Zulu king's circumcision decree

[SirConcis]

It is worth repeating. In africa, HIV is part of the normal population and is widespread. In westerne world, HIV is still fairly limited to the gay and drug using communities.

For non anal sex, circumcision of the penis is proven to significantly reduce the odds of reception from an infected female. And there is understaning of why this is the case (thicker inner foreskin means that HIV can't grab on to the Langerhans cells and penetrate to lower layers and spread to all of body.

When you have something of epidemic proportions with no real cure in sight, then any step which can help reduce the spread of disease significantly is of great help. An epidemic of this proportion costs the economy a huge amount of money, not only for mediacl treatments/help for those who get it, but also because a large proportion of your population is not productive, not working and sick, and even worse, a large percentage of kids are orphans from HIV+ parents who require state aid to grow up and with high risk that their HIV will develop into AIDS and they'll never be productive in the economy.

 

[craigr]

Male Circumcision and Risk for HIV Transmission: Implications for the United States | Factsheets | CDC HIV/AIDS

Includes citations to published scientific articles on the benefits of circumcision in the prevention of HIV. Gives reasons WHY circumcision helps biologically, despite it's being considered a mucosal membrane. Yes, there is a section that deliver inconclusive data for the general public in 16 of 35 studies, but follows it with the remaining 19 that had overwhelmingly positive results. Yes, there is debate, as there is with everything in science, but science has spoken and, in this case, Gaydoc followed science and public health and not opinion, and he should be praised for his decision. I have no doubt that it was a hard one to make, especially considering current cultural practices.

That is all.

 

[Snozzle]

...the claim is that the rate of female to male transmission is reduced. What about male to female transmission? Sounds like a bad solution to me.

You're absolutely right. Wawer et al. in Uganda (Lancet 374:9685, 229-37) began to show that circumcising men INcreases the risk to women - already at greater risk - but they cut that study short for no good reason (since they now knew that circumcising the control group would add no protection, and the men were already HIV+) before the finding could be confirmed. These people just don't want to find anything bad about circumcision.

 

[Snozzle]

http://www.cdc.gov/hiv/resources/factsheets/circumcision.htmYes, there is debate, as there is with everything in science, but science has spoken.

Science is not a church and there is never a moment when "science has spoken". In the case of circumcision, even the "science" is culture-driven. It has for aeons been an intervention looking for an excuse, then as medicine became "scientific", a "cure" looking for a disease, and HIV is only the latest example. If you read the actual papers, you can see the circumcision-culture looking back at you. For example, a paper about circumcision and cervical cancer will begin with, not a history of cervical cancer and methods of diagnosing and treating it (to read such a paper you'd never know that screening is highly effective), but a history of circumcision, from the time of the Egyptians!

 

[Snozzle]

If cutting a small flap of skin

It's not small and it's not a flap of skin

saves the lives of others

It doesn't, it is only even claimed to somewhat reduce the risk of infection to the man who's cut - so little that he has to be warned not to slacken off other safe-sex measures

There comes a point where the health of the many is more important than the opinions of the few.

But it's not just their opinions, it's their human right to decide for themselves what part of their own bodies they may keep. And you just made that "many" and "few" bit up, when any one person is at risk of giving HIV only to the people he has sex with (who might be one or none), and these mass-circumcision campaigns target whole populations from 15 to 49 and sometimes children and babies as well, who aren't having sex at all.

 

[Snozzle]

as a gay bottom this is what i dream of, a top who lasts longer than 3 or 5 thrusts.

Well if you're a gay bottom who barebacks, we should really be listening to your opinion on HIV preventions, shouldn't we?
But even if you don't, a less sensitive glans doesn't automatically mean an Energizer Bunny top (who keeps going and going). All his sensitivity is now concentrated in his frenulum and he has less feedback and hence less control. He may still cum before he's ready (or you are).

 

[Snozzle]

I don't believe that the doctor is saying "once you get cut you can fornicate without fear! "

But that is the message the people are getting. At the AIDS 2012 Conference itself, a poster-boy for circumcision, Angelo Kaggwe from Uganda, said "Now I have no worries if I have an opportunity and I have forgotten to bring along a condom." and none of the top circumcision honchos, Daniel Halperin, Bertran Auvert or Robert Bailey, who were listening, corrrected him.

