Letter to the Editor -cd

Regarding Professor Robert C. Bailey’s presentation during the Bioethics Lectures Series April 23, this statement attributed to him cannot go unchallenged: “Through observational studies, it was concluded that male circumcision protects against HIV acquisition.” This is just not true, yet the media are gobbling it up. As published in “Future HIV Therapy” this month, my coauthors and I point out that the African studies were conducted in atypically sanitary clinics with highly skilled operators and cannot be extrapolated to the general population. The studies have been criticized for their poor science including: the men were paid to be circumcised, received free condoms and extensive education, and the studies were halted after only 21 to 24 month periods. During the course of these studies, 77 fewer circumcised than uncircumcised males contracted HIV, however, the circumcised group needed to refrain from sex to recoup from surgery, and they were receiving extensive monitoring and counseling about sexual behavior. Also, hundreds of study participants were lost to follow-up. There is not enough evidence to conclude circumcision would offer any real long- term benefit in the HIV battle. Even if circumcision did reduce the risk of HIV infections, condoms and safe-sex practices are still far more effective. If an individual is engaging in high-risk behavior, he and his partner are at risk, regardless of whether he is circumcised or not. Promoting circumcision to prevent HIV will drain millions, possibly billions, of dollars away from more effective strategies, and cause tens of thousands of infections and other surgical complications, further straining an already overwhelmed healthcare system and undermining the current ABC (abstinence, be faithful, and use condoms) campaigns by creating a false sense of immunity and increasing risk-taking behaviors. African males are already lining up to be circumcised, believing that they will no longer need to wear condoms, and this is a serious concern. John W Travis, MD, MPH