New study re: circumcision and AIDS

Anguirus · Post by **Anguirus** » 2006-12-17 02:23pm

I know there have been no end of circumcision topics on here, but there's nothing on the most recent study. It seems worth looking at because as far as I can tell, the methodology isn't total crap for once:

http://www.msnbc.msn.com/id/16227308/site/newsweek/

Ron Gray: In August of 2003, we launched a randomized trial of 5,000 uninfected Ugandan men between the ages of 15 and 49 who agreed to either receive information about HIV prevention and immediate circumcision, or get the information about HIV prevention and wait two years before receiving circumcision. Two years later, we followed up with them in order to determine the rates of HIV and other infections. An independent analysis of our data showed that the rate of HIV had been almost halved in the circumcised men compared to the uncircumcised men. The study was stopped this month because, of course, it would be unethical to deprive the men in the control group of the benefits of this procedure.

What is it about circumcision that confers this protection?
We believe this happens in three ways. On the inner surface of foreskin, the mucosa, there is a very large number of immune cells that are targets of the HIV virus. During sex, it is unprotected. The external section of the foreskin and the shaft of the penis (exposed on an uncircumcised man during sex) is more protected because it is covered by a protein called keratin which provides a very effective barrier to HIV. Secondly, during intercourse, the foreskin can get traumatized and it can get breaches in it, allowing the virus to enter. A third factor is that the men who are circumcised are less likely to have genital ulcers, and genital ulcers increase the risk of HIV acquisition.

Personally, I'm a bit worried about advocating general circumcision in Africa because the practice itself can easily spread AIDS and/or lead to infections, because of the poor quality of medical facilities. As we all know, cutting leads to complications even here.

I had an interesting utilitarian argument with my parents over these results. I mentioned that condoms would, of course, be more effective than cutting off bits of people, and they responded that for cultural reasons, mass circumcision would probably be more palatable there than significantly increasing condom use (what sickens me is that I can imagine a mass-circumcision-in-Africa-initiative being more politically palatable HERE than a campaign to increase sex ed and condom use), and that obviously this would be the thing to do if subsequent studies showed that that will actually cut infection rates 50%. (For reference, my parents do not support routine circumcision in America. I am not cut.)

So, I was naturally curious to see what the population here thought of the study. I greet these with a lot of skepticism, but some points in the study's favor: it wasn't done by Americans, it was randomized rather than survey-based, and it was on a large scale.[/quote]

Singular Intellect · Post by **Singular Intellect** » 2006-12-17 02:38pm

It doesn't matter how statistically viable the figures are.

Butchering the human body for the purpose of fending of disease is hardly a solution.

It's a bit like curing the disease by killing the patient arguement.

Post by **fgalkin** » 2006-12-17 02:43pm

Bubble Boy wrote:It doesn't matter how statistically viable the figures are.

Butchering the human body for the purpose of fending of disease is hardly a solution.

It's a bit like curing the disease by killing the patient arguement.

Ever heard of gangrene?

Have a very nice day.
-fgalkin

Singular Intellect · Post by **Singular Intellect** » 2006-12-17 02:54pm

fgalkin wrote:
Bubble Boy wrote:It doesn't matter how statistically viable the figures are.

Butchering the human body for the purpose of fending of disease is hardly a solution.

It's a bit like curing the disease by killing the patient arguement.
Ever heard of gangrene?

Have a very nice day.
-fgalkin

Not the same thing, and you should bloodly well know it. The only arguement here is that circumcision statistically would prevent possible infection by HIV.

While we're at it, why not chop off other body parts that have the potential to increase the chances of infection by other diseases? Why is only the foreskin being targetted here? I'm sure we could come up with plenty of body parts that could be safely removed without significantly hinderance to functioning in society, with the logic of preventing potential infections, diseases, etc.

Note: For the record, I'm arguing from the position of a circumsized male myself.

Einhander Sn0m4n · Post by **Einhander Sn0m4n** » 2006-12-17 03:46pm

This again? I thought this was done to death three months ago. Either way, a condom works just fine.

