A rabbi holds an eight-day-old baby during a circumcision ceremony in Brussels, August 20, 2009..
(photo credit: REUTERS)
The lower incidence of HIV among heterosexual men in low-prevalence countries such as Israel is due to circumcision, according to a study published by a Health Ministry AIDS expert.
Dr. Daniel Chemtob, director of the ministry’s department of Tuberculosis and AIDS, and colleagues from the Netherlands and France published the study in the open-access Israel Journal of Health Policy Research. The researchers compared Israel – in which almost all heterosexual males, both Jewish and Muslim – are circumcised, with the Netherlands and France, where only a minority of males are circumcised.
“We showed that global annual rates of new HIV diagnoses were much lower in Israel, both among men and women,” they wrote.
While the protective effect of male circumcision on the prevalence of HIV has been shown in countries with a high prevalence of the disease, until this study, such results were not observed among the general heterosexual population in a country with a relatively low rate, Chemtob and colleagues wrote.
As other factors that influence the transmission of HIV are similar in Holland, France and Israel, the lower rates of HIV among Israeli heterosexuals compared to these countries can be explained by male circumcision alone, they wrote.
Despite the fact that circumcision has been proven beneficial in reducing the spread of HIV, more studies are needed to decide whether to recommend circumcision in other and similar countries “considering the risk of developing a false sense of security and of neglecting condom use.
What the outcomes will be, preventive strategies for HIV should always be delivered as a ‘package’ including [medical] counseling,” the authors wrote.
A commentary on the study by Dr. Brian Morris of the School of Medical Sciences at the University of Sydney in Australia and Dr. Jeffrey Klausner of the University of California, Los Angeles, observed that in countries with a high incidence of HIV, such as the sub-Saharan region of Africa, Israeli public health experts and others have recommended adultmale circumcision.
The new study “supports the evidence and recent polices in the US advocating male circumcision to reduce the spread of HIV,” in countries where prevalence of the virus is relatively low. Over the long term, the reviewers wrote, performing circumcision on newborn boys “is the most desirable option, since is it simpler, safer, cheaper and more convenient than circumcision performed in adult men.” The reviewers also noted that circumcision confers “immediate protection from infections, penile inflammation, genital cancers and physical problems.”
The annual incidence of HIV infection in Israeli men is on average “six times lower than that of the Netherlands (2.0 annual cases per 100,000 population) and France (a mean of 3.3). HIV prevalence was also lower in women in Israel, where the number of cases per year were 10 times fewer over that period when compared with the annual number of cases in women in the Netherlands.