Circumcision in the control of HIV?

Ken Rankin (AH, Jan '94, p 34) rightly points out that more circumcisions are carried out than are justified on clinical grounds alone. However, the advent of AIDS raises a number of interesting points about the possible role of circumcision as an epidemiological tool for the control of HIV transmission. It has been reported that an absence of circumcision increases susceptibility to acquiring STDs. STDs, especially those that cause genital ulcer disease (such as syphilis, chancroid and genital herpes), are recognized major risk factors for the transmission of HIV. Furthermore, some studies have shown that the distribution of HIV seroprevalence in Africa is closely associated with the geographical pattern of circumcision practices, whilst other workers have shown an association between absence of circumcision and HIV seropositivity. In some societies where circumcision was formerly practiced on religious/cultural grounds, it has now largely been abandoned as a consequence of urbanization and the adoption of Western lifestyles. In such situations, a revival of this ancient custom might supplement other control measures against HIV transmission. The only proviso would be an insistence on sterile procedures. The devastating impact of AIDS, especially in sub-Saharan Africa, necessitates a consideration of all possible interventions.