Infant male circumcision should be encouraged to reduce HIV transmissions in Australia, according to a high- profile public health expert.
Sydney’s St Vincent’s Hospital Alcohol and Drug Service director Alex Wodak said male circumcision prevents the transmission of HIV in heterosexual intercourse and should be a long-term strategy to reduce HIV transmission in Australia.
Wodak’s comment follows three random trials which found that uncircumcised males acquired HIV more often than circumcised males.
The trials done in Uganda, Kenya and South Africa, where HIV is common, involved 11,000 men, some circumcised.
“In each trial the rate of HIV slowed by 60 per cent among the men who were circumcised. There is no reason those results shouldn’t apply to similar heterosexual behaviour in other countries,” he said.
Dr Wodak said there was a host of scavenger cells called Langerhans cells underneath the foreskin of the penis. Once HIV entered Langerhans cells it had rapid access to the blood circulation of the male.
Dr Wodak said the removal of the foreskin would reduce the rate of that happening.
Hollywood Hospital consultant urologist Stan Wisniewski said anyone who had unprotected sexual intercourse was at risk of acquiring an infection whether they were circumcised or not.
Dr Wisniewski said it was dangerous and naive for people to think circumcision would protect them from contracting HIV.
“If you think you can get away with having sex with people with HIV because you are circumcised, you would be stupid,” he said.
“The argument is if you’ve got a foreskin [HIV] can grow longer in there and take longer to fester, but the reality is [HIV] will be down the channel of the penis – the urethra – anyway and it will grow in those areas.”
WA Department of Health spokesperson Judith Chew said it was not known if male circumcision effectively prevented heterosexual HIV transmission in a country with such a low HIV prevalence.
Ms Chew said HIV prevalence in Australia was lower than 0.2 per cent from 1999-2008.
She said men should practise safe sex and get regular testing for the disease. Dr Wodak said circumcised men should still wear condoms during intercourse and that infant male circumcision should be viewed as part of a long-term safer sex package. He said the negative connotations toward circumcision needed to be addressed at government level. “The public health system is not available for infant male circumcision,” he said.
Dr Wisniewski said the procedure was unnecessary particularly when condom protection was still required.
“As a public health measure it is not recommended that we pay for every male to be circumcised because there is no long-term benefit from circumcision,” Dr Wisniewski said.
He said scientific bodies around the world did not describe circumcision as a public health issue.
Published in the Western Independent October 2010