The evidence that voluntary medical male circumcision reduces the risk of a heterosexual man contracting HIV in high prevalence areas is beyond reasonable doubt.
In June, Philosopher Brian Earp wrote an article titled A fatal irony: Why the "circumcision solution" to the AIDS epidemic in Africa will increase transmission of HIV.
In an article on circumcision last week, Daily Maverick journalist Jacques Rousseau wrote: "Though it's repeated so frequently as to seem axiomatic, the evidence that circumcision reduces HIV infection is not as clear-cut as many think it is."
They are both wrong. The evidence that circumcision reduces the risk of HIV transmission for heterosexual men in high prevalence areas is about as clear-cut as you'll find in medical science.
Three well conducted randomised controlled trials, in South Africa, Kenya and Uganda showed that circumcision was highly effective. The findings of these trials are supported by quality observational studies. There is also a plausible biological explanation for the mechanism by which circumcision works.
Earp's article is especially poorly researched. Besides making discredited stale arguments against the three clinical trials, he puts forward the much touted but evidence-free view that circumcised men will be at greater risk of HIV infection because they will take more risks due to the false belief that circumcision protects them.
Risk compensation has been studied. There is no sign that it is reversing the considerable benefit of circumcision.
In 2008, a group of us published a clearly written peer-reviewed article in Future HIV Therapy that comprehensively debunks the arguments purporting to show that circumcision does not protect heterosexual men against HIV infection:
Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics
The World Health Organisation recommends circumcision to reduce the risk of HIV infection. So do many other reputable institutions. I am not aware of any reputable medical body that recommends against it for areas with large primarily heterosexual HIV epidemics.
There are complex ethical questions about infant circumcision. There are difficult operational and political problems to be overcome to properly implement circumcision in South Africa. The Kwa-Zulu Natal government is rolling out circumcision irresponsibly, particularly - but not only- because it is using an unsafe circumcision device called the Tara KLamp. Traditional - as opposed to medical - circumcisions in the Eastern Cape are a disaster, with 20 initiates reportedly dying this year. That the state continues to fail to prevent this annual tragedy is shameful.
Nevertheless the science is clear: medical circumcision of adult males reduces their risk of acquiring HIV from HIV-positive women.
Source: http://www.quackdown.info/article/getting-circumcision-science-right-media/
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Yes, but please don't take the africa numbers to justify a third generation of circumcising american babies. First off, note that the United States paid for those three studies, and the US is paying for 3-quarters of the million new male circumcisions to fight AIDS in Africa. I don't disagree with you on it being a high-impact way of slowing spread today. The numbers generated in the African experience are being used by American physicians to "market" baby circumcisions, which are medically unnecessary, FORCED, and have major impacts on the recipient. The loss of sensation is routinely NOT acknowledged by the pro circ. A dialog is needed.
The difference is a baby being FORCED, and a grown man is making a CHOICE: grown men in are committed --- for social, medical, family and religious reasons --- not to get AIDS. Circ is probably the ultimate gesture in that direction.
But when the US sponsors of this campaign in Africa use the numbers showing prevention to "market" millions of baby circumcisions, in the places where AIDS is not in an epidemic, you have an unnecessary procedure harming a third consecutive generation of Americans, where --- mark my words --- AIDS Started and Spread in America, where we had universal circumcision. Think about it. That runs against "evidence-based medicine" and medical ethics.
There is no real world evidencve that cutting off penis parts has any benificial effect viz. HIV. The three studies are so flawed it is pathetic. They should have at least done another study where they bludgeoned the man's penis so it was wounded. They could then bandage it, give him safe sex counseling and tell him his penis banged up penis can't be used for 6 weeks. Maybe there would be a similar HIV risk change to that alleged. Maybe it was the WOUND, the 6 weeks of no sex and the condom advice that allowed these men to avoid risk.
There is ample proof that the huge resource being spent by the US (at the urging of US circumpushers) are WASTED.
The HIV prevalence rate among circumcised males between the ages of 15 and 49 in Zimbabwe is higher than that of the uncircumcised males owing to the misconception that circumcision completely shields people from HIV infection.
http://www.zimdiaspora.com/index.php?option=com_content&view=article&id=881 1%3Ahiv-infection-rate-higher-on-circumcised-men&catid=38%3Atravel-tips&Ite mid=18
"According to the latest Zimbabwe Health Demographic Survey (ZHDS 2010/2011), the prevalence rate among the circumcised is 14 percent while that of the uncircumcised is 12 percent.
National Aids Council (Nac) public health officer Dr Blessing Mutede said authorities were concerned about the high rate of infection among the circumcised.
He said it was largely a result of “risk compensation behaviours”.
Most men, after circumcision, harbour the false impression that they have been equipped with an invisible condom, he added."
so, the article here on AllAfrica says there's no evidence of risk compensation, never mind the fact that it's actually happening.
http://www.thevoicebw.com/2012/06/08/sex-in-the-city/
"“When I confronted my wife about her multiple sexual encounters with Mtlhabaphiri and cautioned her that she could be exposing us to sexually transmitted diseases such as HIV and AIDS, she told me to my face that Matlhabaphiri could not infect her with HIV/AIDS because he was circumcised.”"
Further, of the three trials showing a decrease in transmission rates, only one of them followed he male to female transmission rate; the South Africa study. Unfortunately, that showed a 54% increase in male-to female transmission. given that women are already the significant majority of heterosexual infections, this is not good.
http://www.zimeye.org/?p=53896
And by the way, here is Brian Earp's article:
http://blog.practicalethics.ox.ac.uk/2012/05/when-bad-science-kills-or-how- to-spread-aids/
"What does the frequently cited “60% relative reduction” in HIV infections actually mean? Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive, so the absolute decrease in HIV infection was only 1.31%.
That’s right: 60% is the relative reduction in infection rates, comparing two vanishingly small percentages: a clever bit of arithmetic that generates a big-seeming number, yet one which wildly misrepresents the results of the study. The absolute decrease in HIV infection between the treatment and control groups in these experiments was a mere 1.31%, which can hardly be considered clinically significant, especially given the numerous confounds that the studies failed to rule out."
Real world data suggests that male circumcision has little or no effect on HIV rates.
From a USAID report: "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher." http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms". http://www.info.gov.za/issues/hiv/survey_2009.htm
From the committee of the South African Medical Association Human Rights, Law & Ethics Committee : "the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/a bstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.
Real world data suggests that male circumcision has little or no effect on HIV rates.
From a USAID report: "There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher." http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms". http://www.info.gov.za/issues/hiv/survey_2009.htm
From the committee of the South African Medical Association Human Rights, Law & Ethics Committee : "the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/a bstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.
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