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Circumcision Trials to Prevent HIV – More Hype Than Fact

by VR Sreeraman on  August 30, 2008 at 6:08 PM Health In Focus   - G J E 4
Circumcision is the norm in some cultures and HIV is still incurable and deadly, therefore, the possibility of using the one to prevent the other has been given far more credence than it deserves.

The recent claim that circumcision prevents HIV is only the latest in a 150-year history of its medical use against virtually every feared disease of the day, from tuberculosis to cancer. As each claim is overthrown, a new one rises, hence it is almost inevitable that HIV/AIDS should join those ranks.

The foreskin is an integral part of the penis that most men with one take for granted, rich in sensory nerves that make an important contribution to sexual function, and which, by its rolling action, contributes to both partners' pleasure and stimulation. It also has protective functions. Cutting off the foreskin - circumcision - goes back before recorded history, and has been done for a dizzying variety of reasons, mainly magical. Where it is not already customary, the medical need for it is very rare. Complications, risks and harm, up to and including death, are measurable but usually underestimated.

The three Randomised Clinical Tests carried out in Africa have been held up as if they were the gold standard, proving it to be "a vaccine of high efficacy"; a figure of "60% protection from HIV transmission" is often cited. In fact, they took a total of 10,800 volunteers for circumcision, circumcised half immediately, and periodically tested them all for HIV (but didn't tell them when they were infected - that would be "unethical"). After less than the planned two years, 64 (1.8%) of the circumcised volunteers had HIV, compared to 137 (2.5%) of the non-circumcised control group. That is the whole basis of the "60% protection".

The gold standard is actually a double-blinded, placebo-controlled random test, but that would, by the nature of circumcision, be hard to carry out. Thus the experimenters' hopes and the subjects' desire to please the experimenters who paid them could easily distort the results. So also the loss of 673 men from the study, their HIV status unknown. Half were circumcised, but if you had endured a painful and marking operation to prevent HIV and then found you had it, wouldn't you be more likely not to go back to the people who had done that to you?

Evidence completely overwhelming the claims of benefit could easily be buried among those unknowns. The studies assumed all transmission was heterosexual, while sex between men is stigmatized and underreported in Africa, and "needle men" on street corners offer an injection for every ailment - from the same needle.

The studies show no protection for women (in fact, greater risk if infected men have sex before their wound has fully healed), but the researchers are happy to calculate "indirect benefits" to women via fewer men becoming infected. The same few researchers have done all the pro-circumcision studies. They multiplied their results by the population of Africa to prove that "millions could be saved", and asked the men about their sex lives and subsequent behaviour to prove that the former is not impaired and the latter is no more risky. Their measures of sexual satisfaction were so coarse that virtually 100% of the men seemed to enjoy perfect sex, circumcised or not! Something's very wrong there.

All these findings have been launched with fanfares before fellow scientists could critique them, and lapped up by uncritical media. It is time to be less gullible, before vast sums are wasted and many more lives are lost.

Editors Note- We thank Mr.Hugh Young for his views on this important topic. The last word on this topic is still to be written. Evaluating the role of Circumcision in preventing HIV infection requires many more trials that need to be done in other countries. The study should be better designed, as there are many variables to look at including the transmission factor to women - which has been ignored in these randomized trials. It should also be designed to be carried out in people of other races and in those with different sexual preferences.

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Ed: I found the evidence in the papers themselves. I doubt that many people have actually read them, just the media hype. It may turn out that circumcision does offer some protection, but that would still have to be carefully balanced against the costs and risks, including the false sense of security it may give, the disempowerment of women, and HIV transmission itself. (So far, the claims discounting those have all come from the same people who did the original studies.) Even then, circumcision of any but informed, consenting adults would still be a human rights violation.
guest Tuesday, September 2, 2008
Penectomy will "protect" against HIV acquisition for sure!
guest Monday, September 1, 2008
@Ed: This works both ways - Just because you personally like circumcision it does not mean that all the scientific studies disputing its supposed value are wrong. And there are many.

Ultimately it must only ever be a personal choice for a man, and a properly informed one at that.

guest Monday, September 1, 2008
One of the cited studies of male circumcision was conducted in Kisumu, Kenya. It is dominated by members of the Luo tribe. It has long been customary for Luo men to remain uncircumcised but to wash their penises after sexual intercourse. But the circumcision researchers never asked the men they studied about their customary washing.
In 2006, the "Journal of AIDS" published results of a first scientific study to focus on the HIV-prevention potential of such washing, conducted in another Luo center. It found that such washing was independently associated with reduced risk of HIV infection. Future studies of post-sex washing have been commissioned.

guest Monday, September 1, 2008
You don't provide any evidence to support your claims. Just because you personally dislike circumcision does not mean that all the scientific studies supporting the procedure are wrong.
guest Monday, September 1, 2008
Ed, India, here's your proof:There have been 4 recent studies of men in Australia, New Zealand, The US and England that showed no difference in the infection rate. If circumcision provided the effect claimed, the difference would be stark.Consider a similar case - polio. Polio is easily communicable by casual contact and is present in the environment. HIV only lives in the body and is difficult to transmit requiring exchange of body fluids. The polio vaccine is only 70 effective but wiped out the infection in The US in a single generation. 80 - 85 of US males are circumcised yet have the highest infection rate in the industrialized world. If circumcision has the protective effect claimed, the vectors of transmission would be effectively broken and HIV would be virtually unknown in The US.
guest Tuesday, September 2, 2008
And you will not get hepatites if part of your liver is removed. LOL
guest Saturday, August 30, 2008

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