Mandatory Circumcision Not Cost Effective for HIV Prevention

The topic has generated controversy in recent years as the Centers for Disease Control and Prevention was said to be considering recommendations promoting routine circumcision for HIV prevention.

(SAN DIEGO) - Mandating circumcision in the United States would prevent 24 more cases of HIV than does the traditional optional approach to circumcision, but would increase costs by approximately $389 million, making it far less cost effective, an analysis of published data suggests.

The investigators assumed that the overall incidence of HIV in the United States is 27 cases/100,000 people and the lifetime cost of care for someone with HIV is $119,000, based on published data from government statistics and peer-reviewed studies. Using the $392 cost of a circumcision at their institution, they developed computer-generated estimates of the cost-effectiveness of mandatory or traditional circumcision strategies for various populations, said Dr. Sarah E. Drennan, a third-year resident in ob.gyn. at Ochsner Medical Center, New Orleans.

For the overall U.S. population, mandatory circumcision would prevent 494 cases of HIV at a cost of approximately $790 million. Traditional circumcision – in which the parents choose whether or not to circumcise a newborn – would prevent 470 cases of HIV at a cost of approximately $401 million, she reported at the annual meeting of the American College of Obstetricians and Gynecologists.

The idea of mandatory circumcision policies in the United States has come up because of randomized, controlled trials in Africa showing that male circumcision reduces the risk of female-to-male transmission of HIV by 50%-60%, Dr. Drennan said.

She and co-investigator Dr. Rajiv Gala, also of the Ochsner Medical Center, conducted the current analysis to account for key differences between the two geographical regions. HIV is spread mainly through heterosexual contact in Africa and by intravenous drug use or men having sex with men in the United States. The prevalence of HIV is 5% in sub-Saharan Africa and 0.6% in North America .

The study also compared the two strategies in the United States among African American and Hispanic populations, who have lower rates of circumcision and a higher prevalence of HIV, compared with the population as a whole. Traditional circumcision was the more cost-effective strategy in those subgroups too, although not as strongly as in the population as a whole, she said.

For African Americans, mandatory circumcision would prevent 1,878 cases of HIV at a cost of approximately $816 million. Traditional circumcision would prevent 1,807 cases of HIV at a cost of approximately $613 million.

For Hispanics, mandatory circumcision would prevent 472 cases of HIV at a cost of approximately $792 million. Traditional circumcision would prevent 435 cases of HIV at a cost of approximately $342 million.

"Given the U.S. incidence of HIV, recommendations for mandatory circumcision are not supported" and require more U.S. studies on the role of circumcision in HIV prevention, Dr. Drennan said.

Circumcision would have to cost a mere $2.90 for the two strategies to be equally cost effective in the overall population, she said. The price of circumcision would need to be no more than $3.80 for Hispanics or $15.50 for African Americans for the two strategies to be equally cost effective in those subgroups.

Alternatively, the lifetime cost of HIV would need to be $15 million/case for the two circumcision strategies to be equally cost effective in the general population.

The topic has generated controversy in recent years as the Centers for Disease Control and Prevention was said to be considering recommendations promoting routine circumcision for HIV prevention. The CDC still is considering what might be recommended, but any recommendations will be voluntary in nature, according to the CDC website.

The analysis was limited by a lack of data from randomized clinical trials and by the subjective nature of measuring behavioral risk, she said. The study also did not consider adverse events associated with circumcision or other health benefits other than prevention of HIV.

Sherry Boschert is an Ob.Gyn., this story was first published by News Digital Network

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Anonymous June 26, 2012 11:22 pm (Pacific time)

This IS satire right?

Editor: I'm sorry, are you a penis mutilating proponent? Ha! you were just kidding right?

Pure_Whole_Pristine June 19, 2012 8:53 am (Pacific time)

How can any government in 21st century think of compulsorily mutilating all male genitals? Even the worst country with the worst human rights record cannot even begin to think of it. Perhaps the nation of Americans with all their hubris should look at themselves how dumb they can be to conduct such studies, but then they also routinely take away four wisdom tooth even when there is no problem and pay their dentists to screw them.

Pure_Whole_Pristine June 19, 2012 8:57 am (Pacific time)

Only Dumb Americans can even begin to think of such studies that will suggest to compulsorily mutillate all boys' genitals in 21st century. They also take out their wisdom tooth without any symptoms by paying dentists $2000 and living with less chewing equipment and damaging nerves, wasting time, experiencing pain and suffering after effects of anesthesia.

Frank OHara June 17, 2012 9:37 am (Pacific time)

“The study also compared the two strategies in the United States among African American and Hispanic populations, who have lower rates of circumcision and a higher prevalence of HIV” This is an old myth. The circumcision rate for African American children has been higher (than whites) in every year since 1986. This belief that African Americans are not circumcised comes from the admonishment of “You don’t want to be like “them” do you?” “For African Americans, mandatory circumcision would prevent 1,878 cases of HIV at a cost of approximately $816 million. Traditional circumcision would prevent 1,807 cases of HIV at a cost of approximately $613 million.” This is a leap based on flawed research. HIV is communicated by the exchange of infected body fluids. In sexual intercourse, the man ejaculates infected seminal fluid into the vagina of the woman and she is infected. If circumcision could prevent this exchange of infected fluid, it might prevent some cases of HIV infection. The only thing that can prevent this exchange of fluid is a condom. This is why condoms are 98% effective. Old technology that still works! However, research has shown that circumcised men are more resistant to wearing condoms than genitally whole men. What effect would that have on the spread of HIV? “For Hispanics, mandatory circumcision would prevent 472 cases of HIV at a cost of approximately $792 million” Well over $1 million for each case averted? Can our economy afford that? I shudder to think what an insurance policy would cost. Could the workers who contribute to Medicaid afford the payroll deductions? There are approximately 1.6 million male births each year. The current cost of a neonatal circumcision is approaching $400.00. Do the math? “"Given the U.S. incidence of HIV, recommendations for mandatory circumcision are not supported" Of course not! Our health is our own responsibility. It is known how to stop HIV. Scientists are working on treatments/cures for HIV and apparently are close to a solution with developments such as the Delta 32 genetic program. What do you say to a man that wanted to keep his foreskin when these therapies are introduced? “Sorry” is going to come a little short of adequate.

Harry June 17, 2012 1:04 am (Pacific time)

I'm glad the researcher pointed out the absurdity of it but, honestly, Mandatory Genital Mutilation of Americans? How is that even under consideration in the 'Land of the Free?'

Pat June 16, 2012 9:16 pm (Pacific time)

Cost effective? Is there any concrete evidence that it's even effective in the first place? Men can get HIV through intercourse with infected women, circumcised or not. It's a shame that circumcision is being promoted over preventive methods that are known to work, such as condoms, or HIV testing so people can determine if they actually have the virus to avoid spreading it.

Rick June 16, 2012 4:31 pm (Pacific time)

I anyone ever tried to mutilate my childs genitalia they would pay with swift justice at hand.

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