Howedar · Post by **Howedar** » 2006-12-17 04:05pm

Bubble Boy wrote:
fgalkin wrote:
Bubble Boy wrote:It doesn't matter how statistically viable the figures are.

Butchering the human body for the purpose of fending of disease is hardly a solution.

It's a bit like curing the disease by killing the patient arguement.
Ever heard of gangrene?

Have a very nice day.
-fgalkin
Not the same thing, and you should bloodly well know it. The only arguement here is that circumcision statistically would prevent possible infection by HIV.

While we're at it, why not chop off other body parts that have the potential to increase the chances of infection by other diseases? Why is only the foreskin being targetted here? I'm sure we could come up with plenty of body parts that could be safely removed without significantly hinderance to functioning in society, with the logic of preventing potential infections, diseases, etc.

Note: For the record, I'm arguing from the position of a circumsized male myself.

You're arguing from the position of a fucking idiot.

I'm not saying that this specific situation is good cause for circumcision, but to say that "it doesn't matter how statistically viable the figures are", well, that is akin to saying that if circumcision conclusively made you 100% immune to AIDS, it would hardly be a "solution".

Life ain't black and white, kid. If you could end a disease that infects (and dooms to certain death) something like a third of a continent, hundreds of millions of people, you wouldn't cut off a piece of skin to do that?

Rye · Post by **Rye** » 2006-12-17 06:31pm

Not too many infants are going to be fucking, so this doesn't really affect the pro-circumcision argument, only the pro-body modification of consenting adults argument, which I doubt anyone would want to intervene in anyway.

I have to say, I find it darkly humourous that it's easier to take skin away from africans than to give them rubber.

Anguirus · Post by **Anguirus** » 2006-12-17 07:01pm

^ That is one thing that annoys me. You want to get it chopped off, fine. If it makes you less likely to get AIDS, all the better. But mutilating infants is awful no matter how you slice it. They may not remember the pain in a few years, but that's still quite a hefty (and permanent) trauma...and all the more important, they never got a choice in the matter. It's possible that this is the best solution from a utilitarian standpoint, but it would take much more proof to convince me.

Anyway, the difference between now and then is that for once, the study actually looks reliable and implies that circumcision actually helps, as opposed to a simple "correlation through questionairres" bullshit study.

Lord Zentei · Post by **Lord Zentei** » 2006-12-17 07:02pm

Much as I disaprove of circumcision (or rather genital mutilation) of children, if an individual mature enough to give consent to such a procedure (and hence likely to have sex) does so, I have no problem with that any more than any other cosmetic operation they might want to undertake. If it also helps prevent STD infection, that is a perfectly spiffy bonus.

From a purely utilitarian perspective, to oppose such operations in adults is for this reason unsound: a piece of skin is less of a loss than the possibility of infection by HIV. Of course, it would still be better to use a rubber, but OTOH, these two methods of preventing infection are not mutually exclusive. In any case it is alas, not too easy to overcome cultural barriers to condom distribution. That barrier must be overcome, of course. But in the meantime, to look the gift horse in the mouth vis-a-vis possible weapons in the fight against AIDS would be unwise.

Junghalli · Post by **Junghalli** » 2006-12-17 07:05pm

Anguirus wrote:^ That is one thing that annoys me. You want to get it chopped off, fine. If it makes you less likely to get AIDS, all the better. But mutilating infants is awful no matter how you slice it. They may not remember the pain in a few years, but that's still quite a hefty (and permanent) trauma...and all the more important, they never got a choice in the matter.

What annoys me is how often it's done out of pure social inertia. Not even because of religion but just because the parents shrug and go "why not?"

Anguirus · Post by **Anguirus** » 2006-12-17 07:09pm

^ Yeah! And it's amazing how universally it was adopted in the US. Apparently, it only really took off because a fraudulent study suggested that it prevented syphilis! Oh, and it also helped "cure" masturbation.

