Circumcision reduces HIV risk?

[SteveHd]

Clarification: My question pertains to giving advice to adults.

 

[2322]

My reply doesn't change.

 

[rawbone8]

the difference is HIV is preventable and is not contagious in the sense that non-sexual touching or interacting with another person will cause infection.....Unlike bubonic plague which was relatively highly contagious through fleas, HIV can literally be stopped in its tracks through education and personal responsibility (this goes even for men or women raping someone and passing it on that way). This unfortunately, is unlikely. Yes there are other cases where someone is accidentally infected, like a healthcare worker, but these remain the absolute minority of cases. If HIV was not sexually transmitted, it would be much more "acceptable" of a disease, although, due to the mere genetics of the virus, im not sure if treatments would be any better due to its amazing ability to mutate

Thanks for the clarification about contagion and epidemiology, but that misses the main point I was making with the comparison which is about the massive scale of the health problem, not whether it is contagious or morally repugnant because of it being tied to sexual activity. On that last note though you raise a very interesting aspect of just why the world chooses not to respond adequately to this crisis. It smacks of Blaming the Victims.

 

[Mr._dB]

In my estimation, the biggest effect that adult circumcisions in Africa will have on HIV transmission rates is that the circumcision patients will be taken out of circulation for a few weeks, thus reducing their total time of exposure to risk.

Unless they're impatient and start banging whores and virgins before they heal up...

 

[chico8]

The fact is that condoms don't get used regularly or at all in many circumstances. Converting masses of the population to consistently using condoms is failing to occur. That said, the circumcision route may mediate the rate of infection and may save lives. I still stand by the idea that condom use must be promoted and supplies distributed cheaply or for free.

We are seeing a massive continent's health and viability in peril, on a level that may rival the historic bubonic plagues of Europe in terms of destroying the population that forms the economic and societal base. We haven't seen tragedy on this scale in our lifetime.

Funding for condoms, reproductive health and sex education in Africa has been drastically reduced under bushco. Abstinence is the major tool and is being wielded by a bunch of xian fundamentalists. Condoms are easy to use, cheap and highly effective. If their use was furthered by USAID, not only would the AIDS rate plummet but so would the birthrate. And overpopulation is Africa's biggest problem, not AIDS.

Circumcision is just another panacea promoted by those who view the foreskin as irrelevant as opposed to the center of male sexual feeling that it is.

 

[basque9]

Thinking has not changed all that much concerning infections and circumcision over the years. Almost 30 years ago I was advised that I should get cut so that my high incidence of urethral infections would be reduced. I was ... and it worked remarkably to reduce infections..... did diminish the quality of sexual relations for a few years though!

 

[JonahFalcon]

Has anyone seen this?

http://today.reuters.com/news/artic...KOC_0_US-AIDS-CIRCUMCISION.xml&src=rss&rpc=22

It's called "a lie" to get people to pay $$$ for a circumcision, since the previous "health risks" were proven bogus.

 

[baseball99]

Thanks for the clarification about contagion and epidemiology, but that misses the main point I was making with the comparison which is about the massive scale of the health problem, not whether it is contagious or morally repugnant because of it being tied to sexual activity. On that last note though you raise a very interesting aspect of just why the world chooses not to respond adequately to this crisis. It smacks of Blaming the Victims.

I wasnt trying to one-up you.....just hitting the same point from a different angle. Unfortuntately I have seen many young people recently diagnosed with HIV and its not only "blaming the victims" but its also because people, especially teenagers, think "this only happens to other people, it cant ever happen to me.".....Same way most smokers always think lung cancer will happen to someone else but not them.....We live in a society with a lack of responsibility and we all think we're supermen.....fact of the matter is HIV could theoretically be wiped out if those that are positive did not have sex with anyone negative, if IV drug abusers did not share needles, nobody got raped, everyone practices safe sex, and healthcare workers never accidentally stuck themselves.....but the fact of the matter is it does exist and will continue to be a problem for a long time. Another major problem is the latent time of the infection, where someone could basicallly remain healthy for 10 years and not know they are infected.....i think its something close to 30% of people infected don't even know it.....scary.

