Opinion Pieces Examine Male Circumcision for HIV Prevention

The Los Angeles Times and the Journal of the American Medical Association recently published opinion pieces about male circumcision as a method of HIV prevention. Summaries appear below.

• Los Angeles Times: As circumcision "gain[s] a hold in communities where historically it has not been practiced" in sub-Saharan Africa, policies surrounding the procedure "must be supported with appropriate resources, and government and health leaders must work with practitioners on the ground to make sure that the procedure is wholly beneficial and in no way harmful," Paul Perchal -- director of the HIV/STI Program for EngenderHealth -- writes in a Times opinion piece. According to Perchal, "Support is needed in regions where health systems are weak so that health professionals are properly trained to perform circumcisions and always use sterile instruments." To be effective, Perchal writes that circumcision "must be offered as part of an overall HIV prevention strategy, not as a stand alone service." He writes that proper information about circumcision is "essential" for men to "understand that circumcision won't make them immune to HIV or other sexually transmitted infections, and that condom use is still crucial." Without this information, women could be harmed by an increase in male circumcision because "men who are circumcised may believe that they do not need to use condoms," Perchal writes, adding that funding for HIV prevention methods that "involve and benefit both women and men may be shifted disproportionately" to circumcision -- which "serves only men." Recognizing that "what works in one community may not be appropriate in another," governments must "remai[n] respectful of existing traditions while ensuring safety" for all who undergo the procedure. He concludes that "having full information" and "high-quality care" are "two factors that should never be compromised for anyone, anywhere" (Perchal, Los Angeles Times, 12/3).
  
  
• JAMA: Lawrence Gostin of the O'Neill Institute for National and Global Health Law at Georgetown University and Catherine Hankins of UNAIDS write that "male circumcision can have deep symbolic meaning that could pose barriers to implementation." They add that because "the procedure may be viewed with suspicion, particularly if outsiders propose it," implementation planning "should involve all sectors of society, including government, health professionals, persons living with HIV, the media, nongovernmental organizations, traditional health practitioners, as well as men, women and youth." The authors continue that in order to make the procedure "available and affordable to all who seek it, human resources, training, infrastructure, logistics, funding, ... quality assurance, monitoring and evaluation" are necessary. They write, "All sectors of society should be able to access accurate information about the benefits and risks of male circumcision," adding that "health professionals should communicate with patients and their sexual partners or parents in a culturally and linguistically appropriate and effective way." Confidentiality of a person's HIV and circumcision status is "essential for the dignity of the person," the authors write. Lastly, they add that it is "important that male circumcision services do not diminish the resources and attention devoted to prevention, treatment and empowerment of women" and "sexual partners should be involved in the decision-making process." They add that "governments should take strong measures to ensure that male circumcision is not used as an excuse to tolerate female genital circumcision, which has no health benefits and is harmful to the health and well being of girls and women." The authors conclude, "To be fully effective, male circumcision services -- whether for adults, adolescents or infants -- need to be scaled up to achieve coverage levels adequate for population effect" (Gostin/Hankins, JAMA, 12/3).