General Zod · Post by **General Zod** » 2006-12-17 07:16pm

What is it about circumcision that confers this protection?
We believe this happens in three ways. On the inner surface of foreskin, the mucosa, there is a very large number of immune cells that are targets of the HIV virus. During sex, it is unprotected. The external section of the foreskin and the shaft of the penis (exposed on an uncircumcised man during sex) is more protected because it is covered by a protein called keratin which provides a very effective barrier to HIV. Secondly, during intercourse, the foreskin can get traumatized and it can get breaches in it, allowing the virus to enter. A third factor is that the men who are circumcised are less likely to have genital ulcers, and genital ulcers increase the risk of HIV acquisition.

So, how exactly is this any more effective than simply wearing a fucking condom?

Post by **Cairber** » 2006-12-17 07:42pm

It has been a dark week for genital integrity coalitions across the United States. I know my inbox has been jammed with parents worried that their intact sons are at higher risk for AIDs. I can repeat the information until I am blue in face...the USA has an extremely high circumcision rate and a high rate of HIV infection when compared with other developed nations. Again and again I write about safe sex. I send links from Scandanavian sources about their low STD rates and low circumcision rates.

It doesn't matter. Days like this I am convinced that no matter how hard we work and no matter how much information we get out there, Americans will use any reason to mutilate their sons.

*sigh*

*gets back to answering the letters of hundreds of American parents who are now questioning their decision not to cut their sons.*

Post by **Cairber** » 2006-12-17 07:45pm

Oh, and here's a study that suggests HIV infection risk is lower for circumcised women:

http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138

I support the right of any adult to do whatever they please with their genitals. But these studies should not affect the genitals of unconsenting infants.

Anguirus · Post by **Anguirus** » 2006-12-17 10:13pm

Do people just read headlines these days, or what? The relevance of this study to American infection rates is marginal, since it is trivial to attain the education needed to engage in safe sex. Better yet, ask your kid if he wants to be circumcised in order to "reduce the risk" when he's old enough to make such a decision!

Glad to know you're soldiering on, Cairber.

Post by **Darth Wong** » 2006-12-17 10:51pm

So the solution to AIDS is to stop promoting safe sex, and start circumcising everyone? Doesn't this sound utterly retarded in every conceivable way?

The risk of AIDS transmission in unprotected sex may be reduced by circumcision if someone wants to go that route (and as others have pointed out, that's a choice that should be made by the individual), but it is hardly comparable to the safety of protected sex.

Anguirus · Post by **Anguirus** » 2006-12-17 11:12pm

So the solution to AIDS is to stop promoting safe sex, and start circumcising everyone? Doesn't this sound utterly retarded in every conceivable way?

To his credit, the scientist they interviewed in the link said that his big fear was that the results would lead to that. He's recommending circ + condoms +education in Africa, and saying that for America the CDC should decide what to do. (I don't know what more you could do in the US, with a 75% circ rate, but whatever.) He also noted that all of the people in the study were given safe sex info.

Crossroads Inc. · Post by **Crossroads Inc.** » 2006-12-18 12:11am

Exactly how badly have we failed in stopping AIDS when it is admitted that Mass circumcising is "Easier" then trying to get people to sue Condoms?

The Grim Squeaker · Post by **The Grim Squeaker** » 2006-12-18 12:45am

Bloody moronic (As has been stated).
The fact that it reduces the risk of AIDs transmission is made useless due to the risk of contracting AIDS in the various unhygienic hospitals where the process might be carried out (And thats if you could convince people that having a layer of their Wing-wang chopped off wouldn't make the impotent, this is the same continent where raping virgins is considered a Cure for AIDS).
The real stupidity is that a condom is 100% (Or at least well unto the 90+% scale if you take rips into account) effective, and this merely reduces the chance.
In the words of [someone who gave us a sex ed & aids lecture in school] - "There's a certain chance that you may not contract AIDS/HIV from unprotected sex, but I won't tell you it since its useless, since it won't matter if you do get it [to you] and you will contract it eventually from sleeping with an infected partner" [Paraphrased].

Crossroads Inc. wrote: Exactly how badly have we failed in stopping AIDS when it is admitted that Mass circumcising is "Easier" then trying to get people to sue Condoms?

