Circumcision Gains Ground as Anti-AIDS Measure

[Kanastrous]

Kisumu, Kenya - Sitting underneath the bright murals at a clinic, 22-year-old Elijah Ochanda gestures at his shorts and explains: "When they remove this thing, it makes you safer.''

He is talking about the circumcision he is about to undergo at the urging of his older brother. He has watched several friends die of AIDS, and has come to believe the science that says circumcision can prevent men from being infected.

Dr. Robert Bailey, an epidemiology professor from the University of Illinois, is helping to roll out Kenya's first free circumcision project, which offers operations at public health facilities. Such projects are already running in Swaziland, Rwanda and Zambia, other countries where a large percentage of the population traditionally do not circumcise.

Bailey's study in Kisumu, western Kenya found infection rates were cut by 60 percent among men who were circumcised. The study, funded by the U.S. Institutes of Health and the Canadian Institutes of Health Research, was one of several that led the World Health Organization to include circumcision in its prevention policies a year ago.

It prompted the Kenyan government to form a task force to promote voluntary, medically safe operations.

But it's not that simple. Circumcision has become entangled in the violence that followed the disputed presidential election of last December.

Supporters of President Mwai Kibaki, whose Kikuyu tribe circumcises its men, clashed with supporters of opposition leader Raila Odinga, who is Luo, a tribe that does not circumcise. The rite took on political significance, with Odinga's rivals publicly saying he wasn't a complete man. Many Luo were forcibly circumcised in the violence.

The violence has subsided, but Bailey says it has made the new power-sharing government, with Odinga as prime minister, wary of taking a public stance on circumcision. The disruption initially delayed the launch of the task force's program.

Still, it's noteworthy that Ochanda has overcome the tradition issue in opting for circumcision. And the Luo tribe's council of elders doesn't forbid it outright although they do say it is contrary to their traditions and worry it will promote promiscuity.

"If you want to do that on your own, no one will question you, but it is not our custom,'' said elder Odungi Randa.

http://www.msnbc.msn.com/id/24740291/

***


Many Luo were forcibly circumcised in the violence.

For sure, that's the passage that stood out, to me.

[General Zod]

This nonsense again? I thought it was debunked months ago.

[Cairber]

Yeah we have had a few studies show that the results don't seem to hold true in populations in Australia and the UNited States, both homosexual and heterosexual.

But it won't stop the Africa stuff....or parents wanting more reasons to cut their kids here.

sigh...


(no fight left at the moment on this particular area of the anti circ fight)

[CaptainZoidberg]

Wouldn't it just be easier and - you know - more effective to just distribute condoms at prevention centers?

Nevertheless, if circumcision really does protect against AIDS, then it ought to be legalized, whether the tribe traditionally does it or not.

[General Zod]

Wouldn't it just be easier and - you know - more effective to just distribute condoms at prevention centers?

Good luck convincing the Catholic Church with their stranglehold on Africa.

Nevertheless, if circumcision really does protect against AIDS, then it ought to be legalized, whether the tribe traditionally does it or not.

Except there's zero evidence whatsoever to suggest it protects against aids. Especially considering its infection rate in the US.

[Kanastrous]

Except there's zero evidence whatsoever to suggest it protects against aids.

Bailey's study conclusions have been shown to be in error?

[Broomstick]

It seems that in any health crisis there are always people who want to do anything but what actually works. In this case, that's condoms and having the self control not to fuck everything on two legs.

I fear some of these men getting circumcised are working under the assumption that this will allow them fuck anything and everything with 100% protection. And it won't.

[General Zod]

Except there's zero evidence whatsoever to suggest it protects against aids.

Bailey's study conclusions have been shown to be in error?

Without seeing the study itself the 60% statistic is absolutely worthless. Besides which, even if those claims were accurate it fails to adequately explain the increase in HIV of developed countries like the US, where circumcision is almost a matter of course.

[CaptainZoidberg]

It seems that in any health crisis there are always people who want to do anything but what actually works.

In this case, that's condoms

If only there was a spermicide, or better yet - a spermicide that also broke down proteins and the so such to prevent STD transmission.

I have a gut instinct that Catholics would be less opposed to that than condoms.

and having the self control not to fuck everything on two legs.

I'm sure that's the Catholic's strategy. It just seems like that would contrary to all of human nature.

I fear some of these men getting circumcised are working under the assumption that this will allow them fuck anything and everything with 100% protection. And it won't.

I'm sure they'll still be told that abstinence is the best policy, and that circumcision just reduces the risk - but someone will still manage to go out of control.