If getting cut, makes the head skin tougher and less able to transmit the virus,

It doesn't, it is only claimed to make the head skin somewhat less able to receive the virus. The virus is transmitted in blood and semen.

 

[craigr]

It's not small and it's not a flap of skin

"In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus" but, ok, small is a relative term, fine.

It doesn't, it is only even claimed to somewhat reduce the risk of infection to the man who's cut - so little that he has to be warned not to slacken off other safe-sex measures

1. It reduces to risk of infection to a man.
2. HIV/AIDS kills those infected.
3. Reduced risk of infections means that, with time, less men AND women will be infected.
3. Less mena and women infected means lives saved.

But it's not just their opinions, it's their human right to decide for themselves what part of their own bodies they may keep. And you just made that "many" and "few" bit up, when any one person is at risk of giving HIV only to the people he has sex with (who might be one or none), and these mass-circumcision campaigns target whole populations from 15 to 49 and sometimes children and babies as well, who aren't having sex at all.

Give that they are minors, their parent has the right to chose for them. Basic medical policy. Although, I will admit, I imagine Zulu cultural standards of caring for a child may be less guided by medical policy and more by the parents, who STILL make the decision. The whole "human right to decide for themselves" only legally applies to adults.

By "many" I mean the Zulu population (~10.7 million) and by "few" I mean those who hold this belief that circumcision is inhumane and care more about that flap of SKIN than about SAVING LIVES. No, those babies and children are not having sex...now. Are you so confident that the HIV/AIDS epidemic will be solved when a currently young boy starts having sex in his near future,only several years away? Also, I see that age group of 15 to 49 only being a problem in those who are already married and in monogamous relationships with no chance of having sex with another person, and with divorce and infidelity, there still remains a chance.

 

[gymfresh]

"In male human anatomy, the foreskin is a generally retractable double-layered fold of skin and mucous membrane that covers the glans penis and protects the urinary meatus" but, ok, small is a relative term, fine.

I mean those who hold this belief that circumcision is inhumane and care more about that flap of SKIN

Snozzle wasn't disputing that the foreskin is skin, he rightly pointed out that it's not a "flap". A flap of anything is attached/hinged at its base and can't spread out and disappear; it can only flap. Either you have no real understanding of the anatomy of the foreskin or you're just trying to be a dick. You may even believe the foreskin has no real function in sex or preserving health, which is your prerogative.

The matter is not settled that circumcision reduces the uptake of HIV. Loads of people with a vested interest in circumcision would love to believe it so, but thus far no studies have proven a causal relationship. In at least one of the African RCTs, intact subjects had exactly the same HIV seroconversion rate as the circumcised subjects (who had less time to acquire the virus) as long as they waited at least 10 minutes post-coitus to wash. Those intact subjects who washed their penises in the first 3 minutes after sex had a significantly greater uptake rate. Also, the numbers were not large in this study. More participants were lost to attrition than actually seroconverted. Overall, the RCTs are a hot mess, were not undertaken independently and have never been replicated anywhere.

The mass circumcision campaigns have been roaring ahead for more than 3 years now, and there are zero reports of lowered HIV acquisition among the cut (and at least one recent report of increased HIV in men who opted for circumcision).

 

[D_Miranda_Wrights]

1. It reduces to risk of infection to a man.
2. HIV/AIDS kills those infected.
3. Reduced risk of infections means that, with time, less men AND women will be infected.
3. Less mena and women infected means lives saved.

Right...that's all pretty simplistic analysis, though. There are other issues at hand: complication rate; opportunity costs (the possibility for more effective treatments using the same resources); moral hazards (like the issue of the population behaving recklessly despite protection); etc. This is a complicated analysis that even some experts simplify for various reasons.

Science hasn't "spoken" here. Scientists and medical activists have a reason to report their research and activity as being efficient and ethical even if it isn't. This isn't a conspiracy; it's just a fact of life in academia and health policy. If I publish my research study on a new health policy, I'm not going to go to pains to point out its flaws and relative inadequacies. This has happened some with the Africa/HIV studies. I'm not saying to reject them, but rather to parse them thoughtfully, and not just read the white papers from WHO researcher committees. They are not the "last word" of science.

