I think "top researchers" is big spin. At least Mr. Halprin is a big pusher of circumcison. The people that did the African studies were pushing it too. They don't talk much about the companion study where circumcised men passed HIV at a higher rate than intact men. How can it be more effective to cut off a genital part and dull sexual pleasure instead of pusing condoms?

I agree with the report that gets little notice:

Promoting male circumcision in Africa is risky and dangerous and could lead to more HIV infections, warns a new paper published in the May issue of Future HIV Therapy.

Lead author Dr. Lawrence Green says, "Having served on both the US Preventive Services Task Force and the Community Preventive Services Task Force, which do systematic reviews of research to arrive at government-supported evidence-based guidelines for practice, I believe the African studies on the basis of which some are promoting circumcision as HIV prevention would be classified at best as 'insufficient evidence%u2019 by both panels."

"Promoting circumcision will drain millions, possibly billions, of dollars away from more effective prevention strategies," cautions co-author John Travis, MD, "and cause tens of thousands of infections and other surgical complications, further straining an already overwhelmed healthcare system and undermining the current ABC (abstinence, be faithful, and use condoms) campaigns by creating a false sense of immunity and increasing risk-taking behaviors. African males are already lining up to be circumcised, believing that they will no longer need to wear condoms, and this is a serious concern."

Travis says, "The African studies were conducted in atypically sanitary clinics with highly skilled operators and cannot be extrapolated to the general population. The studies have been criticized for their poor science including: the men were paid to be circumcised, received free condoms and extensive education, and the studies were halted after only 21 to 24 month periods."

During the course of these studies, 77 fewer circumcised than uncircumcised males contracted HIV, however, the circumcised group needed to refrain from sex to recoup from surgery, and they were receiving extensive monitoring and counseling about sexual behavior. Also, hundreds of study participants were lost to follow-up. "There is not enough evidence to conclude circumcision would offer any real long-term benefit in the HIV battle. Even if circumcision did reduce the risk of HIV infections, condoms and safe-sex practices are still far more effective. If an individual is engaging in high-risk behavior, he and his partner are at risk, regardless of whether he is circumcised or not."

The paper also cautions against neonatal circumcision for HIV prevention, stating it is unethical to circumcise an infant for a possible benefit 15%u201320 years later, if at all, to reduce the risk of contracting an adult-acquired disease for which there are far more effective prevention strategies available.

Circumcision proponents, hailing from English-speaking countries, have been intensely lobbying world health agencies to adopt male circumcision as an additional HIV-prevention tool based on the release of three African randomized clinical trials reporting reduced HIV infections during their study periods.

Many sources of data contradict the claim that circumcision protects against HIV. The United States has one of the highest rates of circumcision and HIV infection in the developed world. European nations, which rarely practice circumcision, have very low rates of HIV. Numerous regions in Africa show higher rates of HIV in circumcised populations compared to uncircumcised populations. For example, 2004 data from Lesotho show HIV infection of 15 percent for uncircumcised males and 23 percent for circumcised males. A 2007 study showed that, once commercial sex worker patterns were taken into consideration, circumcision status was irrelevant in HIV infection rates.

Circumcision can only possibly help men who have unsafe sex with HIV+ partners, so why this bizarre obsession with genital surgery when we know that ABC works better than circumcision ever could? (ABC=Abstinence, Being Faithful, Condoms). 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 in 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. 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. It's worth noting that Daniel Halperin is the grandson of a mohel, so can't be considered objective about circumcision.

Latest news is that HIV+ men are more likely to transmit the virus to women if they are circumcised.

Female circumcision seems to protect against HIV too btw, but we wouldn't investigate cutting off women's labia, and then start promoting that. In fact we're trying to stamp out female circumcision, something which won't be made easier by promoting male circumcision.

It is the same few "top researchers" - Daniel Halperin among them - who did the human experiments in order to claim that circumcision protects against HIV, who multiplied the small numbers of men involved by hundreds of thousands to claim that millions would be protected, and who now push for funding to be diverted from condoms - which work - toward circumcision.

In the Kenyan experiment, a greater proportion of the circumcised men got HIV than the non-circumcised men in Uganda, where there was a "Zero grazing" campaign.

These experiments were not (and maybe could not have been) double-blinded or placebo-controlled, and both experimenters and experimentees very much wanted circumcision to be effective, so bias is likely. Many more men dropped out, their HIV status unknown to the researchers, than were known to be infected, so circumcision could easily have had no effect at all. Evidence of non-sexual transmission was ignored.

For thousands of years people have believed that cutting men's and boy's foreskins off will have magical benefits. This is just one more.

What these authors are suggesting here is insane. There is a very real risk that many people will miss the part that CONDOMS are STILL required. There are already stories leaking out about people overestimating the protective effects.

In this recent article in the trinidad express[1], we have this gem: "Aah," one subject said during trials, "I have a natural condom." Or from Rwanda, in a recent article[2] by David Gusongoirye, Nothing can fight HIV/AIDS better than discipline, speaking of the new campaign a man was quoted as saying: "Mister, these Aids people have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one. Don’t have sex, don’t do this, don’t do that. Eh, man, how can a young man such as I forfeit sex, eh? And the condoms – where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!" There are some circumcised men who will get HIV in part because now they believes they has a "natural condom".

In a study published on the effectiveness of condoms in preventing HIV acquisition, heterosexual couples that included an HIV-infected partner used condoms consistently in a total of about 15,000 instances of intercourse. None of the uninfected partners became infected.[3] So if we just get down to the proverbial brass tacks the whole issue boils down to the following question: If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected? Clearly the answer is no. The critical point is you have only two options:

A. You don't need a circumcision, but you need to always wear a condom and be choosy about your sex partners.

B. You can get a circumcision but you need to always wear a condom and be choosy about your sex partners.

The primary advice just doesn't change. A recent article[4], The No-Brainer Syndrome, discusses this point particularly well; as does a recent editorial in Future Medicine[5]. The Australian Federation of AIDS Organization's had two excellent publications on this issue: Their July 2007 statement[6] and one that was distributed at at last year's International AIDS Society Conference[7]. The second said in part: "How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection)." That's good advice.

There has been a lot of progress made in Africa over the last decade with regard to HIV. In Rwanda, for example, the HIV/AIDS rate has fallen from 11% of the adult population in 2000 to 3% in 2007 using conventional HIV reduction strategies. There are no short cuts, no silver bullets. The only way to deal with HIV in Africa is through safe sex, education, and pulling people out of poverty. We won't cut our way out of it and if we want to do them a favor we would buckle down and do the actual hard work that needs to be done. If condoms are not available everywhere we need to solve the distribution problem. If they are for some reason not willing to use them this too must be fixed. It is a message that we shouldn't muddy lest we undo all the hard work that has been done to ameliorate the epidemic over the last 20 years.

[1] http://www.trinidadexpress.com/index.pl/article_features?id=161191863

[2] http://www.newtimes.co.rw/index.php?issue=13438&article=4113

[3] De Vincenzi, I. “A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners,” New England Journal of Medicine 331 (1994): 341-6.

[4] http://www.rhrealitycheck.org/blog/2008/03/04/the-no-brainer-syndrome

[5] http://www.futuremedicine.com/doi/pdf/10.2217/17469600.2.3.193

[6] http://www.afao.org.au/library_docs/policy/Circumcision07.pdf

[7] http://www.circumcisionandhiv.com/files/CircumcisionIAS07.pdf