CDC HIV/AIDS Science Facts:

Male Circumcision and Risk for HIV 

Transmission and Other Health Conditions: 

Implications for the United States

1-800-CDC-INFO (232-4636)

In English, en Español

24 Hours/Day

cdcinfo@cdc.gov

http://www.cdc.gov/hiv 

Updated February 2008

This fact sheet summarizes information in four 

areas of male circumcision: 1) male circumcision 

and risk for HIV transmission; 2) male 

circumcision and other health conditions; 3) risks 

associated with male circumcision; and 4) status of 

HIV infection and male circumcision in the United 

States.

What is Male Circumcision?

Male circumcision is the surgical removal of some 

or all of the foreskin (or prepuce) from the penis 

[1]. 

Male Circumcision and Risk for 

HIV Transmission

Several types of research have documented that 

male circumcision significantly reduces the risk of 

HIV acquisition by men during penile-vaginal sex.

Biologic Plausibility

Compared with the dry external skin surface, the 

inner mucosa of the foreskin has less keratinization 

(deposition of fibrous protein), a higher density of 

target cells for HIV infection (Langerhans cells), 

and is more susceptible to HIV infection than other 

penile tissue in laboratory studies [2]. The foreskin 

may also have greater susceptibility to traumatic 

epithelial disruptions (tears) during intercourse, 

providing a portal of entry for pathogens, including 

HIV [3]. In addition, the microenvironment in the 

preputial sac between the unretracted foreskin and 

the glans penis may be conducive to viral survival 

[1]. Finally, the higher rates of sexually transmitted 

genital ulcerative disease, such as syphilis, 

observed in uncircumcised men may also increase 

susceptibility to HIV infection [4].

International Observational Studies

A systematic review and meta-analysis that 

focused on male circumcision and heterosexual 

transmission of HIV in Africa was published in 

2000 [5]. It included 19 cross-sectional studies, 5 

case-control studies, 3 cohort studies, and 1 partner 

study. A substantial protective effect of male 

circumcision on risk for HIV infection was noted, 

along with a reduced risk for genital ulcer disease. 

After adjustment for confounding factors in the 

population-based studies, the relative risk for HIV 

infection was 44% lower in circumcised men. The 

strongest association was seen in men at high risk, 

such as patients at sexually transmitted disease 

(STD) clinics, for whom the adjusted relative risk 

was 71% lower for circumcised men. 

Another review that included stringent assessment 

of 10 potential confounding factors and was 

stratified by study type or study population was 

published in 2003 [6]. Most of the studies were 

from Africa. Of the 35 observational studies in 

the review, the 16 in the general population had 

inconsistent results. The one large prospective 

cohort study in this group showed a significant 

protective effect: the odds of infection were 42% 

lower for circumcised men [7]. The remaining 

19 studies were conducted in populations at high 
Page 2

Male Circumcision and Risk for HIV Transmission: Implications for the United States

risk. These studies found a consistent, substantial 

protective effect, which increased with adjustment 

for confounding. Four of these were cohort 

studies: all demonstrated a protective effect, with 

two being statistically significant. 

Ecologic studies also indicate a strong association 

between lack of male circumcision and HIV 

infection at the population level. Although links 

between circumcision, culture, religion, and risk 

behavior may account for some of the differences 

in HIV infection prevalence, the countries 

in Africa and Asia with prevalence of male 

circumcision of less than 20% have HIV infection 

prevalences several times higher than those in 

countries in these regions where more than 80% of 

men are circumcised [8].

International Clinical Trials

Three randomized controlled clinical trials 

were conducted in Africa to determine whether 

circumcision of adult males will reduce their 

risk for HIV infection. The study conducted in 

South Africa [9] was stopped in 2005, and those 

in Kenya [10] and Uganda [11] were stopped in 

2006 after interim analyses found a statistically 

significant reduction in male participants’ risk for 

HIV infection from medical circumcision. 

