SHOULD THE CDC RECOMMEND CIRCUMCISION?

The New York Times reports that the CDC is weighing recommending routine circumcision of baby boys, and even adult circumcision for populations at high-risk of contracting HIV. As I've written before, this would be a curious and rather hasty move. While it's true that the World Health Organization recommends circumcision, the studies that showed the procedure significantly decreased the risk of HIV contraction are not easily applicable to the United States. The research was conducted entirely in Africa, among heterosexuals. But in America, half of all new HIV cases are among men having sex with men, compared to 33 percent among heterosexuals engaged in what the CDC calls "high risk" sex. And gay sex is simply much riskier than straight sex, meaning that any method short of a condom is unlikely to provide much protection against STIs.

There's another interesting health policy link here: the American Academy of Pediatrics says circumcision of baby boys is "not essential," so in many states, Medicaid -- which pays for 40 percent of all American births -- does not cover the procedure. That means low-income boys, who are disproportionately black and Hispanic, are less likely to be circumcised. They are also more likely to be exposed to HIV.

Medicaid should cover circumcision, so that all parents can weigh the pros and cons and make a choice. But it would be a dire mistake to send the message that circumcision is a highly effective HIV prevention method -- especially in those communities most likely to contract the disease. The public health messaging needs to be consistent and based on good science: We know condoms work, for both straight and gay people. Other methods simply aren't as effective.

--Dana Goldstein

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