by Patrick Appel
A reader writes:
Behavior change is hard - that's why everyone's looking for something (relatively) quick and easy like a medical intervention for HIV prevention. MC/MGM was one of those promising medical interventions. But as an HIV researcher, I am in complete shock and disbelief that the NYT would be so irresponsible as to publish an article scolding South Africa for not promoting male circumcision a mere three days after this piece was published in the Lancet. Two to three times as many female partners of newly circumcised men were newly infected with HIV at every follow-up point than female partners of men who didn't receive the procedure.
This is one of the largest randomized control trials of male circumcision's effects among serodiscordant couples, and had to be stopped for ethical reasons because of the higher infection rates among female partners. They're attributing the higher infection rates in the intervention group to men not waiting to have sex long enough to heal properly, making them more infectious to their partners. Risk compensation leading to new infections among women may counteract the benefit from herd immunity that would be gained by circumcising men. I agree you and Andrew, that this is an entirely separate debate from performing the procedure at birth. South Africa, for everything it has done wrong in the epidemic, should be applauded for waiting until evidence from the trials came available. Especially after this news has come to light, I don't think anyone should be ready to say that circumcising adult, sexually active males is the magic bullet that a. everyone hoped it was or b. the NYT claims it is.