Circumcision and HIV

[Kiamo]

I, personally think that any connection between circumcision, and the rate of HIV infection is a load of bull. The BBC disagrees.

http://news.bbc.co.uk/2/hi/health/5165118.stm

 

[Snozzle]

I, personally think that any connection between circumcision, and the rate of HIV infection is a load of bull. The BBC disagrees.

http://news.bbc.co.uk/2/hi/health/5165118.stm

Deborah Jack, chief executive of the National AIDS Trust, said:
"... people who are circumcised can still be infected with HIV and any awareness campaign would have to be extremely careful not to suggest that it protects against HIV or is an alternative to using condoms."

So let's see. They're going to promote circumcision in order to protect against HIV (and it can only protect if you're not using a condom), but they'll have to be extremely careful not to suggest that it protects against HIV or is an alternative to condoms. And they'll accomplish that feat how?

The other problem is that many of these studies don't correct for such factors as: the circumcised sample is Muslim, so has multiple wives, ritual cleansing, strict rules about when and who you have sex with, and a prohibition on alcohol, resulting in less loss of inhibitions, while the intact sample has none of that.

One much touted result is of a group of circumcised men with HIV+ wives, none of whom got HIV during the course of the study. What they don't mention is that a third of the circumcised potential recruits were kept out of the study because they already had HIV. And so it goes.

Circumcision is a cure looking for a disease, and it always homes in on the most frightening disease of the day. It was inevitable that it would be touted as being good against AIDS - in fact a doctor called Fink made that claim before there was any evidence at all.

 

[DC_DEEP]

I have seen some of the numbers from a few similar studies, but have never seen any of the actual research results.

I'm just guessing here, but this is my take on the "circumcision and HIV" link: after circumcision, especially when done at birth, there is keratinization of the glans (something like a callus, the skin gets thickened). That part, at least, is fact. An uncircumcised cock, with its more delicate tissues, is more prone to abrasion during sexual activity, therefore providing more possibility for a pathway for the virus.

That being said, condoms still provide more protection, for cut or uncut men, and for all women.

Studies like this really bother me, for three reasons: first, I'm not sure I trust the datasets. I seriously doubt that the sample group and controls are sufficiently large and sufficiently random. Second, the "results" may tend to encourage more unnecessary infant circumcisions. And third, possibly most important, the "results" may tend to discourage condom useage, especially among circumcised men.

 

[col]

I'm just guessing here, but this is my take on the "circumcision and HIV" link: after circumcision, especially when done at birth, there is keratinization of the glans (something like a callus, the skin gets thickened). That part, at least, is fact. An uncircumcised cock, with its more delicate tissues, is more prone to abrasion during sexual activity, therefore providing more possibility for a pathway for the virus.

I think this is an important factor in completely negating the comments made about circumcision and HIV. The BBC has promoted these so called 'findings' since their Horizon science programme in 2000 called 'The Valley of life and death' which suggested that one side of the valley had a high incidence of HIV because they were all uncut and the other had less (not none, only less) because they were circumcised. No other factors were mentioned in that documentary and it even followed a guy deciding to get cut for the spurious reasons put forward in the documentary.

The interesting part of the findings is that the inner foreskin because it is softer and thinner apparently is more susceptible to the HIV virus and that circumcision stops this. The reason why I think it is very wrong for these officials to start jumping up and down suggesting that everyone should be circumcised is that surely if their reasoning is correct shouldn't they monitor the method of circumcision?

After all I've seen pictures of circumcised penises where all the inner foreskin is left and stretched back down the shaft. Surely, if the reasoning that the inner foreskin is more susceptible is to be believed, all circumcisions should remove all the inner skin completely with the scar close to the head? Because otherwise wouldn't that nullify the 'beneficial' effect of having the foreskin cut off? It is obvious that while the skin might be out in the open once a guy has been circumcised the inner foreskin left is still a lighter colour, and I hear that some people find whatever is left above the circumcision scar more sensitive than the skin below? Wouldn't the findings suggest these men are just as much at 'risk' as if they were uncut?

