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“New York City remains the epicenter of the AIDS epidemic.” This was the statement made by the City health commissioner Dr. Thomas R. Frieden as he outlined a planned policy to encourage circumcision in men at the highest risk for contacting the Human Immunodeficiency Virus (HIV), which caused AIDS.
The initiative taken by the City health officials follows a recommendation by the World Health Organization last month touting circumcision as a method to fight the spread of HIV/AIDS in high risk areas like sub-Saharan Africa. Thus far AIDS prevention efforts have focused on practicing safe sex by the use of condoms, abstinence and staying away from used needles.
The CDC estimates that 250,000 Americans are HIV positive currently, but are unaware of it. AIDS is quietly taking root in the country and NYC is at the forefront of this calamity. New York City’s Department of Health and Mental Hygiene has now decided to add circumcision as a method to prevent HIV/AIDS.
“In some subpopulations, you have 10 to 20 percent prevalence rates, just as they do in parts of Africa," Dr Frieden pointed out. The department is also asking Health and Hospitals Corporation to provide circumcision free of charge to uninsured men.
Circumcision is a procedure where the foreskin of the penis is surgically removed. The foreskin has a rich reservoir of white blood cells, which are the main target of the AIDS-causing virus. Removing this area is considered to be very helpful in preventing HIV from crossing over into the body.
It is an outpatient procedure performed under local anesthesia or mild sedation. Barring some discomfort for 24 hours, the patient does not feel anything. The wound heals within 2-3 weeks after which normal intercourse may be safely resumed.
HIV was identified in 1984 by the Institut Pasteur of France. However it was only in n 1985 that Dr. Robert Gallo linked HIV to AIDS.
Those at highest risk for contracting it include homosexual or bisexual men engaging in unprotected sex, intravenous drug users who share needles, the sexual partners of those who participate in high-risk activities, infants born to mothers with HIV.
In recent times circumcision is recognized as a way to prevent new HIV infections in men. Circumcision advocates have urged the WHO to recommend the procedure mainly in sub-Saharan Africa, where AIDS has assumed epidemic proportions.
The basis for the endorsement by the WHO on March 28 are three African trials, which were halted midway due to the huge success in preventing occurrence of new HIV infections.
The trials in Kisumu, Kenya, Rakai District, Uganda and Orange Farm, South Africa, which showed the procedure, had the potential to reduce the risk of heterosexually-acquired HIV infection in men by almost 60 percent. Male circumcision could possibly avert 5.7 million new HIV infections globally, the WHO has estimated. It added that 30 percent of men are circumcised worldwide.
However it must be emphasized that circumcision does not guarantee non-transmission of HIV to female partner. If the viral load in the man is less than 50,000 copies/mL, chances of transmission are remote. But if the man has intercourse before the circumcision wound is healed, chances of passing HIV to his partner are high.
The National Center for Health Statistics says 65 percent of all male babies in the United States are circumcised. But Dr Frieden pointed out cases in NYC where black, Hispanic and foreign-born men are less likely to be circumcised than white Americans.
Reactions to the NYC health department decision were mixed. Peter Staley, a AIDS activist and co-founder of ACT-UP New York, the Treatment Action Group and AIDSmeds.com said it was a catch-22 situation, “Should we proceed when we don’t have hard data yet on the population here?” he asked. “On the other hand, if we wait the three years it would take to answer that question, how many will be infected in the meantime?”
However Mayor Michael R. Bloomberg was doubtful if the procedure could be implemented. In a statement he said “whether it’s something that the government should be involved in, or just giving advice and making sure that people get educated, education in the end is the real tool to stop the spread of AIDS in our society.”
The Department of Health and Mental Hygiene later clarified it had not outlined any policy change, but had only called for discussion on whether circumcision could be used in the anti-AIDS campaign.
For more information, please visit City health department: http://www.nyc.gov/html/doh
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