 

[baseball99]

It's called "a lie" to get people to pay $$$ for a circumcision, since the previous "health risks" were proven bogus.

im not sure what health risks you are talking about, but no there is definitely a clear distinction between circumcised and uncircumcised contraction rates of HIV. Sorry if you dont want to believe it but it is there and there are very logical reasons for this. Now, again, does this mean mass circumcisions should take place.....no. Protection is not 100% and you cant lead people to believe so. However, based on presence of particular cells, infection does occur more commonly, sorry but that risk was not proven bogus.....but all this does not take away from personal responsibility

 

[B_dxjnorto]

By robbing foreskins, circumcisers are literally severing a male from a means of perceiving, experiencing, sharing, and enjoying his existence.

 

[Snozzle]

I...people, especially teenagers, think "this only happens to other people, it cant ever happen to me."...

Not just teenagers. In the early days of the epidemic British guys avoided Americans, young men avoid old men, old men avoid young men. Everybody likes to think "people like me" don't get HIV. So now in Africa it'll be intact guys who'll be the outsiders. Already 60% of African men are circumcised, yet the epidemic is rampant.

----
They quote those 48% and 53% Relative Risk Reduction figures because they sound like significant protection, but what they don't tell you is that the rate of infection within one year is so low that they'll have to circumcise 56 men in Uganda to prevent one case of HIV (if the study is accurate). In the US, the figure is much higher because the rate is lower. I doubt that's cost-effective compared to spending the money, time and expertise on education and the promotion and use of condoms.

Paradoxically the Catholic church and the US govt will probably fall in behind promoting circumcision, even though this implies just as much non-marital sex as condoms do, and now it'll be condomless sex. A recipe for disaster.

It's suspicious that they have not let any of the three experiements run their course "because it would be unethical not to offer the men circumcision". Yet they thought it was quite ethical to test the men for HIV and not tell them they were positive "because they might get stigmatised" but rather let them go their merry way infecting women (and men?). This experiment would NEVER have got ethical approval in the US, and there's a degree of racism about experimenting with circumcision on them (rather like injecting 3rd world women with depo povera) because "Africans can't control their animal urges or take control of their own sexuality" but must be given a one-off fix.

Cutting the experiment short gives a spuriously high risk reduction for purely statistical reasons, and because the circumcised men had to abstain from sex while they healed.

And if they combine circumcision with safe-sex eduction in future, they'll be able to give the circumcision the credit for any reduction in HIV that follows, or blame any failure on "not taking enough mucosa" or "not circumcising them early enough".

 

[snoozan]

They quote those 48% and 53% Relative Risk Reduction figures because they sound like significant protection, but what they don't tell you is that the rate of infection within one year is so low that they'll have to circumcise 56 men in Uganda to prevent one case of HIV (if the study is accurate)

I haven't looked at the study itself but this was precisely the information I was looking for. There's a huge difference, if say, the risk reduction meant the infection rate theoretically goes from 50% to 25%, not so much if it means the risk reduction goes from 2% to 1%.

I agree that it seems like a rather bass-ackwards way of trying to prevent HIV-- if these men still refuse to use condoms, eventually they or their partners are still going to get infected, it will just happen more slowly. I guess that's part of the point, but it doesn't stop HIV from spreading. And I agree that there are going to be men that think that now that they are circumcised they don't have to worry about HIV as much and have either more partners or use condoms less, and the infection rate goes right back up. That's just how people think.

Circumcision is not the answer to HIV in Africa or the US. It's akin to saying "well, have sex with prostitutes 10 times a year instead of 20 and you'll reduce your risk." Which is true to a point, but how much is that really helping overall?

