The American Academy of Pediatrics advocates reimbursement for circumcision. The arguments put forward astonish the French experts. Circumcision, as a weapon to reduce HIV transmission, is not justified in the West.
“It is healthier for young boys to be circumcised. And insurance should reimburse circumcision ”. This position does not come from a community lobby but from the very serious American Academy of Pediatrics. If the AAP takes this long-standing debate in favor of circumcision, it is because medical but also economic arguments weigh in the balance.
On the medical side, the American learned society brandishes studies carried out in Africa.
The first, of short duration, dates from 2005. Conducted by the National AIDS Research Agency (ANRS) in South Africa, it shows a 60% reduction in the risk of HIV transmission in circumcised men with heterosexual intercourse. In 2007, two other trials conducted by the National Institutes of Health, one in Kenya and the other in Uganda, confirmed the preventive effect of circumcision: the risk of HIV infection was reduced by 50%.
From an economic point of view, the AAP highlights a recent study conducted by American academics. According to them, each circumcision not performed would cost the American health care system $ 313. A slate due to the costs of care for sexually transmitted infections that could not have been avoided.
But the demonstration does not convince frankly across the Atlantic. Professor Willy Rozenbaum, co-discoverer of the AIDS virus, says he is “surprised” by the American position. “Recommend circumcision to everyone and pay for it by social security would not be of interest in France, and in all Western countries. Circumcision only brings a cost-effective benefit in countries where the HIV prevalence rate is very high, such as in Africa ”. However, to date, no serious study has been carried out in a Western country. This led the National AIDS Council to say in its 2007 opinion on circumcision that it was “a questionable method of reducing the risk of HIV transmission”.
The World Health Organization is also on the same wavelength. She certainly leads campaigns in favor of circumcision in some African countries, encouraging them to provide care, “free of charge or at as low a cost as possible given the potential benefits that the expansion of circumcision services could have on. public health “. In fact, a new HIV infection would be avoided for each group of 5 to 15 circumcised men… but only in regions where HIV prevalence exceeds 15%.
“These data are clearly not transposable in the West,” says urologist François Desgrandchamps, head of the urology department at Saint-Louis hospital (Paris). And suddenly, the economic argument does not hold in his eyes either.
Listen to Prof. François Desgrandchamps, head of the urology department at Saint-Louis hospital: “Economic calculations are made from approximate data.”
Should circumcision be recommended in certain groups at risk?
For Willy Rozenbaum, the question deserves to be asked. “In the city of Washington, the HIV prevalence rate among African Americans is the same as in Uganda! “. WHO responded in part already in 2007, stating that “in countries where the HIV epidemic is concentrated among specific population groups, for example sex workers, injecting drug users or men who have sex with men, promoting circumcision among the general population would be of little benefit to public health. Nonetheless, it may provide individual benefits to men at high risk for heterosexually transmitted HIV infection. “
However, reducing the risk of infection by 60% does not make circumcision the ultimate weapon against AIDS, or any other transmissible infection. The experts insist on hammering it. If the message is “circumcision protects against AIDS”, risky behavior could resurface. And Prof. Rozenbaum is categorical, “the protection rate of 60% can very quickly be offset by disinhibition behavior.
Unconvinced by the scientific arguments put forward by the AAP, the French experts are wondering. Has the American Pediatric Association made a decision more political than medical?
Listen to it Prof. François Desgranchamps: “The bottom line is money. Pediatricians want reimbursement for circumcision. “
Cecile Coumau
Circumcision has nothing to do with hygiene
In the United States, circumcision has long been promoted as a means of hygiene. Medical research has contradicted these hygienic theses, but they still carry a lot of weight in American society. In fact, to solve the questions of intimate hygiene of the little boy, it is no longer recommended to practice a forced cracking in a hot bath. Not only is it painful, but in addition, the foreskin protects the glans from infections. In fact, the skin covering the little boy’s penis will come off naturally with the first erections. And around 4 years old, dad will just have to tell his son how to practice daily intimate hygiene.
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