The Health Department in South Australia is now reviewing its position on male circumcision after Victoria joined NSW, Western Australia and Tasmania and recently stopped allowing the procedure at public hospitals for non-medical reasons.

From next month, infant male circumcisions will be performed in Victoria only when doctors establish a medical need because of concerns about infections or disease.

There is now compelling evidence — accepted by the World Health Organization — that male circumcision reduces by 50-60% the risk of males becoming infected with HIV from heteros-xual intercourse.

Three recent randomised control trials carried out in sub-Saharan Africa confirm that adult male circumcision at least halves the risk of HIV transmission from women to men during heteros-xual intercourse. Two of these recent trials were stopped early when circumcision was found to be so effective that it was considered unethical to continue the research and not provide circumcision to the uncircumcised men who were acting as controls. If all men in sub-Saharan Africa were circumcised during the next ten years, it is estimated that this could avoid up to 2 million new HIV infections.

Male circumcision reduces but does not eliminate the risk of men becoming infected with HIV. Accordingly, it should only ever be considered as part of a comprehensive package which also includes male or female condoms, reducing the number of s-xual partners, delaying the initiation of s-xual activity and HIV testing and counselling.

On 28 March, the World Health Organisation and UNAIDS recommended that male circumcision should now be recognised as an effective intervention for the prevention of heteros-xually-acquired HIV infection in men.

The number of new HIV infections is currently increasing in all jurisdictions in Australia except NSW. Although the majority of these HIV infections involve male to male s-x, the much smaller number of new HIV infections among heteros-xual men and women has been slowly increasing for years in Australia.

There are many other benefits apart from HIV-related effects. Recent studies show that male circumcision also protects men against Human Papilloma Virus infection, the cause of cancer of the penis, and it halves the risk of the female partner developing cancer of the cervix, one of the commonest cancers in women. Male circumcision may also halve the risk of cancer of the prostate.

Uncircumcised boys have higher rates of infections and inflammations of the penis than circumcised boys. Many studies show that neonatal circumcision substantially reduces the risk of urinary tract infections in young boys.

Of course, any decision about male circumcision, especially in infants who cannot provide informed consent, requires a careful weighing of potential benefits against potential risks and costs. The evidence for benefits is increasing. Potential risks and costs are low. Male circumcision rates in Australia (10-20%) are now comparable with Canada (14%) but lower than the US (56%) and higher than New Zealand (< 5%) or the United Kingdom (6%).

Curiously, Australian parents are being gently discouraged from circumcising their infant sons just at a time when the evidence of significant health benefit is getting much stronger.