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AIDS Watch: Measure Twice, Cut Once

Circumcision is more than a religious experience.

By Kelly A. McCann

Kelly McCann

I am a lesbian and I always have been, so I don’t have any experience with penises. I possess no maternal instincts, so I have no children, and, specifically, no sons. And I’m neither Jewish nor Muslim. Therefore, it’s easy to understand why circumcision is a topic with which I had very little familiarity. Until now.

Male circumcision involves the surgical removal of the foreskin (prepuce) of the penis. Although the end result of the procedure is basically the same regardless of where in the world one is, culture and geography do influence the ways in which the practice is carried out. For example, in certain traditions the surgical procedure is performed on infants, while others require that circumcision not be done until adolescence or even adulthood.  

Other differences have to do with the actual procedure itself. The foreskin might be removed by a scalpel, a stone knife, or a sharpened shell. Anesthesia may or may not be a part of the equation. Methods for disposal of the foreskin range from burial to (uh, there’s no delicate way to put this) eating it.

It is thought to have begun thousands of years ago, and ancient cave drawings and paintings in Egyptian tombs give evidence of its lengthy history. Whether it started as a religious sacrifice, a rite of passage into adulthood, or as an aid to hygiene, circumcision is a long-standing practice that is still commonplace today.

The World Health Organization estimates that approximately 30 percent of the world’s male population over the age of 15 is circumcised. It is commonly practiced in the Jewish and Islamic faiths, and it is prevalent in Southeast Asia, most of Africa, and North America. However, it is a relatively rare practice in South Africa, Europe, Latin America, most of Asia, and Australia.

It should be noted that in recent years, the practice of circumcising infant males has decreased in the United States. It is believed that fewer procedures are performed because Medicaid does not cover the cost, and because the American Academy of Pediatricians does not recommend it. Even the American Medical Association stated in 1999, “Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice.”

Obviously, circumcision is currently controversial. Those who oppose it make several different arguments: it is unethical to remove healthy, functioning tissue from a minor. It reduces sexual sensitivity and sexual satisfaction. It is a painful and medically unnecessary procedure that can cause complications.

Despite the claims of opponents, there exists a body of evidence that suggests the benefits of circumcision outweigh the potential risks. One significant benefit may be a reduction in the likelihood of contracting HIV.

Many studies have indicated that circumcised men are less frequently infected with HIV than those who are not circumcised. More specifically, several clinical trials in the African countries of Kenya, Uganda, and South Africa showed that circumcised adult males had their risk of contracting HIV from an infected woman reduced by as much as 60 percent when compared to their non-circumcised counterparts. Due to the results of these studies, the CDC is considering the issuance of recommendations that promote routine circumcision for all baby boys born in the United States.

Here’s why circumcision may help to prevent the spread of HIV. The foreskin has immune cells called dendritic cells. It is theorized that HIV can more easily enter the body through dendritic cells. By removing the foreskin, and thus the dendritic cells, it reduces a man’s chances of contracting HIV.

More evidence for the theory that HIV has easy entry into the body through foreskin dendritic cells came in the form of a study conducted by Johns Hopkins University’s Rakai Health Sciences Program. The researchers followed 965 Ugandan men (who were initially HIV-negative) and investigated the correlation between foreskin size and HIV infection risk.

The results of the study were published in the October 2009 issue of the journal, AIDS. Findings showed significantly larger foreskin surface areas among the men who acquired HIV during the study. It’s simple. Bigger foreskin equals bigger risk. And that makes sense if you consider that bigger foreskins contain more dendritic cells.

So it appears that foreskin, especially larger foreskin areas, increase a man’s chance of contracting HIV. Since circumcision provides some protection, it should be considered as an HIV-prevention technique.

However, circumcision alone does not completely prevent HIV transmission, so it is still strongly recommended that condoms and other barrier methods also be employed every time one engages in sexual activity.

Kelly McCann is chief executive officer of AIDS Foundation Houston. For information on AFH’s World AIDS Day luncheon, call 713/623-6796 or visit the website at


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