Calls for a return to circumcision as a standard practice would only help prevent the spread of HIV among heterosexual men, not gay men.
In the Medical Journal of Australia St Vincent’s Hospital’s Dr Alex Wodak, National Centre in HIV Epidemiology and Clinical Research director David Cooper and Sydney University Molecular Medical Sciences professor Brian Morris wrote that circumcision would help prevent HIV infections in Australia by 2030. They urge Australia to not only encourage the practice, but export it to other countries in the region.
“Male circumcision is one of the most powerful interventions that is currently available in the fight against HIV,” the three wrote.
“The prospect of the availability of a vaccine over the next 20 years is unlikely. Thus, circumcision now to prevent heterosexual HIV transmission in 2030 makes sense … Condom use plus circumcision [is] analogous to seatbelts plus airbags for reducing the road toll.”
“Australia would also be acting compassionately if it promoted infant male circumcision in the Asia–Pacific region, especially in Papua New Guinea where a generalised HIV epidemic has become well established.”
The authors said data from developing nations where HIV was widespread showed circumcision reduced the risk of males catching HIV from females, suggesting countries with far lower HIV rates could benefit too.
“Being a low-prevalence country does not preclude a population-wide approach to HIV prevention … we test pregnant women to prevent cases of vertical HIV transmission. Infant male circumcision would be a comparable, albeit more interventionist, population-wide strategy.”
Dr Gervase Chaney, a member of the Royal Australasian College of Physicians’ Committee for Paediatric Physician Training, told Sydney Star Observer that realities around HIV in Australia were very different to those in developing nations.
“The College does not believe the African data can be directly extrapolated to the Australian or New Zealand circumstance as HIV and other sexually transmitted infections have a much higher prevalence in Africa,” Dr Chaney said.
He said there were also ethical issues to consider when “clearly an infant is unable to consent to a procedure”, and that efforts to educate heterosexuals about the risks of HIV infection would produce better outcomes.
Australian Federation of AIDS Organisations executive director Don Baxter advised caution on circumcising male infants to tackle HIV in straight men.
“There needs to be thorough discussion about the impacts and the value of moving in this direction, particularly in light of the nature of the epidemic in Australia where it is overwhelmingly among gay men and remains around seventy percent so,” he said.
Baxter said there was little evidence to suggest circumcision did much to prevent HIV transmission in gay men, though it was somewhat protective against human papillomavirus (HPV).
However, a vaccine was available for HPV which could be made available on the Pharmaceutical Benefits Scheme.