Steep Drop Seen in Circumcisions in U.S.

Despite a worldwide campaign for circumcision to slow the spread of AIDS, the rate of circumcision among American baby boys appears to be declining.

A little-noted presentation by a federal health researcher last month at the International AIDS Conference in Vienna suggested that the rate had fallen precipitously - to fewer than half of all boys born in conventional hospitals from 2006 to 2009, from about two-thirds through the 1980s and '90s.

Last week, officials at the Centers for Disease Control and Prevention cautioned that the figures in the presentation were not definitive. But they are already stirring a sharp debate on the Internet.

The slide portrays a precipitous drop in circumcision, to just 32.5 percent in 2009

from 56 percent in 2006. The numbers are based on calculations by SDI Health, a company in Plymouth Meeting, Pa., that analyzes health care data; they do not include procedures outside hospitals (like most Jewish ritual circumcisions) or not reimbursed by insurance.

Andrew Kress, the chief executive of SDI Health, cautioned that the data had not yet been published and was still being analyzed, but he confirmed that the trend had been toward fewer circumcisions each year.

He added that measuring the circumcision rate was not the purpose of the study, which was designed to measure the rate of complications from the procedure.

Opponents of circumcision hailed the trend as a victory of common sense over what they call culturally accepted genital mutilation. For federal health officials, who have been debating whether to recommend circumcision to stem the spread of AIDS, the news suggests an uphill battle that could be more difficult than expected.

The study found a very low rate of complications associated with newborn circumcisions; most were considered mild and no babies died.

Both the C.D.C. and the American Academy of Pediatrics have been reviewing the scientific evidence on circumcision with an eye to issuing new policy recommendations, but so far neither body has done so, although the federal agency was to have issued its new recommendations by the end of last year.

The World Health Organization in 2007 endorsed male circumcision as “an important intervention to reduce the risk of heterosexually acquired H.I.V.”

Several state Medicaid programs stopped covering circumcision after the academy issued its current policy in 1999, and Dr. Brady said that may be one reason fewer parents opt for the procedure. Other possible reasons include a growing Hispanic population that has traditionally been disinclined to circumcision, as well the anti-circumcision movement and a broader trend among parents to spurn medical interventions like vaccination.

Some 80 percent of American men are circumcised, one of the highest rates in the developed world. Yet even advocates of circumcision acknowledge that an aggressive circumcision drive in the United States would be unlikely to have a drastic impact on H.I.V. rates here, since the procedure does not seem to protect those at greatest risk, men who have sex with men.

And while studies in Africa found that circumcision reduced the risk of a man’s becoming infected by an H.I.V.-positive female partner, it is not clear that a circumcised man with H.I.V. would be less likely to infect a woman.

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