I think most of these things are cultural rather than medical - as the poster above said circumcision is a cure without a disease, and people are ready to ascribe all sorts of mystical protections to carrying it out, when any sensible person, let alone a medical journal, someone working for the UN and a respected media outlet like the BBC would surely ask for more tangible proof or benefits before pushing this as a universal measure.

Since this news is only related to Africa does anyone else get a whiff of colonial, "these Africans can't take care of themselves, so we have to do it for them" thinking about this?

 

[Dr Rock]

there's also the fact that lowering the death rate in subsaharan africa is an idea of questionable merit to begin with. most of the countries worst afflicted by HIV are the ones that are suffering worst from uncontrollable population growth. it is not in the interests of the human species as a whole to further unbalance birth/death ratios in developing countries - we have way too many people on this planet already.

 

[B_dxjnorto]

That's hard Dr.

This is even harder. I've attached a Powerpoint of a study that purports to show a protective effect of female circumcision in Tanzania.

What's good for the gander is good for the goose? Cut out as much mucosa as possible, male and female?

Incurable STDs still elicit the same premodern tendency to blame anatomy for the action of microorganisms.

Crap. It won't let me upload the .ppt because it's not a supported file type. It's got 39 slides, if anybody wants the file PM and I will provide it. Here's some information copied from the presentation:
_______________________

The surprising and perplexing significant inverse association between reported female circumcision and HIV seropositivity remained highly statistically significant in the final logistic regression model, despite the presence of other significant potential confounders, namely, geographic zone, household wealth index, woman´s age, lifetime sex partners, and current/past union status.

Some additional analyses were undertaken using those women for whom a male partner was interviewed and could be linked (n=2305).

The couples analysis also suggests a protective effect, real or not, of female circumcision.

 

[chico8]

The study also began the minute the guys had their circumcisions. That means the intact guys were having sex for 2-6 weeks longer than the cut guys. Also, most guys claim they have increased sensitivity for a few weeks or months after they've been cut. That could very well mean they're ejaculating quicker which of course means the duration of the act of sex is shorter, therefore limiting their exposure to the virus.

There was also no tracking of the amount of sex the guys had nor was there any tracking of condom usage. The study is so horribly flawed that it might be the reason no reputable medical journal will print it.

 

[Jeffin90620]

Circumcision is a cure looking for a disease, and it always homes in on the most frightening disease of the day. It was inevitable that it would be touted as being good against AIDS - in fact a doctor called Fink made that claim before there was any evidence at all.

Especially considering that the HIV infection rate for heterosexuals is far lower in countries (such as the US) where circumcision is common than it is in countries (e.g., Europe) where it is not.

Just a quick review at http://www.avert.org/statindx.htm shows that the cumulative heterosexual infection rate for Great Britain is 28%. For the United States, it is 17% (this, of course, presumes that both sample sets have identified closeted homosexual males with the same degree of accuracy).

 

[Jeffin90620]

Circumcision is a cure looking for a disease, and it always homes in on the most frightening disease of the day. It was inevitable that it would be touted as being good against AIDS - in fact a doctor called Fink made that claim before there was any evidence at all.

Dang. I forgot to include the European results. Couldn't find cumulative totals separated by probable source of infection in my quick overview, but the results for 2004 show that "56% probably acquired HIV through heterosexual contact" in Western Europe, compared to 31% for the United States.

Granted, Europe and Great Britain have varying degrees of socialized medicine and that always results in inferior health care (take a look at cancer survival rates, after noting that you are 40% more likely to acquire a fatal infection in a German hospital than in an American one) and, from what I have read but connot properly attribute here is that open sores on the genitalia are far more common in Europe than in America (I think it was a factoid in Playboy magazine article on AIDS back in the 80s, but am not certain).

 

[B_dxjnorto]

I think we are talking about several studies here now.

