Turns out that even before NYC health commissioner Thomas Frieden spoke to The New York Times on plans to promote circumcision as an HIV prevention method for men "at high risk" of HIV transmission in the city, the head of another health department a few thousand miles away had pretty much rejected that same idea based on the same studies that Frieden used to support his push.
On March 28th, the World Health Organization and UNAIDS released a joint statement recommending that "male circumcision should be part of a comprehensive HIV prevention package."
In the statement Dr. Kevin De Cock (love the name), Director of the HIV/AIDS Department at WHO, said:
The recommendations represent a significant step forward in HIV prevention. Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment.In addition the statement warns that before implementing the plan among other populations further research was needed:
In countries where the HIV epidemic is concentrated in specific population groups such as sex workers, injecting drug users or men who have sex with men, there would be limited public health impact from promoting male circumcision in the general population.Not heeding those caveats, the Times says that Frieden told them that "it is logical to assume that circumcision would offer protection in some types of gay sex."
Enter Brazil: Known for their groundbreaking HIV prevention programs, particularly in gay populations, Mariángela Simao - the technical advisor of the Brazilian health ministry - told news agency EFE that the studies did not provide any data that circumcision reduced the risk of HIV transmission among gay men.
She also pointed out that the recommendations only were applicable in countries where HIV incidence reached more than 15% of the population which would leave out every Latin American country.
Simao expressed concern that circumcised men might get the message that it is OK for them to have unprotected sex without any risks of HIV transmission and said that she feared that, based on the recommendations, developed countries would now devote current international HIV treatment funding towards circumcision surgery procedures instead of proven methods.
In other words, Brazil has officially rejected circumcision as an HIV prevention method amongst gay men - until specific studies are done - and says that they would rather concentrate their prevention funding on promoting condom use and the free availability of HIV treatments for those that test positive.
Updates: In his statement to the New York Times Commissioner Frieden said that he had consulted gay rights and helth service organizations before speaking to the Times but in the April 6 edition of The New York Post, Tokes Osubu, Executive Director of Gay Men of African Descent says "For anyone to think there is going to be a long line of men in their 20's lining up to have part of their anatomy chopped off, it's ludicrous" and Michael Robinson of People of Color in Crisis says "I can't imagine us going around encouraging adult men to have adult circumcision. It's just too painful."
If these are the reactions of two top gay African-American leaders in the city I wonder which gay advocacy and health service organizations the Commissioner did reach before speaking to media. An April 7 New York Post editorial criticized Dr. Frieden for the proposal (but it should be said that the Post has previously assailed Frieden for some of the City's sound health policy projects including the indoor public space smoking ban and a proposal to ban trans-fats from being used in restaurants throughout the city).
On April 6, the New York Times printed a follow up article in which Mayor Michael Blooberg seemed to distance himself a bit from Frieden's statements.
The Agenda blog also points out that the New York City Department of Health and Mental Hygiene posted a brief response to some of the criticism that sprung over at the New York Times political blog, The Empire Zone (read comments here).
In the brief statement Geoffrey Cowley, a spokesman for the Department of Health, denies that agency is ready to launch a campaign to promote circumcision as an HIV prevention tool in New York City but says that, considering the results of the research in Africa, the possibility is worth exploring.
The Department of Health has also said that they will be organizing community town-hall meetings on the issue to get some feed-back.