by Hanna Rosin
The responses to the Center for Disease Control's proposal this week to require all American boys to be circumcized are predictably hysterical. Hundreds of commenters wrote into the New York Times today to complain about "child abuse" and "genital mutilation" and one "religious sect's agenda of control" (i.e. Jews). Subsequent news stories refer to the "controversial procedure" and quote CDC epidemiologists carefully measuring their words.
But the procedure is only "controversial" because people have emotional, psychological and religious reactions to it. Scientifically speaking, it's not remotely controversial. The anti-circumcision sites always refer to the American Academy of Pediatrics' 1999 policy statement on circumcision, which declined to recommend the procedure. But that statement was issued before the most compelling studies emerged about the role circumcision plays in reducing the risk for transmission of HIV and other STD's. This is a good overview from medical writer Arthur Allen.
Three trials in which Kenyan and Ugandan men were randomly selected to receive circumcision were halted when it became clear that circumcision helped prevent transmission of HIV. Men who got it were about half as likely to get infected. “A 50% reduction is about the same as some vaccines,” says [Edgar Schoen, MD, who was chief of pediatrics at Kaiser-Permanente Healthcare.]
Yes, conditions in Africa are different. The trials showed results mostly in heterosexual transmission. But the evidence is still pretty strong, and even stronger for STD's. The problem with all this "controversy" is that Medicaid now doesn't pay for the procedure, which costs all of $300 in most hospitals. Rates of circumcision for the poor, particularly African Americans and Latinos, have plummeted in the last ten years.
Over on DoubleX, KJ Dell'Antonia makes the good feminist point. With the HPV vaccines, conservatives raise a fuss that removing the risk of STD's will make girls more sexually promiscuous. In the circumcision debate, silence on the promiscuity front.
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