The only way to dramatically lower HIV infection rates is by using condoms, abstinence, staying monogamous, using clean needles, using uninfected blood products, and medical staff using protection when in contact with bodily fluids. I don't know how this is going to be accomplished because it seems damn near impossible. But it's the only way that HIV infection will be reduced in a meaningful way unless there is a vaccine or a cure.

 

[B_dxjnorto]

Snoozan, to get the other 50%, 10%, 5%, whatever, we have to cut the women.

Double standard?

In any event, leave the babies out of it. Unless mothers are infected, their risk is zero.

 

[Nelly Gay]

Further...

Circumcision is “not a magic bullet, but a potentially important intervention,” said Dr. Kevin M. De Cock, director of H.I.V./AIDS for the World Health Organization.

Good name ....

 

[JonahFalcon]

Foreskins do not contain blood nor semen. Smegma is NOT, repeat, NOT a substance that can transmit the HIV virus.

 

[Christiaan]

Isn't it strange that some of the highest rates of HIV are in the US where the male population is largely circumcised? I wonder why their theeory hasn't worked in the US? Europe, on the other hand, has a much, much, lower rate of HIV infevtion WITH a majority uncircumcised population.

But they go to Africa, where the populations of cut or uncut males are largely separated by their tribal/ethnic situations and draw conclusions for the whole world. Tragically they now tell these Africans that if they have part of their penis removed they have a much less chance of being infected with HIV! I wonder how many cases of HIV this causes and how many die because their statistical sample is screwed?

I keep waiting for statisticians somewhere to step forward and point out that their statistical sample is not valid to draw the conclusion that the world's males should be routinely mutilated because of a mistake in the conclusion.

I am happy I have my foreskin and I feel very sorry for all the boys whose parents buy into this absolute rubbish.

 

[Snozzle]

I haven't looked at the study itself

Nobody has. It hasn't yet been published in a peer reviewed journal. The people promoting circumcision did it a month ago with the Sexually Transmitted Disease study: then when it's published, and the replies show how circumcision is not the greatest thing since sliced bread, they publish a halfarsed retraction (admitting in that case that it would take more than 20 circumcised men to prevent one minor STD) which gets no traction at all. But by then the meme "circumcision protects against X" is out of the bottle and away we go again.

 

[Snozzle]

when you are infected you will never get the virus out of your genome.

you can never get the hiv DNA out of the genome from a human cell!!!
you have to take strong medicaments and your immune system gets attacked!
besides the insertion od hiv DNA into a human genome can create cancer cells!
so be patient

I'm open to correction but my understanding was that HIV is made of, and replicates using RNA, not DNA, and that the genome comprises only DNA except when it's replicating.

 

[Snozzle]

Originally Posted by Snozzle

OF COURSE men who think they are protected by being circumcised will be less likely to use condoms. (Even if they don't in this experiment, where they're getting regular counsellling.)

By that same logic those on HIV medicine just might think they are cured so why give them the medicine?

That isn't the same logic. They're proposing to give healthy men a painful operation that will leave their penis looking different and their sexuality feeling different, and tell them "This will protect the community against the spread of HIV, but it won't protect YOU much, and you must go on using condoms."
That's one hell of a mixed message, and I think (like the Larson cartoon of what a man says and what his dog hears), they will hear "This will protect... against the spread of HIV." and nothing after the but.

 

[Snozzle]

Is it ethical to advise mass circumcision of African men "for their own good" but then not give the same advice to men of the First World?

Dunno about ethical. In Uganda, with 4.1% infected (according to the CIA's world factbook), the study implies you'd have to circumcise 56 men to prevent one case of HIV, so I figure that in the US, with 0.6% infected, you'd have to circumcise 382 men to prevent one case.

It's very unlikely they would have had ethical approval to do this experiment in the US, especially testing men for HIV and not telling them when they were positive, but letting them go out and infect others.