevention Leadership Summit in New Orleans.