In these studies, men who had been randomly 

assigned to the circumcision group had a 60% 

(South Africa), 53% (Kenya), and 51% (Uganda) 

lower incidence of HIV infection compared 

with men assigned to the wait-list group to be 

circumcised at the end of the study. In all three 

studies, a few men who had been assigned to 

be circumcised did not undergo the procedure, 

and vice versa. When the data were reanalyzed 

to account for these occurrences, men who had 

been circumcised had a 76% (South Africa), 60% 

(Kenya), and 55% (Uganda) reduction in risk for 

HIV infection compared with those who were not 

circumcised. The Uganda study investigators are 

also examining the following in an ongoing study: 

1) safety and acceptability of male circumcision 

in HIV-infected men and men of unknown HIV 

infection status, 2) safety and acceptability of male 

circumcision in the men’s female sex partners, and 

3) effect of male circumcision on male-to-female 

transmission of HIV and other STDs.

Male Circumcision and Male-to-Female 

Transmission of HIV

In an earlier study of couples in Uganda in which 

the male partner was HIV infected and the female 

partner was initially HIV-seronegative, the 

infection rates of the female partners differed by 

the circumcision status and viral load of the male 

partners. If the male’s HIV viral load was <50,000 

copies/mL, there was no HIV transmission if 

the man was circumcised, compared with a 

transmission rate of 9.6 per 100 person-years if 

the man was uncircumcised [7]. When viral load 

was not controlled for, there was a nonsignificant 

trend toward a reduction in the male-to-female 

transmission rate from circumcised men compared 

with uncircumcised men. Such an effect may be 

due to decreased viral shedding from circumcised 

men or to a reduction in ulcerative STDs acquired 

by female partners of circumcised men [12]. A 

clinical trial in Uganda to assess the impact of 

circumcision on male-to-female transmission 

reported that its first interim safety analysis 

showed a nonsignificant trend toward a higher rate 

of HIV acquisition in women partners of HIVseropositive men in couples who had resumed 

sex prior to certified postsurgical wound healing 

and did not detect a reduction in HIV acquisition 

by female partners engaging in sex after wound 

healing was complete [13].

Male Circumcision and Other 

Health Conditions

Lack of male circumcision has also been 

associated with sexually transmitted genital 

ulcer disease and chlamydia, infant urinary tract 

infections, penile cancer, and cervical cancer 

in female partners of uncircumcised men [1]. 

The latter two conditions are related to human 

papillomavirus (HPV) infection. Transmission 

of this virus is also associated with lack of male 
Page 3

Male Circumcision and Risk for HIV Transmission: Implications for the United States

circumcision. A recent meta-analysis included 

26 studies that assessed the association between 

male circumcision and risk for genital ulcer 

disease. The analysis concluded that there was a 

significantly lower risk for syphilis and chancroid 

among circumcised men, whereas the reduced 

risk of herpes simplex virus type 2 infection had a 

borderline statistical significance [4].

Risks Associated with Male 

Circumcision 

Reported complication rates depend on the type 

of study (e.g., chart review vs. prospective study), 

setting (medical vs. nonmedical facility), person 

operating (traditional vs. medical practitioner), 

patient age (infant vs. adult), and surgical 

technique or instrument used. In large studies of 

infant circumcision in the United States, reported 

inpatient complication rates range from 0.2% to 

2.0% [1, 14, 15]. The most common complications 

in the United States are minor bleeding and local 

infection. In the recently completed African trials 

of adult circumcision, the rates of adverse events 

possibly, probably, or definitely attributable to 

circumcision ranged from 2% to 8%. The most 

commonly reported complications were pain or 

mild bleeding. There were no reported deaths or 

long-term sequelae documented [9, 10, 11, 16]. 

A recent case-control study of two outbreaks 

of methicillin-resistant Staphylococcus aureus

(MRSA) in otherwise healthy male infants at one 

hospital identified circumcision as a potential risk 

factor. However, in no case did MRSA infections 

involve the circumcision site, anesthesia injection 

site, or the penis, and MRSA was not found on any 

of the circumcision equipment or anesthesia vials 

tested [17]. 