It's totally rational to defer to broad medical policy when it's impossible for a layman to parse it out. However, if you took them as absolutes, you'd get some absurd results: for instance, does anyone actually think infant circumcision is a reasonable parental choice in the U.S., and an unjustifiable violation of the child in Holland? No; there's nothing medical about the conflict between these medical opinions. The U.S. statement exists to capitulate to a tradition that doesn't exist in Holland. Treating these as the "last word of science" would be totally nonsensical.

(For the record, I'm undecided on the overall circumcision issue for HIV prevention in Africa. I'd need to read more into the criticisms of the studies. Stuff like Snozzle's anecdote dominate the debate, but I want actual empirics.)

Give that they are minors, their parent has the right to chose for them. Basic medical policy. Although, I will admit, I imagine Zulu cultural standards of caring for a child may be less guided by medical policy and more by the parents, who STILL make the decision. The whole "human right to decide for themselves" only legally applies to adults.

This paragraph is off the mark. Neither medical ethics nor the law has ever held that those under 18 have no right to the consideration of their eventual autonomy. Just because we functionally defer to parental proxy doesn't mean all parental decisions should be presumed ethical, and that the patient's eventual interests (including preferences) are irrelevant.

 

[D_Miranda_Wrights]

(optional post)

By the way, I especially encourage you to read into the ethical arguments. The CDC links to an ethical argument -- this one -- that really requires no medical knowledge to parse.

Look, for instance, at the paragraph "Informed Consent." The authors argue against the only exception to informed consent being "when medical necessity is immediate and clear." Their example is vaccination, which they rightly point out isn't immediately necessary, but is still ethical. Once they argue this, they revert to assuming that there's no reason to wait for informed consent unless a procedure is "unequivocally harmful."

I'm not the world's smartest guy, but even I know this argument is badly flawed. Waiting for informed consent has no ethical value unless a procedure is "unequivocally harmful"? Here's an analogy: When my kid is 12, I somehow sign him away to work as an actuary his entire life. Is this "unequivocally harmful"? No -- hell, actuaries apparently are the most well-adjusted occupation. But does the possibility he might benefit from choosing his occupation become ethically irrelevant simply because my doing so for him isn't "unequivocally harmful"? No sane person would argue that. There's obvious benefit to giving someone autonomy in the eventual choice of their occupation. The paper's argument discounts the value of this autonomy because the forced, permanent choice is not "unequivocally harmful." Somehow, the authors of this well-regarded paper apparently didn't realize this demonstrates a major (and effectively fatal, IMO) hole in their ethical argument.

So, yeah: it's reasonable to defer reflexively to expert authorities when we have to, but we often don't have to, and the expert authorities' arguments and interpretations can be flawed in ways even non-experts can recognize.

 

[colgan1999]

me, too, Gaydoc Right on!

 

[ManchesterTom]

Right. And if they wore a condom each time, they'd be 99% infection-free.
If they get circumcised, they'd still get HIV.

Firstly, I live in South Africa, I have had the sad displeasure of having to communicate to some of my staff members that the initial HIV tests came out positive, and that a second test needs to be done.

I work with Zulu people, and speak their language.

The feedback, I have is that white coloured condoms look ridiculous on a black penis. There are still racial problems in South Africa, and I can understand the sentiment that some brown people do not want their penis to be white.

Poverty is rife, and if free condoms are not immediately available, some people simply don't have the money to buy a condom. Not only the cost of buying a condom, but the willing hard-on and willing partner might be hours away from the nearest store.

Please people don't look at the Zulu King's message through UNQUALIFIED western understanding.

Also the infection rate is not 25% - it is much closer to double this figure.

It is so common here, that people very often don't care if they have aids or not. To quote another poster here, at the moment AFRICA IS SCREWED.

 

[ManchesterTom]

"

By "many" I mean the Zulu population (~10.7 million) and by "few" I mean those who hold this belief that circumcision is inhumane and care more about that flap of SKIN than about SAVING LIVES. No, those babies and children are not having sex...now. Are you so confident that the HIV/AIDS epidemic will be solved when a currently young boy starts having sex in his near future,only several years away? Also, I see that age group of 15 to 49 only being a problem in those who are already married and in monogamous relationships with no chance of having sex with another person, and with divorce and infidelity, there still remains a chance.

