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  • Circumcision reduces risk of AIDS - doctors
    • Mangi Mosbi
      Posted Sep 21, 2010 8:49 AM

      Doctors resume circumcision debate
      ABC

      Barbara Miller reported this story on Monday, September 20, 2010 12:38:00


      ELEANOR HALL: It's the exception rather than the rule these days to have baby boys circumcised for health reasons, but several prominent physicians say that should change.

      The doctors argue that boosting the male circumcision rate in Australia could significantly reduce HIV transmission among heterosexuals, but the Royal Australasian College of Physicians is against the move, as Barbara Miller reports.

      BARBARA MILLER: These days it's the exception when an infant boy in Australia is circumcised for non-religious reasons.

      Sydney woman Sally said she thought long and hard about the pros and cons of having the procedure done when she had a baby boy earlier this year. She decided to go ahead, but wasn't prepared for the backlash.

      SALLY: It was a terrible decision because I didn't feel like I could talk to other mums about it and when I did ask mums who did have sons and I mean, it had never been a question on my mind because I had two girls, most of them hadn't and a number of women were quite aggressive about it and quite, you know, confronting about it.

      BARBARA MILLER: Sally says one factor in her decision was evidence from studies in sub-Saharan Africa that circumcision can reduce the rate of HIV-AIDS transmission in heterosexuals.

      In the current edition of the Medical Journal of Australia a group of physicians argue that that evidence is compelling. They say boosting circumcision rates as a long-term strategy to reduce HIV transmission would be sound public health policy in Australia.

      One of the authors is Dr Alex Wodak, the director of the Alcohol and Drug Service at St Vincent's Hospital in Sydney.

      ALEX WODAK: It is a significant reduction. Now, of course, we shouldn't be abandoning all the excellent prevention measures that we already have. In fact, we should be intensifying them. This should be a new prevention measure in addition to the other ones.

      BARBARA MILLER: Is it not a bit extreme to recommend that the entire male population is circumcised in the hope of just achieving a reduction in possible rates of transmission?

      ALEX WODAK: Well, no one is calling for this to be mandatory or obligatory or routine. What we are calling for is a level playing field. That is to say parents should be given balanced information, not the extremist information they are given at present which exaggerates the risks and underestimates the benefits.

      ANDREW PESCE: I guess on a personal level I find it difficult to believe that a foreskin evolved over billions of years of human evolution needed to be chopped off as soon as the baby was born.

      BARBARA MILLER: Dr Andrew Pesce is the president of the Australian Medical Association.

      ANDREW PESCE: What we are talking about is that otherwise healthy boys have an operation because of a feeling that it's good for them in the future even though there is nothing wrong now and that requires a lot of rigorous data collection, a really good understanding of what the potential benefits over the lifetime of the operation are and balancing them up against the immediate surgical risks of a procedure which can have a low but a measurable complication rate of bleeding, infection, scarring things like that.

      BARBARA MILLER: Just last week the Royal Australasian College of Physicians affirmed its opposition to routine circumcision after a review of the latest evidence.

      Gervase Chaney is the college's president of the paediatrics and child health division. He says he can't support the arguments put forward by Alex Wodak and his colleagues:

      GERVASE CHANEY: We don't agree with it. We believe that the evidence currently would not support that in Australia, that it might be supported in other countries particularly obviously in Africa where there are much higher rates of HIV transmitted heterosexually but that at this stage that that is not something that we would support but that we agree to disagree with that group.

      BARBARA MILLER: The College of Physicians says parents need to make their own decision about circumcision, saying it recognises it's a difficult choice and Sydney woman Sally says it's not just medical issues that need to be considered.

      SALLY: I was worried that he would get teased at school when he was older you know, in the dressing sheds if everybody else was not circumcised and he was and the doctor said to me that by the time he is an adolescent about 30 even 40 per cent of boys will probably be circumcised and as a friend of mine said to me, look Sally, no adolescent boy is going to admit looking at someone else's penis let alone teasing them for it so maybe that is not such a big deal.

      BARBARA MILLER: The Royal Australasian College of Physicians is expected to make its latest advice on circumcision publicly available later today.

      ELEANOR HALL: Barbara Miller reporting.
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