Effects of Male Circumcision 

on Penile Sensation and Sexual 

Function

Well-designed studies of sexual sensation and 

function in relation to male circumcision are 

few, and the results present a mixed picture. 

Taken as a whole, the studies suggest that some 

decrease in sensitivity of the glans to fine touch 

can occur following circumcision [18]. However, 

several studies conducted among men after adult 

circumcision suggest that few men report their 

sexual functioning is worse after circumcision; 

most report either improvement or no change 

[19–22]. The three African trials found high levels 

of satisfaction among the men after circumcision 

[9, 10, 11, 16]; however, cultural differences limit 

extrapolation of their findings to U.S. men. 

HIV Infection and Male 

Circumcision in the United 

States

In 2005, men who have sex with men (MSM) 

(48%), MSM who also inject drugs (4%), and 

men (11%) and women (21%) exposed through 

high-risk heterosexual contact accounted for an 

estimated 84% of all HIV/AIDS cases diagnosed 

in U.S. areas with confidential name-based HIV 

infection reporting. Blacks accounted for 49% 

of cases and Hispanics for 18%. Infection rates 

for both groups were several-fold higher than 

the rate for whites. An overall prevalence of 

0.5% was estimated for the general population 

[23]. Although data on HIV infection rates since 

the beginning of the epidemic are available, 

data on circumcision and risk for HIV infection 

in the United States are limited. In one crosssectional survey of MSM, lack of circumcision 

was associated with a 2-fold increase in the 

odds of prevalent HIV infection [24]. In another, 

prospective study of MSM, lack of circumcision 

was also associated with a 2-fold increase in risk 

for HIV seroconversion [25]. In both studies, the 

results were statistically significant, and the data 

had been controlled statistically for other possible 

risk factors. However, in another prospective 

cohort study of MSM, there was no association 

between circumcision status and incident HIV 

infection, even among men who reported no 

unprotected anal receptive intercourse [26]. And in 
Page 4

Male Circumcision and Risk for HIV Transmission: Implications for the United States

a recent cross-sectional study of African American 

and Latino MSM, male circumcision was not 

associated with previously known or newly 

diagnosed HIV infection [27]. In one prospective 

study of heterosexual men attending an urban STD 

clinic, when other risk factors were controlled, 

uncircumcised men had a 3.5-fold higher risk for 

HIV infection than men who were circumcised. 

However, this association was not statistically 

significant [28]. And in an analysis of clinic 

records for African American men attending an 

STD clinic, circumcision was not associated with 

HIV status overall, but among men with known 

HIV exposure, circumcision was associated with 

a statistically significant 58% reduction in risk for 

HIV infection [29].

Status of Male Circumcision in the 

United States

In national probability samples of adults surveyed 

during 1999–2004, the National Health and 

Nutrition Examination Surveys (NHANES) found 

that 79% of men reported being circumcised, 

including 88% of non-Hispanic white men, 73% 

of non-Hispanic black men, 42% of Mexican 

American men, and 50% of men of other races/

ethnicities [30]. It is important to note that 

reported circumcision status may be subject to 

misclassification. In a study of adolescents ̧ only 

69% of circumcised and 65% of uncircumcised 

young men correctly identified their circumcision 

status as verified by physical exam [31]. 

According to the National Hospital Discharge 

Survey (NHDS), 65% of newborns were 

circumcised in 1999, and the overall proportion 

of newborns circumcised was stable from 1979 

through 1999 [32]. Notably, the proportion of 

black newborns circumcised increased during this 

reporting period (58% to 64%); the proportion 

of white newborns circumcised remained stable 

(66%). In addition, the proportion of newborns 

who were circumcised in the Midwest increased 

during the 20-year period—from 74% in 1979 to 

81% in 1999; the proportion of infants born in 

the West who were circumcised decreased from 

64% in 1979 to 37% in 1999. In another survey, 

the National Inpatient Sample (NIS), circumcision 

rates increased from 48% during 1988–1991 to 

61% during 1997–2000. Circumcision was more 

common among newborns who were born to 

families of higher socioeconomic status, born in 

the Northeast or Midwest, and who were 

black [33]. 

