What Is the Potential Role for Male Circumcision to Prevent Transmission of HIV and Other STD in the United States?

Background:  Male circumcision (MC) has been shown to prevent transmission of HIV and other STD.  However, the epidemiology of HIV, STD, and MC in the United States differs from that in the sub-Saharan African clinical trial settings.  The CDC is drafting recommendations for MC for prevention of HIV and other adverse health outcomes in the United States, taking into account scientific evidence; review by external experts, government agencies, and professional societies; and public comment.

Objectives:  To review research, surveillance data, and other information relevant to MC and the prevention of HIV, STD, and other adverse health outcomes in the United States.

Methods:  A systematic literature review on the risks and benefits of MC was undertaken. Surveys of acceptability and feasibility were conducted among medical providers, insurance payers, and consumers (parents, adult men). Policy and ethical implications of elective MC were reviewed.

Results:  The United States differs from the clinical trial sites in ways that may limit the effectiveness of MC as a prevention tool. The prevalence of HIV is much lower (0.4% vs 6-19%, respectively). Furthermore, most cases of HIV among U.S. men are acquired through male-male sexual contact, and only ~15% are through high-risk heterosexual sex. The preventive benefit of MC among men who have sex with men is not well defined; a recent comprehensive meta-analysis of observational studies found no statistically significant overall association. Finally, the overall prevalence of MC among adult men is nearly 80%.

Conclusions:  The potential role of MC to limit HIV transmission in the United States may be limited, but there are specific considerations for high-risk heterosexual men, men who have sex with men, and male infants.

Implications for Programs, Policy, and/or Research:  Future activities should ensure access to accurate information to make evidence-based individual and policy decisions about MC.