[DPDarkPrimus]

Wouldn't it just be easier and - you know - more effective to just distribute condoms at prevention centers?

Good luck convincing the Catholic Church with their stranglehold on Africa.

Believe it or not, even with the Church out of the picture, it still wouldn't work. A reporter who traveled down "the AIDS Belt" as a major highway is known (because the truckers there carry the disease over its length) and he saw free condoms from the WHO being sold everywhere, and they were almost half the price of a hooker.

[Justforfun000]

Ultimately most here have agreed that it's a useless statistic because anything less then near 100% protection is not going to make a true difference. If they are engaging in unsafe sex, all this may do is make it a bit LONGER before they get infected. On top of that the ones who foolishly draw too much optimistic hype from this study will be even less careful then before and simply increase their risks statistically by the number of sexual encounters they have.

In the long run it's a complete red herring to the issue of true HIV prevention. Abstinence, monogamy between two negative people and condom use are the ONLY methods that have enough statistical efficacy to prevent AIDS. They should never have focused on circumcision. Especially since it's already being performed routinely on unconsenting infants to this day which myself and many others feels is barbaric, cruel and completely unethical .

[CaptainZoidberg]

Ultimately most here have agreed that it's a useless statistic because anything less then near 100% protection is not going to make a true difference. If they are engaging in unsafe sex, all this may do is make it a bit LONGER before they get infected. On top of that the ones who foolishly draw too much optimistic hype from this study will be even less careful then before and simply increase their risks statistically by the number of sexual encounters they have.

A 60% reduction might not benefit a person if they misinterpreted the figure. But if they didn't change any behavior patterns than AIDs transmission in Africa would indeed slow down.

I can sort of see how circumcision reduces HIV risk. Perhaps after sexual activity fluid gets caught in the foreskin and has a long time to contact the head of the penis, where it might spread AIDs through any small cuts or raw areas. Perhaps the additional sexual fluid kept in contact with the head of the penis via the foreskin increases HIV transmission in non-circumsized men.

This is, of course, pure speculation on my part.

In the long run it's a complete red herring to the issue of true HIV prevention. Abstinence, monogamy between two negative people and condom use are the ONLY methods that have enough statistical efficacy to prevent AIDS. They should never have focused on circumcision. Especially since it's already being performed routinely on unconsenting infants to this day which myself and many others feels is barbaric, cruel and completely unethical .

Realistically, condom distribution seems like the best strategy out of the 3 you listed. Abstinence runs contrary to human nature and HIV doesn't immediately show symptoms, so knowing if your partner is negative might be unrealistic in large parts of Africa. I know they have tests, but people might take a request to take the test as an insult, or as an accusation of being promiscuous. Also people might not have easy access to the test.

[General Zod]

A 60% reduction might not benefit a person if they misinterpreted the figure. But if they didn't change any behavior patterns than AIDs transmission in Africa would indeed slow down.

I can sort of see how circumcision reduces HIV risk. Perhaps after sexual activity fluid gets caught in the foreskin and has a long time to contact the head of the penis, where it might spread AIDs through any small cuts or raw areas. Perhaps the additional sexual fluid kept in contact with the head of the penis via the foreskin increases HIV transmission in non-circumsized men.

This is, of course, pure speculation on my part.

The 60% figure is absolutely worthless without knowing what factors were involved. Were the people circumcised already married? How old were they? What was their current state of health? How promiscuous were they? What was the sample of patients who had circumcisions, etc. Without knowing these 60% is utterly meaningless. So again, trying to claim that it reduces it ignores the increase of HIV in countries where circumcision is practically the norm.

[Kanastrous]

Apparently the tissue of the foreskin tends to have more receptors of a type useful to HIV viruses in the process of infection.

Although that doesn't make circumcision sounds like anything more than an ancillary sort of patch.

[General Zod]

There's also this study, as old as 1999, which flat out contradicts the claims in the OP. I haven't seen anything with newer figures but I'd imagine the ratios don't change too drastically.

Three studies have linked the foreskin to HIV infection by looking at maps, instead of men. These studies found an association between the practice of male circumcision at a societal level and regional HIV seroprevalence in Africa. In locations where male circumcision is practiced, HIV seroprevalence was found to be considerably lower than in areas where it is not practiced2-4. Other cultural factors, such as age at first coitus, chastity and monogamy, that could otherwise explain the differences were not considered by the authors. The authors employed data collected in the 1950s concerning circumcision practices. They assumed that circumcision practices had not changed since that time and that, within a given area, circumcision was universal or completely absent. Circumcision was not a panacea in preventing the spread of HIV as several areas where circumcision was practiced also demonstrated high levels of HIV seroprevalence.