Extremely so when its considered more viable than Abstinence only programs

wolveraptor · Post by **wolveraptor** » 2006-12-18 02:04am

Since when was a 50% chance of getting AIDS ever acceptable to a rational adult? It's like playing fucking Russian roulette. Why the hell wouldn't you use a condom, which has, for all intents and purposes, a 100% prevention rate? This isn't difficult math. 100 > 50. Plus, you don't have to chop off a part of your penis. What kind of man wants that?

Post by **K. A. Pital** » 2006-12-18 02:18am

If people are dumb enough to go against condom use at all costs, why not circumcise them (at consenting age of course). AIDS will not be stopping just because some idiot thinks he doesn't like to wear a condom. Why are people such dicks? I mean, for fuck's sake, this disease has no cure and kills millions of people, and all you have to do is wear a _fucking_ condom.

"Cultural traditions", my sorry ass.

Justforfun000 · Post by **Justforfun000** » 2006-12-18 10:51am

It's threads like this that makes this site the breath of fresh air in my life. I read those studies and their idiot conclusions and it seemed like every take on it was pro-mutilate. I'm glad to see I'm not the only one who thinks it's utter stupidity to even suggest it makes a difference unless people are having unprotected sex anyway. Besides, it just means it will take them LONGER to get it, and very likely with the misguided idea that it made them basically immune. How many people actually listen to the full explanation? I think this entire issue will end up causing more harm than help.

I mean look at this study"

Researchers enrolled 2,784 HIV-negative men in Kisumu, Kenya, and 4,996 HIV-negative men in Rakai, Uganda, into the studies. Some were circumcised; others were just monitored.

Over two years, 22 of the circumcised Kenyans became infected with HIV compared with 47 uncircumcised men, a 53 percent reduction. In Uganda, 22 circumcised men became infected vs. 43 of the uncircumcised, a 48 percent reduction.

Does this REALLY look like a definitive study to you? With such small numbers to compare here...I mean TWENTY people? couldn't there by a number of unrelated reasons for this?

To start with, I wonder whether anyone has cross-referenced the rate of circumcision with economics? I'll bet that - especially in third-world countries - circumcision rates are higher among the educated and/or above-the-poverty-line families. This could provide a different reason for the same result - educated people and those above the poverty line have a better chance of understanding how to avoid HIV infection.

Alex Moon · Post by **Alex Moon** » 2006-12-18 11:10am

Justforfun000 wrote:
I mean look at this study"

Does this REALLY look like a definitive study to you? With such small numbers to compare here...I mean TWENTY people? couldn't there by a number of unrelated reasons for this?

Female to male transmission has always been lower than male to female or male to male tranmission.

To start with, I wonder whether anyone has cross-referenced the rate of circumcision with economics? I'll bet that - especially in third-world countries - circumcision rates are higher among the educated and/or above-the-poverty-line families. This could provide a different reason for the same result - educated people and those above the poverty line have a better chance of understanding how to avoid HIV infection.

The article makes it clear that they briefed the men on how to practice safe sex. If the study was properly done, then they would have accounted for any variables such as economics, cultural differences, etc. Furthermore, there are plenty of techniques to deal with skewed data.

Frankly, with no copy of the report, it's hard to make any judgement calls other than that this is an interesting finding, if it holds up.

PainRack · Post by **PainRack** » 2006-12-18 12:11pm

Bubble Boy wrote: While we're at it, why not chop off other body parts that have the potential to increase the chances of infection by other diseases? Why is only the foreskin being targetted here? I'm sure we could come up with plenty of body parts that could be safely removed without significantly hinderance to functioning in society, with the logic of preventing potential infections, diseases, etc.

Note: For the record, I'm arguing from the position of a circumsized male myself.

Appendix.....
Tonsils........
Prostrate Gland.......

Admiral Valdemar · Post by **Admiral Valdemar** » 2006-12-18 02:20pm

Given the success condoms have been in Africa (read: none), I'm not surprised people are pushing this idea. Much as it disgusts me, there's just no getting the masses to take up condoms, even with the Church wavering on the subject somewhat.