The point is let science do it's work. I personally know a guy who had his son cut twelve years ago owing to the touted correlation between anatomy and HIV risk. Clearly an infant has zero risk of contracting HIV (unless the mother is infected). Furthermore, the jury is still out twelve years later.

Fearmongering and scare tactics have ever been the province of circumcisers.

 

[ChuckRich]

I just saw an article on this on MSNBC (http://msnbc.msn.com/id/13812938/?GT1=8307) and was about to post it. I should've known it'd already be a topic. There's always somebody trying to find a definitive reason for or against cicumcision. Personally, I don't think it's necessary or disastrous. If someone wants to be circumcised then go ahead, if not then don't. By that same token I think it'd be better for parents not to have their sons cut simply so that it can be their own choice later in life. But given that there's no real reason to do it I doubt many men would choose to be circumcised anyway.

 

[chico8]

Dang. I forgot to include the European results. Couldn't find cumulative totals separated by probable source of infection in my quick overview, but the results for 2004 show that "56% probably acquired HIV through heterosexual contact" in Western Europe, compared to 31% for the United States.

Granted, Europe and Great Britain have varying degrees of socialized medicine and that always results in inferior health care (take a look at cancer survival rates, after noting that you are 40% more likely to acquire a fatal infection in a German hospital than in an American one) and, from what I have read but connot properly attribute here is that open sores on the genitalia are far more common in Europe than in America (I think it was a factoid in Playboy magazine article on AIDS back in the 80s, but am not certain).

The fact remains that Europe has less than half the infection rate of the US. Part of the difference could be attributed to the fact that Reagan refused to acknowledge the problem in the early days whereas Europe took immediate action and helped stop the spread of the virus. It could also be contributed to the more open attitude towards sexuality in Europe and the puritanical attitude towards sex ed many Americans have. Knowledge is power.

It would be interesting to see your figures on cancer survival statistics. What's known for sure is the rate of MSR in British hospitals has skyrocketed due to the overhaul of the NHS, Thatcher and Blair have done everything they can to destroy the system. France, Germany and Scandinavian countries have the highest rated medical care systems in the world. When ~35% of Americans don't have health care, it's pretty obvious that socialized medicine is far superior to what exists in America. Preventative care is a primary objective of socialized medicine but comes in last in the US.

 

[Sergeant_Torpedo]

I, personally think that any connection between circumcision, and the rate of HIV infection is a load of bull. The BBC disagrees.

http://news.bbc.co.uk/2/hi/health/5165118.stm

The BBC was an independent voice of reason. Now it licks the boots whomever has Tony Blair and his cronies in its pocket.

 

[B_nocock2big4me]

I think this all goes back to using a condom during sex.... the circumcision has little or nothing to do with preventing infection. This, of course, would go against the religious zelots telling the rest of the world what is right and wrong {you can't promote condom use because that promotes sex line of bullcrap}.

 

[Sergeant_Torpedo]

More spurious unscientific propaganda clothed in white coats. First promulgated by fundamentalist group who financed research in Africa. In same locality cut Islamacists had low HIV rates compared to promiscuous pagan uncut population. It isn't science and has nothing to do with circumcision that one group had higher HIV rates than the more puritanical and continent group.

 

[Snozzle]

I now see that Auvert, who led the Orange Farm randomised control test (but not of course double-blind, nor was the control group given a placebo operation or the strong warnings against unprotected sex that the circumcised experimental group was given), is on the team that made these calculations.

They seem to have made a number of unspoken assumptions:

• circumcision is risk-free and cost-free (and any costs will not be deducted from other prevention measures)
• all circumcisions are equally effective
• circumcision will have no effect on the frequency of intercourse, or the likelihood of using a condom

I have a strong suspicion, from the way many of these studies are written up, that the agenda of some people is not (or not so much) to prevent HIV, but to promote circumcision: one sees the same people involved, where circumcision is the only common factor.

 

[baseball99]

When ~35% of Americans don't have health care, it's pretty obvious that socialized medicine is far superior to what exists in America. Preventative care is a primary objective of socialized medicine but comes in last in the US.

