Over the next year, the Office of National AIDS Policy, led by Dr. Jeffery Crowley, will come up with a strategy for fighting HIV in the United States. That project is long overdue. While the Bush
administration devoted unprecedented resources to combating HIV/AIDS in
the developing world, it largely ignored the epidemic here at home.
Over 1.1 million
Americans live with HIV. In 2006, over 56,000 new infections were
recorded. And the disease is increasingly associated with minority
communities and the poor; in Washington, D.C.,
the major American city with the highest HIV/AIDS rate, 4.3 percent of
all African Americans are infected. Among black men in D.C., 6.5
percent are HIV-positive.
Internationally, the HIV-prevention method gaining the most momentum -- and attracting the most press -- is male circumcision. A series of studies
conducted in Africa found that circumcision decreases female-to-male
HIV transmission by as much as 60 percent. That is because the cells of
the foreskin are especially susceptible to infection. (Women though,
aren't any less likely to contract HIV from circumcised men.) Since
2007, the World Health Organization has strongly recommended
circumcision, calling the new research on the procedure "an important
landmark in the history of H.I.V. prevention."
Considering this evidence, should circumcision-promotion be among the policy levers the Obama administration considers? As New York City Mayor Michael Bloomberg learned
two years ago, when he created a maelstrom by asking the city health
department to encourage the procedure, American public health efforts
must tread carefully
around this issue. The promising circumcision research was conducted
entirely in Africa, largely among heterosexuals. In the United States,
HIV continues to disproportionately affect the gay community. In 2005,
half of all new cases were among men having sex with men, compared to
33 percent among heterosexuals engaged in what the CDC calls
"high-risk" behaivor -- a woman who has unprotected sex, for example,
with a man who is also having unprotected sexual encounters with other
men.
American HIV/AIDS advocates have worked for nearly three decades to
send the message that condoms are the best way to protect against the
disease. That messaging has been effective, and it's important to
double down on it within the gay community: Clinical studies show that
gay sex is much more likely to lead to HIV infection than hetero sex.
Among men having sex with men, circumcision is likely to offer very
little protection against the disease. But the truth is, we don't have
good research on that question -- and certainly not in an American
context.
About 60 percent of American men are already circumcised. Those who
aren't are more likely to be recent immigrants or first generation
Americans, and to hail from cultures resistant to condom usage. For
these men, a public health push on condoms is likely to reap far
greater dividends than a pro-circumcision campaign, which is likely to
be seen as even more radical and intrusive. What's more, condoms are
far cheaper than circumcision. So when it comes to extrapolating
American public health policies from the African circumcision research,
we should proceed with caution. After all, the United States already
has the highest circumcision rate in the developed world -- and also
the highest HIV infection rate.
cross-posted at TAPPED
, sociologists Kathryn Edin and Maria Kefalas
demonstrate that many poor, single moms choose to delay marriage
because the immature, jobless, sometimes abusive men in their lives
simply would not be good husbands or stable fathers. These young women
are fairly socially conservative; they aspire to marriage, value
parenthood, and are often anti-abortion. They won't settle for
relationships that devalue these beliefs. 
