Male Circumcision: The New HIV/AIDS Vaccine?(The Options‪)‬

In March 2007, the Centers for Disease Control and Prevention (CDC) released a report indicating that male circumcision showed considerable benefit in reducing HIV incidence in men. In areas where HIV-1 prevalence constitutes a population epidemic, male circumcision could have a dramatic life-saving effect at the population level. Prevention expert Thomas J. Coates, PhD, professor in residence at the University of California at Los Angeles, commented that "male circumcision is the best thing that has happened in HIV prevention since the prevention of mother-to-child transmission. This is a fantastic result." For this reason, circumcision is the perfect issue to stimulate new thinking on prevention interventions that combine behavioral, social, and biomedical approaches. (1) More importantly, circumcision is not just an issue for the developing world where there is a high prevalence of infection. It is becoming an issue for the developed world as well. For example, the rate of circumcision in the United States has declined to about 50% of all adult men, and it is lowest among the younger age groups in which half of HI V infections occur. (1) The implications of the decline in male circumcision in the developed world are significant. The recent focus on antiretroviral treatment--although necessary and appropriate--has made primary prevention a secondary issue. Renewed interest in HIV prevention is welcome. A recent article in the New York Times Magazine astutely pointed out that an AIDS vaccine, when and if it arrives, is likely to be imperfect, with efficacy rates somewhere around 60%. (2) The result is that a vaccine will become "one more tool in our arsenal to be used along with condoms and all our other tools." (2) Male circumcision, therefore, takes on new importance because of the failure of scientists to develop a vaccine to prevent HIV infection and AIDS. Combining male circumcision with prevention strategies known to reduce transmission rates--for example, the use of antiretroviral drugs--would further reduce new infections.