In 1999, the American Academy of Pediatrics 

(AAP) changed from a neutral stance on 

circumcision to a position that the data then 

available were insufficient to recommend routine 

neonatal male circumcision. The Academy also 

stated, “It is legitimate for the parents to take into 

account cultural, religious, and ethnic traditions, 

in addition to medical factors, when making this 

choice” [34]. This position was reaffirmed by the 

Academy in 2005. This change in policy may have 

influenced reimbursement for, and the practice of, 

neonatal circumcision. In a 1995 review, 61% of 

circumcisions were paid for by private insurance, 

36% were paid for by Medicaid, and 3% were 

self-paid by the parents of the infant. Compared 

with infants of self-pay parents, those covered 

by private insurance were 2.5 times as likely to 

be circumcised [35]. Since 1999, 16 states have 

eliminated Medicaid payments for circumcisions 

that were not deemed medically necessary [36]. 

However, AAP has recently (2007) convened a 

panel to reconsider its circumcision policy in light 

of additional data now available.

Cost-Benefits and Ethical Issues for 

Neonatal Circumcision in the United States

A large retrospective study of circumcision in 

nearly 15,000 infants found neonatal circumcision 

to be highly cost-effective, considering the 

estimated number of averted cases of infant 

urinary tract infection and lifetime incidence of 

HIV infection, penile cancer, balanoposthitis, and 

phimosis. The cost of postneonatal circumcision 

was 10-fold the cost of neonatal circumcision [37].

Many parents now make decisions about infant 

circumcision based on cultural, religious, or 

parental desires rather than health concerns [38]. 
Page 5

Male Circumcision and Risk for HIV Transmission: Implications for the United States

Some persons have raised ethical objections to 

asking parents to make decisions about elective 

surgery during infancy, particularly when it is 

done primarily to protect against risks of HIV 

and STDs that don’t occur until young adulthood, 

but other ethicists have found it an appropriate 

parental proxy decision [39].

Considerations for the United States

A number of important differences from subSaharan African settings where the three male 

circumcision trials were conducted must be 

considered in determining the possible role for 

male circumcision in HIV prevention in the United 

States. Notably, the overall risk of HIV infection is 

considerably lower in the United States, changing 

risk-benefit and cost-effectiveness considerations. 

Also, studies to date have demonstrated efficacy 

only for penile-vaginal sex, the predominant 

mode of HIV transmission in Africa, whereas the 

predominant mode of sexual HIV transmission 

in the United States is by penile-anal sex among 

MSM. There are as yet no convincing data to help 

determine whether male circumcision will have 

any effect on HIV risk for men who engage in anal 

sex with either a female or male partner, as either 

the insertive or receptive partner. Receptive anal 

sex is associated with a substantially greater risk 

of HIV acquisition than is insertive anal sex. It is 

more biologically plausible that male circumcision 

would reduce HIV acquisition risk for the insertive 

partner rather than for the receptive partner, but 

few MSM engage solely in insertive anal sex [40].

In addition, although the prevalence of 

circumcision may be somewhat lower in U.S. 

racial and ethnic groups with higher rates of 

HIV infection, most American men are already 

circumcised, and it is not known whether men at 

higher risk for HIV infection would be willing 

to be circumcised or whether parents would be 

willing to have their infants circumcised to reduce 

possible future HIV infection risk. Lastly, whether 

the effect of male circumcision differs by HIV-1 

subtype, predominately subtype B in the United 

States and subtypes A, C, and D in circulation 

at the three clinical trial sites in Africa, is also 

unknown.

Summary

Male circumcision has been associated with a 

lower risk for HIV infection in international 

observational studies and in three randomized 

controlled clinical trials. It is possible, but not 

yet adequately assessed, that male circumcision 

could reduce male-to-female transmission of 

HIV, although probably to a lesser extent than 

female-to-male transmission. Male circumcision 

has also been associated with a number of other 

health benefits. Although there are risks to male 

circumcision, serious complications are rare. 

Accordingly, male circumcision, together with 

other prevention interventions, could play an 

important role in HIV prevention in settings 

similar to those of the clinical trials [41, 42]. 

