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There is good evidence from randomised trials that circumcising African men helps reduce their risk of acquiring HIV during vaginal intercourse with women. Because HIV spreads mostly through heterosexual sex in Africa, encouraging adult circumcision is likely to have some effect on the epidemic. But what about in the US and other developed countries, where the disease has a different epidemiology?
One team of experts says the African findings translate badly to the US. Here, most sexual transmission occurs through men who have sex with men, and there is little or no evidence that circumcision protects the active partner during anal intercourse. Even if circumcision protects US men during heterosexual sex, the effect of circumcision would be less than in Africa, because most American men are already circumcised and the pool of infected women is relatively small.
More work needs to be done before policy makers can issue recommendations, they write. Individual men who decide to be circumcised should be warned of the risks of surgery and the limitations of protection. Condoms and limiting the number of sexual partners are still essential preventive measures for everyone.