I disagree but thats a whole different point. Before you jump on the fact that people are insured and therefore not getting medical care you really need to look at non-compliance rates. Everyone wants a pill for everything but in actuality you could cure so much by diet and exercise. So what do we do, give every obese person gastric bypass?!?! and then basically we would give them all malabsorption syndromes. People need to take responsibility on their own healthcare and keep themselves healthy with diet and exercise and not expect an antibiotic to cure everything. Also I do agree that uninsured people are a problem.....everyone should have access to medical care. The poorest have medicaid and can pretty much get anything and every diagnostic test they demand. Rich people who have boutique doctors get everything they want. Its the working middle class that suffers and believe it or not this would not be saved by socialized medicine. You find longer waits and less procedures done with socialized medicine. Forget about saving grandpa with a triple bypass bc if youre >55 the cost doesnt outweigh the benefits so in socialized medicine they dont get it done. Healthcare needs a big overhaul and the way to do that is to put the power back into the hands of the patients and the medical decisions back into the hands of the doctors. Let doctors and patients decide together what tests to order and what procedures to do and take it out of the hands of businesses that have no idea about medicine or patient care and only care about profit.....

 

[baseball99]

I now see that Auvert, who led the Orange Farm randomised control test (but not of course double-blind, nor was the control group given a placebo operation or the strong warnings against unprotected sex that the circumcised experimental group was given), is on the team that made these calculations.

They seem to have made a number of unspoken assumptions:

• circumcision is risk-free and cost-free (and any costs will not be deducted from other prevention measures)
• all circumcisions are equally effective
• circumcision will have no effect on the frequency of intercourse, or the likelihood of using a condom

I have a strong suspicion, from the way many of these studies are written up, that the agenda of some people is not (or not so much) to prevent HIV, but to promote circumcision: one sees the same people involved, where circumcision is the only common factor.

I mentioned this before in another thread. Under the foreskin you can have microecxorsions (little cuts) and you have increased white blood cells and potential inflammation therefore if 2 people are exposed to an HIV virus the uncircumcised person is slightly at a higher risk because they have more of the risk factors. However, being cut does not make you immune and the virus can still infect in the urethra of men. Now is it enough to justify circumcision of course not. But is the risk decreased, yep. It is like say two people got stuck with needles, one was drawing blood from an HIV+ patient and the other was suturing (stitching) and HIV+ patient, the person drawing the blood is at a higher risk of contracting the virus because a hollow bore needle is more likely to contain more virus than a suture hook. Of course this also will depend on viral load of the patient.

 

[Snozzle]

I mentioned this before in another thread. Under the foreskin you can have microecxorsions (little cuts) and you have increased white blood cells and potential inflammation therefore if 2 people are exposed to an HIV virus the uncircumcised person is slightly at a higher risk because they have more of the risk factors. However, being cut does not make you immune and the virus can still infect in the urethra of men. Now is it enough to justify circumcision of course not. But is the risk decreased, yep. It is like say two people got stuck with needles, one was drawing blood from an HIV+ patient and the other was suturing (stitching) and HIV+ patient, the person drawing the blood is at a higher risk of contracting the virus because a hollow bore needle is more likely to contain more virus than a suture hook. Of course this also will depend on viral load of the patient.

Why do I feel that I know less after reading one of baseball's posts than before?

*micorecxortions = microexcoriations?

 

[baseball99]

Why do I feel that I know less after reading one of baseball's posts than before?

*micorecxortions = microexcoriations?

dude are you serious, get a freakin life bro. The last thing i care about when typing on lpsg is spelling and grammar. Please, for my next paper i'll be sure to contact you as editor for spelling and grammar ok? Btw alot of the time i also dont capitalize the letter i and maybe i dont even put a comma or a period.....oh the heresy. i hop spelign on a formu dosent bohter u tooo muhc bc mots peeple dotn caer enuf to rereed and spelchek k?