People People People, the answer is in monogamy.

Monogamy does not seem to be the rule here in South Africa.

If Monogamy was practiced, HIV would not be at a 50% infection rate in some parts.

There are entire villages where ALL OF THE ADULTS HAVE DIED, and the families are headed by children as young as 12.

Our president Jacob Zuma, has 5 (or there abouts ) wives, has been accused of rape (went to court, and case did not stick.) also has been quoted as saying that he had a shower after sex, introducing the notion in some that HIV can be prevented by showering.

If you don't believe the paragraph above, feel free to google it.

We are brewing a far bigger problem than circumcision pros and cons, what the hell kind of society is coming from child headed households, where is the love, security, stability? This the making of an entire band of young adults who have nothing of monetary value, and pretty little family / parental love?

Africa will always just be Africa. (Well, until the yellow races colonize it, and rule it with a rod of iron.)

 

[craigr]

People People People, the answer is in monogamy.

Monogamy does not seem to be the rule here in South Africa.

If Monogamy was practiced, HIV would not be at a 50% infection rate in some parts.

There are entire villages where ALL OF THE ADULTS HAVE DIED, and the families are headed by children as young as 12.

Our president Jacob Zuma, has 5 (or there abouts ) wives, has been accused of rape (went to court, and case did not stick.) also has been quoted as saying that he had a shower after sex, introducing the notion in some that HIV can be prevented by showering.

If you don't believe the paragraph above, feel free to google it.

We are brewing a far bigger problem than circumcision pros and cons, what the hell kind of society is coming from child headed households, where is the love, security, stability? This the making of an entire band of young adults who have nothing of monetary value, and pretty little family / parental love?

Africa will always just be Africa. (Well, until the yellow races colonize it, and rule it with a rod of iron.)

You bring up a lot of good points that are missed in the pros and cons of circumcision. This is truly a dire situation, as you have stated, and there are far deeper public health and infrastructural issues in Africa that have lead to the easy spread of HIV. Also, yes, monogamy and abstinence, although not as practiced as they should be, are the age old ways of controlling the spread of disease. Two people who are virgins, marry, and have sex only with each other until they die are not the ones spreading STDs. In this debate, I can only continue to refer to the CDC website on HIV and circumcision (Male Circumcision and Risk for HIV Transmission: Implications for the United States | Factsheets | CDC HIV/AIDS) to provide the information that is needed to help slow the spread. Yes, the Zimbabwe 2010/2011 report showed a result opposite to that of the desired effect. However, this has been attributed to the prevailing thought that circumcision=free pass to unprotected sex. This is an entirely different issue that NEEDS to be dealt with immediately, as there is obviously still a risk. It will be difficult to change this mindset, as several studies have documented this effect in the post-puberty circumcisions of men, but, all the same, it should be a priority.

As far as the rights of circumcision. Is circumcision medically necessary at birth? No, granted. Does it still fall the parent's choice? Yes. Whether this is the most ethical approach or not is not up for my decision. It is the way it is, and it will take an act of congress, and a whole lot more "giving a shit" by the general population to ever even think about the circumcision as an exception to the parent-as-a-proxy approach to all things related to a child's health. It is a parent's choice when the child is born, and is usually determined by religious or cultural reasons. In Holland, it doesn't normally happen. In America, it normally does (Of course accounting for variations for cultural or religious reasons). If the child feels that strongly that he was mutilated by his parents, since it was their choice and everything else they did for him throughout the course of his growing up couldn't hold a candle to the permanent damage they did to his body--sorry, a bit immature admittedly, but some arguments do come across this way--then he should make the active decision to regrow his foreskin--although not the same, i know--and not circumcise his child.

On a unrelated note, this has become pleasantly provoking--although not to take away from the overall gravity of this issue. As, not matter on which side of the debate any of stand, I trust that we all support the eradication of this horrible disease in the future.

 

[mandoman]

me, too, Gaydoc Right on!

Gaydoc does not have a handshaking acquaintance with such concepts as putting the needs of the patient first. His view violates basic ethics.
Your support of him indicates the same about you.
Young Native is a doctor, who does understand putting the patient first, and medical ethics.

 

[mandoman]

People People People, the answer is in monogamy.

