NHPC 2009: Physicians woefully ignorant of the foreskin, slightly more ignorant of the belief circumcision “prevents” AIDS

[This is a republished post. I do not know why there is no reference for this report or link to a source. It is highly likely that the percentages cited below have changed. NHPC refers to the National HIV Prevention Conference hosted by the Centers for Disease Control. This report is from the event that occurred in August, 2009.]

The CDC presented today the finding of Katrina Kretsinger, Deb Gust, Bob Chen, James Heffelfinger, and Peter Kilmarx that physicians (internists, family physicians, pediatricians, and obstetricians) are not very knowledgeable of the African RCT conclusion that male circumcision reduces the risk of HIV from females to males. While 87% or more of the physicians who treat newborns and new mothers said they could appropriately counsel their patient’s parents on proxy consent for neonatal circumcision (right? or did they even consider that it is proxy consent?), around 60% of physicians who treat adults said they would recommend male circumcision to men who have sex with men based on the African RCTs. They apparently did not know that there is no evidence circumcised men who engage in sex with men are at lower risk of contracting HIV.

Perhaps more interesting is that between 17% and 24% of physicians treating children said the risks outweigh the benefits from neonatal circumcision. However, only 6% to 7% of physicians actively recommend against infant circumcision. This is the position of the majority of the world’s physicians, suggesting that a majority of American physicians are woefully ignorant of the level of risk and paucity of benefits from neonatal circumcision. The ethics of eliciting proxy consent for a procedure with little benefit during the neonatal period was not considered.

Additionally, between 53% and 59% of physicians treating children said the conclusions of the African RCTs made no difference in their recommendation of infant circumcision to the parents of their patients. The conclusion of the authors characteristically did not reflect the findings of their study or the context of neonatal circumcision in the United States. Instead, they recommended a decontextualized educational campaign to “help physicians make evidence-based recommendations.”

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