Male circumcision may also have a role in the 

prevention of HIV transmission in the United 

States. CDC consulted with external experts 

in April 2007 to receive input on the potential 

value, risks, and feasibility of circumcision as an 

HIV prevention intervention in the United States 

and to discuss considerations for the possible 

development of guidelines. 

As CDC proceeds with the development of public 

health recommendations for the United States, 

individual men may wish to consider circumcision 

as an additional HIV prevention measure, but they 

must recognize that circumcision 1) does carry 

risks and costs that must be considered in addition 

to potential benefits; 2) has only proven effective 

in reducing the risk of infection through insertive 

vaginal sex; and 3) confers only partial protection 

and should be considered only in conjunction with 

other proven prevention measures (abstinence, 

mutual monogamy, reduced number of sex 

partners, and correct and consistent condom use).
Page 6

Male Circumcision and Risk for HIV Transmission: Implications for the United States

References

1. Alanis MC, Lucidi RS. Neonatal 

circumcision: a review of the world’s oldest 

and most controversial operation. Obstet 

Gynecol Surv. 2004 May;59(5):379-95.

2. Patterson BK, Landay A, Siegel JN, et al. 

Susceptibility to human immunodeficiency 

virus-1 infection of human foreskin and 

cervical tissue grown in explant culture. 

Am J Pathol. 2002 Sep;161(3):867-73.

3. Szabo R, Short RV. How does male 

circumcision protect against HIV infection? 

BMJ. 2000 Jun 10;320(7249):1592-4.

4. Weiss HA, Thomas SL, Munabi SK, Hayes 

RJ. Male circumcision and risk of syphilis, 

chancroid, and genital herpes: a systematic 

review and meta-analysis. Sex Transm Infect. 

2006 Apr;82(2):101-9; discussion 10.

5. Weiss HA, Quigley MA, Hayes RJ. Male 

circumcision and risk of HIV infection in subSaharan Africa: a systematic review and metaanalysis. AIDS. 2000 Oct 20;14(15):2361-70.

6. Siegfried N, Muller M, Volmink J, et al. Male 

circumcision for prevention of heterosexual 

acquisition of HIV in men. Cochrane 

Database Syst Rev. 2003;(3):CD003362.

7. Gray RH, Kiwanuka N, Quinn TC, et al. 

Male circumcision and HIV acquisition and 

transmission: cohort studies in Rakai, Uganda. 

AIDS. 2000 Oct 20;14(15):2371-81.

8. Halperin DT, Bailey RC. Male circumcision 

and HIV infection: 10 years and counting. 

Lancet. 1999 Nov 20;354(9192):1813-5.

9. Auvert B, Taljaard D, Lagarde E, SobngwiTambekou J, Sitta R, Puren A. Randomized, 

controlled intervention trial of male 

circumcision for reduction of HIV infection 

risk: the ANRS 1265 Trial. PLoS Med. 2005 

Nov;2(11):e298. Erratum in: PLoS Med. 2006 

May;3(5):e298.

10. Bailey RC, Moses S, Parker CB, et al. Male 

circumcision for HIV prevention 

in young men in Kisumu, Kenya: a 

randomised controlled trial. Lancet. 2007 Feb 

24;369(9562):643-56.

11. Gray RH, Kigozi G, Serwadda D, et al. Male 

circumcision for HIV prevention in men in 

Rakai, Uganda: a randomised trial. Lancet. 

2007 Feb 24;369(9562):657-66.

12. Gray R, Wawer MJ, Thoma M, et al. Male 

circumcision and the risks of female HIV and 

sexually transmitted infections acquisition 

in Rakai, Uganda [Abstract 128]. Presented 

at: 13th Conference on Retroviruses and 

Opportunistic Infections. Feb 5-9, 2006; 

Denver, CO. Available from: http://

www.retroconference.org/2006/

Abstracts/25977.htm. Accessed Jan 24, 2008.