Monogamy does not seem to be the rule here in South Africa.

If Monogamy was practiced, HIV would not be at a 50% infection rate in some parts.

There are entire villages where ALL OF THE ADULTS HAVE DIED, and the families are headed by children as young as 12.

Our president Jacob Zuma, has 5 (or there abouts ) wives, has been accused of rape (went to court, and case did not stick.) also has been quoted as saying that he had a shower after sex, introducing the notion in some that HIV can be prevented by showering.

If you don't believe the paragraph above, feel free to google it.

We are brewing a far bigger problem than circumcision pros and cons, what the hell kind of society is coming from child headed households, where is the love, security, stability? This the making of an entire band of young adults who have nothing of monetary value, and pretty little family / parental love?

Africa will always just be Africa. (Well, until the yellow races colonize it, and rule it with a rod of iron.)

And exactly what does this have to do with circumcision?
In the US, we have buried almost a million mostly circumcised men who died of AIDS. 93% of Ethiopian men are circumcised. Probably a larger percent of Israeli men. Yet, both countries have high rates of HIV infection.

 

[mandoman]

You bring up a lot of good points that are missed in the pros and cons of circumcision. This is truly a dire situation, as you have stated, and there are far deeper public health and infrastructural issues in Africa that have lead to the easy spread of HIV. Also, yes, monogamy and abstinence, although not as practiced as they should be, are the age old ways of controlling the spread of disease. Two people who are virgins, marry, and have sex only with each other until they die are not the ones spreading STDs. In this debate, I can only continue to refer to the CDC website on HIV and circumcision (Male Circumcision and Risk for HIV Transmission: Implications for the United States | Factsheets | CDC HIV/AIDS) to provide the information that is needed to help slow the spread. Yes, the Zimbabwe 2010/2011 report showed a result opposite to that of the desired effect. However, this has been attributed to the prevailing thought that circumcision=free pass to unprotected sex. This is an entirely different issue that NEEDS to be dealt with immediately, as there is obviously still a risk. It will be difficult to change this mindset, as several studies have documented this effect in the post-puberty circumcisions of men, but, all the same, it should be a priority.

As far as the rights of circumcision. Is circumcision medically necessary at birth? No, granted. Does it still fall the parent's choice? Yes. Whether this is the most ethical approach or not is not up for my decision. It is the way it is, and it will take an act of congress, and a whole lot more "giving a shit" by the general population to ever even think about the circumcision as an exception to the parent-as-a-proxy approach to all things related to a child's health. It is a parent's choice when the child is born, and is usually determined by religious or cultural reasons. In Holland, it doesn't normally happen. In America, it normally does (Of course accounting for variations for cultural or religious reasons). If the child feels that strongly that he was mutilated by his parents, since it was their choice and everything else they did for him throughout the course of his growing up couldn't hold a candle to the permanent damage they did to his body--sorry, a bit immature admittedly, but some arguments do come across this way--then he should make the active decision to regrow his foreskin--although not the same, i know--and not circumcise his child.

On a unrelated note, this has become pleasantly provoking--although not to take away from the overall gravity of this issue. As, not matter on which side of the debate any of stand, I trust that we all support the eradication of this horrible disease in the future.

The CDC has a vested interest. The circumcision biz brings in an estimated 1 billion a year, in easy money. You vastly overestimate the circumcision rate in the US. In Nevada, it is 20%. The rate has been declining for decades, as parents realize that there really are no tangible benefits that outweigh the very real risks of surgery. The circumcision instruments and their mishandling are responsible for considerable damage. If you don't think so, read the LA Times (a notoriously pro-circumcision paper in the back yard of some of the most pro-circumcision doctors the planet has seen) article.
Use of Mogen circumcision device called into question - Los Angeles Times

 

[D_Miranda_Wrights]

As far as the rights of circumcision. Is circumcision medically necessary at birth? No, granted. Does it still fall the parent's choice? Yes. Whether this is the most ethical approach or not is not up for my decision. It is the way it is, and it will take an act of congress, and a whole lot more "giving a shit" by the general population to ever even think about the circumcision as an exception to the parent-as-a-proxy approach to all things related to a child's health. It is a parent's choice when the child is born, and is usually determined by religious or cultural reasons. In Holland, it doesn't normally happen. In America, it normally does (Of course accounting for variations for cultural or religious reasons).

