ARC Letter to AAP
A similar letter was sent to the CDC.
706 The Alameda, Berkeley, CA 94707, 510-827-5771
Renée Jenkins, M.D., President, AAP
Department of Pediatrics and Child Health, Howard University Hospital
2041 Georgia Ave, NW, Room 6B02
Washington, DC 20060
December 14, 2007
Dear Dr. Jenkins:
We have followed with alarm the attention being given to a handful of flawed randomized controlled trials (RCT’s) that purport to show a protective effect against HIV of circumcision of adult males in Africa. We have just learned that Dr. Peter Kilmarx of the Centers for Disease Control and Prevention (CDC) recently gave a presentation titled, “Male Circumcision and HIV Infection” at the National HIV Prevention Conference held in Atlanta, Georgia. We understand that the AAP task force on circumcision has reconvened and a new position statement may be issued at some point.
Recent reports indicate that the United Nations and other influential bodies have significantly exaggerated the number of people affected by HIV and AIDS. Moreover, for well over a decade the number of new individuals being infected with HIV has been in decline. Regardless of whether the RCT’s are relevant to adults in Africa, they are completely irrelevant to whether infants should be circumcised in the United States. North America and Africa differ radically in demographics and modalities of infection. Moreover, the circumcision experiment has already been tried and failed, as the US has both the highest circumcision rate and the highest HIV rate in the developed world.
Benefits of neonatal circumcision have not been proven to outweigh risks, despite the suggestion otherwise in Slide 29 of Dr. Kilmarx’ presentation. The CDC’s own research demonstrates that circumcision does not protect males at high risk of contracting HIV. Throughout the world, professional medical organizations, including the AAP and the American Medical Association, have unanimously failed to find that routine neonatal circumcision is medically justified. As ARC has testified before the United Nations (in a presentation that is now part of the official UN record), neonatal circumcision violates several important human rights requirements under US and international law, including the rights to security of the person, to the highest attainable standard of health, to freedom from discrimination based on sex, and to protection from "all forms of physical or mental violence, injury or abuse….”
South Africa is concerned enough about the impact of such a procedure that it recently passed legislation (effective July 1, 2007) to protect males from any form of genital cutting, including circumcision, that is not medically justified.
We ask that the CDC reserve its significant influence to promote measures of proven, not speculative benefit, and procedures for which the benefit clearly outweighs the harm. Neither is true of male circumcision, and thus this operation is not appropriate for use in the United States.
J. Steven Svoboda
Cc: Jay Berkelhamer, MD, FAAP, Past-President, AAP
Children's Health Care of Atlanta
1600 Tullie Circle
Atlanta, GA 30329
David T. Tayloe, Jr., MD, President-Elect, AAP
2706 Medical Office Pl
Goldsboro, NC 27534
Errol Alden, MD, Executive Director
American Academy of Pediatrics
141 Northwest Point Blvd,
Elk Grove Village, IL 60007