13. Wawer MJ. Trial of male circumcision: HIV, 

sexually transmitted disease (STD) and 

behavioral effects in men, women and the 

community. Available from: http://

www.clinicaltrials.gov/ct2/show/NCT00124

878?term=circumcision+AND+uganda&ran

k=2. Accessed Jan 23, 2008.

14. Wiswell TE, Geschke DW. Risks from 

circumcision during the first month of life 

compared with those for uncircumcised boys. 

Pediatrics. 1989;83(6):1011-15.

15. Christakis DA, Harvey E, Zerr DM, Feudtner 

C, Wright JA, Connell FA. A trade-off 

analysis of routine newborn circumcision. 

Pediatrics. 2000 Jan;105(1 Pt 3):246-9.

16. Kigozi G, Watya S, Polis CB, et al. The effect 

of male circumcision on sexual satisfaction 

and function, results from a randomized 

trial of male circumcision for human 

immunodeficiency virus prevention, Rakai, 

Uganda. BJU Int. 2008 Jan;101(1):65-70.

17. Nguyen DM, Bancroft E, Mascola L, et 

al. Risk factors for neonatal methicillinresistant Staphylococcus aureus infection in 

a well-infant nursery. Infect Control Hosp 

Epidemiol. 2007;28:406-11.
Page 7

Male Circumcision and Risk for HIV Transmission: Implications for the United States

18. Sorrells ML, Snyder JL, Reiss MD, et al. 

Fine-touch pressure thresholds in the adult 

penis. BJU Int. 2007 Apr;99(4):864-9. 

Erratum in: BJU Int. 2007 Aug;100(2):481.

19. Krieger JN, Bailey RC, Opeya JC, et al. Adult 

male circumcision outcomes: experience 

in a developing country setting. Urol Int. 

2007;78(3):235-40.

20. Collins S, Upshaw J, Rutchik S, et al. Effects 

of circumcision on male sexual function: 

debunking a myth? J Urol. 2002;167:2111-2.

21. Senkul T, Iseri C, Sen B, et al. Circumcision 

in adults: effect on sexual function. Urology. 

2004;63:155-8.

22. Masood S, Patel HRH, Himpson RC, et al. 

Penile sensitivity and sexual satisfaction 

after circumcision: are we informing men 

correctly? Urol Int. 2004;75:62-6.

23. Centers for Disease Control and Prevention. 

HIV/AIDS Surveillance Report, 2005. Vol. 17. 

Rev. ed. Atlanta: U.S. Department of Health 

and Human Services, Centers for Disease 

Control and Prevention; June 2007:1-54. 

Available from: http://www.cdc

.gov/hiv/topics/surveillance/resources/

reports/. Accessed Jan 24, 2008.

24. Kreiss JK, Hopkins SG. The association 

between circumcision status and human 

immunodeficiency virus infection among 

homosexual men. J Infect Dis. 1993 

Dec;168(6):1404-8.

25. Buchbinder SP, Vittinghoff E, Heagerty PJ, 

et al. Sexual risk, nitrite inhalant use, and 

lack of circumcision associated with HIV 

seroconversion in men who have sex with 

men in the United States. J Acquir Immune 

Defic Syndr. 2005 May 1;39(1):82-9.

26. Templeton DJ, Jin F, Prestage GP, et 

al. Circumcision status and risk of HIV 

seroconversion in the HIM cohort of 

homosexual men in Sydney [Abstract 

WEAC103]. Presented at: 4th IAS 

Conference on HIV Pathogenesis, 

Treatment, and Prevention; Jul 22-25, 

2007; Sydney, Australia. Available from: 

http://www.ias2007.org/pag/Abstracts.

aspx?SID=55&AID=2465. Accessed Jan 23, 

2008.

27. Millett GA, Ding H, Lauby J, et al. 

Circumcision status and HIV infection among 

black and Latino men who have sex with men 

in 3 US cities. J Acquir Immune Defic Syndr. 

2007 Dec;46(5):643-50.

28. Telzak EE, Chiasson MA, Bevier PJ, 

Stoneburner RL, Castro KG, Jaffe HW. HIV-1 

seroconversion in patients with and without 

genital ulcer disease: a prospective study. Ann 

Intern Med. 1993 Dec 15;119(12):1181-6.