I'm an American. I already know circumcision is legal here. I already know it's practiced for vague "cultural" reasons. I already know few people think seriously about whether the parental proxy use makes sense in this case. Heck, I just linked to a CDC-'endorsed' paper with a gaping logical hole about that. You're not telling me anything I don't know, man.

What I'm waiting to see is a rational defense of routine circumcision in the U.S. I'm studying to be a pediatrician -- I've read up, I've discussed it, and I've found none. Either people have thought about the issue very superficially, or respond like you kind of have -- by pointing out it's legal. It's just such a bizarre non-defense of what seems to me a plainly wrong practice.

(I honestly only mentioned the U.S. vs. Holland to point out the folly of uncritically accepting medical org's opinions. I wasn't trying to bring in a debate about infant circumcision in the U.S., although I will talk about that, because that's something I'm not undecided on.)

If the child feels that strongly that he was mutilated by his parents, since it was their choice and everything else they did for him throughout the course of his growing up couldn't hold a candle to the permanent damage they did to his body--sorry, a bit immature admittedly, but some arguments do come across this way--then he should make the active decision to regrow his foreskin--although not the same, i know--and not circumcise his child.

Woah, dude. I've met a handful of people who were that pissed at their parents at most. Most of them thought it was a well-intended decision they disliked, or at least wanted to have for themselves.

I have two responses to this:

1. A man who dislikes being circumcised doesn't have much less reason to circumcise his child than one who likes it. Conversely, "I like being cut" is not a rational argument to circumcise your kid. Circumcision preference isn't genetic. If it were, there wouldn't be all the dissatisfied circumcised guys there are.

2. This is obviously the only options an unhappily circumcised guy has, beyond sucking it up. But why should they have to adjust, when they're not the ones perpetuating an unreasonable cultural practice?

 

[ManchesterTom]

And exactly what does this have to do with circumcision?
In the US, we have buried almost a million mostly circumcised men who died of AIDS. 93% of Ethiopian men are circumcised. Probably a larger percent of Israeli men. Yet, both countries have high rates of HIV infection.

Mandoman, if you go back to the topic at hand - http://www.lpsg.com/168040-zulu-kings-circumcision-decree-4.html

You will see that the Zulu king put out a circumcision decree. Why did he do this? It is an attempt to slow down the HIV infection rate. I don't know anything about you, but I am suggesting / asking that you please not apply your 1st world understanding of the day to day behaviour of rural, impoverished people, many of who live several hours or even days travel from clinics, shops, running water, flushing toilets.

Some people have multiple partners withing a 24 hour period, so, it is very possible and likely that bacteria or viruses from sexual encounters could be on the person when they go for their next encounter. I have heard that without proper sanitation it is possible for certain undesirable biological substances to be trapped under a foreskin, and thereby transported to the next encounter.

I have read on this forum, the debate regarding the medical financial benefit by USA doctors performing the procedure. That mention is not valid. Zululand is not in the USA, and the currency is not American Dollar. The procedures are generally carried out virtually free of charge by South African government outpost clinics, or by missionary hospitals.

You talk about Israeli men and their infection rate being high. In Zululand the infection rate is around 50% in people tested, and who knows what percentage of the population who haven been tested. There are people who live in the Zululand area who have never been to a doctor or dentist ever.

What is also tragic is that some folklore abounds. If a HIV man sleeps with a virgin, he will be cured. We have many many babies / toddlers / preschool kids raped, to cure aids. Some as young as 2 years old. Many of the perpetrators have equipment that would more than qualify them as LPSG members.

What you also need to know is that in this part of Africa the HIV infection is highest in the heterosexual community.

Many people here have no understanding of MONOGAMY. Multiple partner sex is not considered with the same understanding as 1st world population groups. Here sex is very often just a fleeting exchange.

What would the voting population of the USA say if Pres Obama had 5 or more wives? Here in South Africa it is considered as a powerful and honorable scenario.

In ending, please don't look at 3rd world Africa through 1st world lenses and 1st world understanding. Africa has a completely different pulse and heartbeat to any other place.

Which is exactly why I live here - it is a special special privilege.

Tom