Monday, February 2, 2009

Snipping It for Health

This morning on NPR, a rep from the Global Campaign for Microbicides, shared some cutting news (pun intended). Turns out that male circumcision is shown to significantly reduce HIV risk!

From the Global Campaign for Microbicides website: The Data Safety Monitoring Board overseeing the Kenyan and Ugandan male circumcision trials showed that circumcised men who practiced penile-vaginal intercourse had approximately 50% less chance of acquiring HIV than non-circumcised men.

Circumcision rituals vary across the globe. 8 days for little Jewish boys, 13 years for Muslims, The Xhosa in what is now South Africa hold the ritual at 16 years with a public ceremony consisting of all tribal members of the age, the most famous being Nelson Mandela.

So ladies, looks like the the extra somethin' somethin' may not be all its cracked up to be. But it's all individual. Just be safe and strap a jimmy hat on.


Mark Lyndon said...

The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the oft-reported 50-65%, and several of the subjects disappearing. The fact that one study described circumcision as "comparable to a vaccine of high efficacy" seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised.

Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of "dry sex".

The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circed men than intact men, yet they've just started a nationwide circumcision campaign. Other countries where circumcised men are *more* likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. That's six countries where men are more likely to be HIV+ if they've been circumcised. If circumcision worked so well, there shouldn't be any.

Cameroon: table 16.9, p17 (4.1% v 1.1%)
Ghana: table 13.9 (1.6% v 1.4%)
Lesotho: table 12.9 (22.8% v 15.2%)
Malawi: table 12.6, p257 (13.2% v 9.5%)
Rwanda: , table 15.11 (3.5% v 2.1%)

Something is very wrong here. These people aren't interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them.

If you read those reports btw, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn't refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they'd be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.

Circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.

ABC works against HIV. Circumcision appears not to. Remember that circumcision won't make any difference unless someone is having unsafe sex with an HIV+ partner.

Female circumcision seems to protect against HIV too btw, but we wouldn't investigate cutting off women's labia, and then start promoting that.

For a good summary of the case against promoting circumcision in Africa, see this link:

Hugh7 said...

Not just "several" of the subjects disappeared. That's normal in any study. But in these trials, more than twice as many circumcised men dropped out, their HIV status unknown, as non-circumcised (control) subjects contracted HIV.

They were encouraged to be tested elsewhere, it being considered unethical to tell them their test results within the trials. Finding you had HIV, after a painful and marking operation intended to prevent it, would be a powerful inducment not to go back. (While non-circumcised men who found they hadn't contracted HIV might well lose interest and fail to go back.)

In other words, it is quite possible that more circumcised men got HIV than non-circumcised. It is easily possible that there was no significant difference.

The promoters of circumcision love presenting that huge figure of 60% reduction (and remember, that's like condoms that fail 40% of the time), but you have to burrow into the studies themselves to find that we are looking at total of 73 circumcised men who MIGHT have got HIV if they had not been circumcised, out of 10,900 men who began the trials.

Anonymous said...

I've heard some bad news about circumcision. Apparently many men loose sensation in the head of their penis because a lot of the nerves get severed. A guy has about 4,000 nerves in his penis and a woman has 8,000 in her clitoris.

You just have to weigh your options. I want my child to have a reduced risk of contracting HIV but at what cost?

Anonymous said...