Is circumcision the answer to HIV?

Two randomised controlled trials from Kenya and Uganda reported in the Lancet this week have shown that circumcising men can halve the HIV infection rate. This is great news for controlling HIV, confirming what has been suspected for years. The operation is cheap and simple to carry out and just has to be done once. However there are issues surrounding this intervention, not least the ethical one of circumcising children.

First, circumcision does not prevent HIV infection, it just halves the chance of catching it. Condoms used correctly can do better than that. There will be a challenge in persuading the circumcised to continue to use condoms.

Second, circumcision is a surgical operation and such operations carry their own risks in settings that cannot provide suitable sterility and wound care. As a commentary in the Lancet points out, boys in Africa die from being circumcised. 

Then of course there is the question of whether circumcision would work outside Africa in different societies and in homosexual rather than heterosexual groups. The evidence appears to be that it is protective in men generally but studies in the homosexual population are not quite as promising.

If you subscribe to Global Health here's a suggested search: human immunodeficiency virus* or HIV) and circumcision.