Code: Select all

                                                              Population in
                   Circumcision         AIDS prevalence       thousands
   Country         rate(%)              per 100,000           (1990)

   Japan            1                    0.2                   123,638
   Finland          1                    0.9                     4,984
   Norway           1                    1.5                     4,247
   Sweden           1                    2.0                     8,527
   Germany          1                    2.2                    63,237
   France           1                    3.5                    56,367
   Mexico           1                    4.2                    88,598
   Denmark          1.6                  4.4                     5,135
   Italy            1                    8.9                    57,664
   Spain            1                   14.2                    39,405
   UK               7                    2.4                    57,410
   Canada          30                    3.8                    26,560
   New Zealand     40                    1.2                     3,296 
   Australia       40                    4.5                    17,083
   USA             85                   16.0                   251,398
   Israel          95                    0.5                     4,586

[Kitsune]

Let me just ask this.....
People would prefer to get part of their penis chopped off and lose pleasure permanently than wear a rubber ducky?

[CaptainZoidberg]

It looks like the correlation between wealth and low HIV rates is greater than that between circumcision and low HIV rates. Oddly enough, there's a correlation between wealth and circumcision, which creates the illusion of a casual relationship between circumcision and HIV.

I'd be surprised if the researchers forgot the first law of statistics: "Correlation is a necessary but not sufficient condition for causation".

[General Zod]

It looks like the correlation between wealth and low HIV rates is greater than that between circumcision and low HIV rates. Oddly enough, there's a correlation between wealth and circumcision, which creates the illusion of a casual relationship between circumcision and HIV.

I'd be surprised if the researchers forgot the first law of statistics: "Correlation is a necessary but not sufficient condition for causation".

What the hell are you babbling about? I can't make heads or tails out of what the fuck you're trying to criticize with this nonsense.

[Broomstick]

He's saying "coincidences happen"

[Anguirus]

What the hell are you babbling about? I can't make heads or tails out of what the fuck you're trying to criticize with this nonsense.

Uh...what he's saying makes perfect sense to me. Except he probably meant "I wouldn't be surprised if the researchers forgot..."

[Justforfun000]

That was an extremely interesting chart you put up General Zod. The USA has one of the highest amounts of circumcision, yet one of the highest rates of infection. israel has even MORE circumcisions, yet a very low rate of infection...Spain has one of the LOWEST circumcision rates, yet one of the highest HIV infection rates.

How the fuck is that chart supposed to be an argument in favour of circumcision? It looks quite clear to me that it doesn't make any bit of difference one way or the other.

[General Zod]

How the fuck is that chart supposed to be an argument in favour of circumcision? It looks quite clear to me that it doesn't make any bit of difference one way or the other.

Uhm, it isn't an argument in favor of circumcision. Read the actual study I linked to.

[Justforfun000]

Uhm, it isn't an argument in favor of circumcision. Read the actual study I linked to.

LOL. No I know that. I didn't mean that literally. I meant after looking at that, how the hell could anyone argue in favour of circumcision supporting low infection rates.

I'm totally on your side with this one.

[Broomstick]

Circumcism does not take place in a vacuum. In Africa there is a strong correlation between circumcism and Islam - which STRONGLY discourages outside-marriage sex in both women AND men. Less promiscuous sex is what's protecting people in that case, not the state of the foreskin.

The US, however, snips boys in a culture that does NOT discourage sex outside of monogamous relationships... so you get a higher infection rate.

But if you don't consider those cultural differences you might conclude that cicumcizing African men will reduce HIV infection.

If the above holds true, snipping African men who are NOT Muslim will not have an appreciable effect on HIV infection rates.

[Cairber]

Good read on this:

link

The three African RCTs reported a 50–60% reduction in female-to-male transmission of HIV over follow-up periods of 21–24 months. It is beyond the scope of this paper to analyze these studies in depth. However, the world health community must examine the methodology and results of these studies much more carefully than it has done so far. Given that these studies are now being used to promote circumcision of millions of males, it is worth examining several other factors that might have influenced and skewed the results:
• All three of the studies were halted early
• The durations of the experiments were short
• No long-term follow-up has been or can be done
• A large number of participants were lost to follow-up
• Many infections appear to be from nonsexual sources [9]
• Other important confounding factors exist

Lots more in the paper, but it's lengthy so I won't post it all here.