Declining Rates in Male Circumcision amidst Increasing Evidence of its Public Health Benefit

Hubert H. Humphrey Fellowship Program, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
PLoS ONE (Impact Factor: 3.23). 02/2007; 2(9):e861. DOI: 10.1371/journal.pone.0000861
Source: PubMed


Recent experimental evidence has demonstrated the benefits of male circumcision for the prevention of human immunodeficiency virus (HIV) infection. Studies have also shown that male circumcision is cost-effective and reduces the risk for certain ulcerative sexually transmitted diseases (STDs). The epidemiology of male circumcision in the United States is poorly studied and most prior reports were limited by self-reported measures. The study objective was to describe male circumcision trends among men attending the San Francisco municipal STD clinic, and to correlate the findings with HIV, syphilis and sexual orientation.

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    • "However, the rate of circumcision in the African American non- Hispanic population in our sample (36%) is lower than the national average (73%; Xu et al., 2007) and lower than STD clinics in other cities, for example, African Americans in STD clinics in New York (58%–68%; McKinney et al., 2008) and San Francisco (62.2%; Mor et al., 2007). This study raises an additional question: Is the lower rate of circumcision seen in African Americans in the MDC STD clinic driven by lower rates of circumcision in African Americans or by Haitians, both of whom may be reported as " African American. "
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    ABSTRACT: The objectives of this study were assessment of the prevalence of male circumcision (MC) among patients attending the Miami-Dade County (MDC) sexually transmitted diseases (STDs) clinic and exploration of attitudes of MC among Hispanic STD clinic attendees. Prevalence of MC was assessed by a review of 500 clinic records. Attitudes toward MC were explored during focus group sessions. The overall rate of MC was 27%. Men associated acceptability of MC with sexual performance, their partner's anticipated responses to MC, and scientific proof of STD protection; whereas women focused on experiences with previous partners and hygiene. We found a low rate of circumcision in males attending the MDC STD clinic. Approximately half of the Hispanic men and women in focus groups also found MC acceptable or desirable. Spanish Los objetivos del estudio fueron determinar la prevalencia de la circuncisión masculina (CM) en pacientes atendidos en la clínica de transmisión sexual del Departamento de Salud del Condado de Miami-Dade (STD) y la exploración de actitudes hacia la CM entre pacientes Hispanos de esta clínica. La prevalencia de CM se estimó mediante la revisión de 500 historias clínicas y se exploró las actitudes hacia la CM mediante grupos focales. La tasa de CM fue de 27%. Los hombres asociaron positivamente la CM con el buen desempeño sexual, con una respuesta positiva a la CM por parte de sus parejas y con la evidencia científica que señala que la CM proteje contra las enfermedades de transmisión sexual, las mujeres se centraron en experiencias previas y en higiene. Conclusiones: Encontramos una tasa baja de CM en los hombres que atienden la clínica de enfermedades de transmisión sexual sin embargo aproximadamente la mitad de los hombres y mujeres Hispanos encontraron la CM aceptable o deseable.
    Full-text · Article · Dec 2012 · Hispanic Health Care International
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    • "MSM who were uncircumcised had higher STD positivity rates than MSM who were circumcised (18.2% and 11.4%, respectively). Although the difference was not statistically significant, it is likely that a non-urethral, but rather rectal acquisition of those infections (or a possible oral infection in cases of syphilis) among circumcised men was the main route of transmission, as found in other countries [22,23]. Our findings are subject to potential limitations. "
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    ABSTRACT: The increase in human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Israel during the last decade raises concerns regarding other sexuallytransmitted diseases (STD) in MSM, which are yet undetermined. To evaluate the STD burden among MSM and heterosexuals visiting the Tel Aviv walk-in STD clinic. Records of all male patients who attended the clinic once were reviewed to identify demographic characteristics, behavioral attributes, and test results. Between 2002 and 2008, 1064 MSM (22%) and 3755 heterosexuals (78%) visited the clinic once. Positivity rates in MSM for HIV, urethral Neisseria gonorrhoea and infectious syphilis were higher than in heterosexuals (2.5%, 2.5%. 0.7% vs. 0.6%, 1.3%, 0.3%, respectively), while urethral Chlamydia trachomatis was higher in heterosexuals than in MSM (2.7% and 1.4%, respectively). MSM tested in our clinic were younger than heterosexuals (P<0.001), more commonly circumcised (P=0.03) and Israeli-born (P<0.001), used substances during sex (P=0.04), and had prior STD (P<0.001), a greater number of sexual partners (P<0.001), and earlier sexual debut (P=0.02). The final multivariate results for MSM to be diagnosed with HIV/STD were greater number of sexual contacts, previous diagnosis with STD, and infrequent use of condom during anal intercourse. MSM visiting the Levinsky Clinic had higher rates of HIV/STD than heterosexual males, which correlated with their higher-risk behaviors. The unique characteristics of MSM found in our study, such as sex work, substance use, previous diagnosis of STD, multiple partners and inconsistent use of condom during anal sex should be addressed with innovative interventions to prevent STD/HIV in the gay community in Israel.
    Full-text · Article · Mar 2012 · The Israel Medical Association journal: IMAJ
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    • "Topical oestrogen has been shown to hasten wound healing [16] and could also be used before and after circumcision to reduce the postoperative wound healing time. Furthermore, whilst male circumcision is undoubtedly effective [17], [18], implementing it is a daunting task, particularly in countries like India, China and most of South-East Asia where it is culturally unacceptable [15]. In such cases, topical oestrogen could provide a medical alternative to circumcision to reduce HIV infection. "
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    ABSTRACT: With the growing incidence of HIV, there is a desperate need to develop simple, cheap and effective new ways of preventing HIV infection. Male circumcision reduces the risk of infection by about 60%, probably because of the removal of the Langerhans cells which are abundant in the inner foreskin and are the primary route by which HIV enters the penis. Langerhans cells form a vital part of the body's natural defence against HIV and only cause infection when they are exposed to high levels of HIV virions. Rather than removing this natural defence mechanism by circumcision, it may be better to enhance it by thickening the layer of keratin overlying the Langerhans cells, thereby reducing the viral load to which they are exposed. We have investigated the ability of topically administered oestrogen to induce keratinization of the epithelium of the inner foreskin. Histochemically, the whole of the foreskin is richly supplied with oestrogen receptors. The epithelium of the inner foreskin, like the vagina, responds within 24 hours to the topical administration of oestriol by keratinization, and the response persists for at least 5 days after the cessation of the treatment. Oestriol, a cheap, readily available natural oestrogen metabolite, rapidly keratinizes the inner foreskin, the site of HIV entry into the penis. This thickening of the overlying protective layer of keratin should reduce the exposure of the underlying Langerhans cells to HIV virions. This simple treatment could become an adjunct or alternative to surgical circumcision for reducing the incidence of HIV infection in men.
    Full-text · Article · Jun 2008 · PLoS ONE
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