Many Clinicians Unaware of Benefits of Male Circumcision

Emma Hitt, PhD

August 25, 2009

August 25, 2009 (Atlanta, Georgia) — At least a third of American clinicians are "not at all familiar" with the results of randomized controlled trials showing the benefit of male circumcision in preventing HIV transmission.

Katrina Kretsinger, MD, from the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, presented the findings of a physician survey here at the 2009 National HIV Prevention Conference.

A total of 1500 American clinicians — 250 obstetricians, 250 pediatricians, 490 internists, and 510 family physicians — took a Web-based survey to assess their attitudes toward male circumcision.

To date, 3 large randomized controlled trials conducted in heterosexual men in sub-Saharan Africa have shown at least a 50% reduction in HIV incidence among men who have undergone circumcision, compared with control subjects.

More than 90% of the respondents said they felt they could provide appropriate advice to parents of newborn boys about circumcision and most felt they could also counsel adult men. However, 29% to 46% of each of the physician groups surveyed indicated they were "not at all" familiar with the randomized trial data showing the benefit of male circumcision as an HIV prevention strategy.

Of note, 57% of internal-medicine doctors and 58% of family practitioners said that the randomized trial data made them more likely to recommend circumcision for men who engage in high-risk heterosexual sex.

The researchers found that clinicians could misinterpret data from randomized controlled trials as applying equally to homosexual and heterosexual men, even though the population studied included only high-risk heterosexual men.

The survey results also showed that about 30% of clinicians felt that the medical benefits of infant male circumcision outweighed the risks; about 20% said that the benefits did not justify the risk.

"Our findings were concordant with the fact that most physicians profess a neutral view of circumcision, presenting risks and benefits without offering a specific recommendation," Dr. Kretsinger told Medscape HIV/AIDS after the presentation. Currently, the American Academy of Pediatrics does not support routine male circumcision for medical benefit, she said, but "they are reevaluating their policy on this issue."

According to Dr. Kretsinger, the CDC is in the process of weighing scientific and other evidence and formulating recommendations on elective circumcision in populations with high heterosexual HIV transmission, men who have sex with men, and infant boys.

"I'm surprised that the number unfamiliar with the benefits of circumcision is not greater," noted John Bartlett, MD, chief of the Johns Hopkins University School of Medicine, Division of Infectious Diseases, in Baltimore, Maryland. "We hear things again and again, and most of us are on information overload to keep up with the information relevant to our specialty," he told Medscape HIV/AIDS.

Dr. Bartlett added that it is important that primary-care physicians not only maintain awareness of the preventive benefits of male circumcision, but also remain vigilant regarding HIV testing. "That is much, much more important and mainstream for all of medicine," he said.

The study did not receive commercial support. The author and commentator have disclosed no relevant financial relationships.

2009 National HIV Prevention Conference: Abstract A01-3. Presented August 24, 2009.