29. Warner L, Ghanem KG, Newman D, et al. 

Male circumcision and risk of HIV infection 

among heterosexual men attending Baltimore 

STD clinics: an evaluation of clinic-based 

data [Abstract 326]. Presented at: National 

STD Prevention Conference; May 8-11, 

2006; Jacksonville, FL. Available from: http://

cdc.confex.com/cdc/std2006/techprogram/

P11223.HTM. Accessed Jan 23, 2008.

30. Xu F, Markowitz LE, Sternberg MR, Aral 

SO. Prevalence of circumcision and herpes 

simplex virus type 2 infection in men in 

the United States: the National Health and 

Nutrition Examination Survey (NHANES), 

1999–2004. Sex Transm Dis. 2007 July; 

34(7):479-84.

31. Risser JM, Risser WL, Eissa MA, Cromwell 

PF, Barratt MS, Bortot A. Self-assessment 

of circumcision status by adolescents. Am J 

Epidemiol. 2004 Jun 1;159(11):1095-7.

32. Centers for Disease Control and Prevention. 

Trends in circumcisions among newborns. 

Available from: http://www.cdc.gov/nchs/

products/pubs/pubd/hestats/circumcisions/

circumcisions.htm. Accessed Jan 24, 2008.

33. Nelson CP, Dunn R, Wan J, Wei JT. 

The increasing incidence of newborn 

circumcision: data from the nationwide 

inpatient sample. J Urol. 2005 

Mar;173(3):978-81.
Page 8

Male Circumcision and Risk for HIV Transmission: Implications for the United States

34. American Academy of Pediatrics, Task 

Force on Circumcision. Circumcision 

policy statement. Pediatrics. 1999 

Mar;103(3):686-93. 

35. Mansfield CJ, Hueston WJ, Rudy M. 

Neonatal circumcision: associated factors and 

length of hospital stay. J Fam Pract. 1995 

Oct;41(4):370-6.

36. National Conference of State Legislatures. 

State Health Notes: Circumcision and 

infection. Available from: http://

www.ncsl.org/programs/health/shn/2006/

hl475.htm#circumcision. Accessed Jan 

23, 2008.

37. Schoen EJ, Oehrli M, Colby CJ, Machin 

G. The highly protective effect of newborn 

circumcision against invasive penile cancer. 

Pediatrics. 2000 Mar;105(3):e36. Available 

from: http://pediatrics.org/cgi/content/

full/105/3/e36. Accessed Jan 24, 2008.

38. Adler R, Ottaway S, Gould S. Circumcision: 

we have heard from the experts; now 

let’s hear from the parents. Pediatrics. 

2001:107:e20. Available from: http://

pediatrics.org/cgi/content/full/107/2/e20. 

Accessed Jan 24, 2008.

39. Benatar M, Benatar D. Between prophylaxis 

and child abuse: the ethics of neonatal 

male circumcision. Am J Bioeth. 2003 

Spring;3(2):35-48.

40. Koblin BA, Chesney MA, Husnik MJ, et al. 

High-risk behaviors among men who have sex 

with men in 6 US cities: baseline data from 

the EXPLORE study. Am J Public Health. 

2003 Jun;93(6):926-32. Erratum in: Am J 

Public Health 2003 Aug;93(8):1203.

41. World Health Organization and UNAIDS. 

New data on male circumcision and 

HIV prevention: policy and programme 

implications. 2007 Mar. Available from: 

http://www.unaids.org/en/Policies/HIV_

Prevention/Male_circumcision.asp. 

Accessed Jan 24, 2008.

42. Williams BG, Lloyd-Smith JO, Gouws E, et 

al. The potential impact of male circumcision 

on HIV in sub-Saharan Africa. PLoS Med. 

2006;3(7):e262. Available from: http://

medicine.plosjournals.org/perlserv/?

request=get-document&doi=10.1371/journal

.pmed.0030262. Accessed Jan 24, 2008.