Friday, August 8, 2008


Circumcision appears to offer men even greater protection against the AIDS virus than thought and also partially shield them against a common sexually-transmitted disease, two studies presented at the world AIDS conference said Thursday.

University of Illinois put forward long-term data from a trial in Kisumu, Kenya, that in its initial phase enrolled 2,784 uncircumcised uninfected men.

Half of the group were circumcised, and the others were circumcised at a later date and they were later tested for HIV.

Previously-published research from this trial found that, after two years, circumcised men were 59-percent less likely to contract the human immunodeficiency virus (HIV) than uncircumcised counterparts.

The benefit was so astonishing that at this 24-month mark, the uncircumcised men were offered circumision, as it would have been unethical not to have done so.

And he also reported that at the 42-month mark, circumcision offered a protectiveness of 65 percent.

Circumcision has emerged as one of the few bright areas of progress in the AIDS crisis, after the Orange Farm and Kisumu trials.

The discovery has sparked talk in some circles of a "surgical vaccine" a cheap, safe method for shielding men from HIV.

But this enthusiasm has also been tempered by worries that circumcision may face a backlash on cultural, religious or sexual grounds, or may prompt men to abandon use of the condom.

The theory behind the effectiveness of circumcision is that the inner foreskin is an easy entry point for HIV. It is rich in so-called Langerhans cells, tissue that the AIDS virus finds particularly easy to latch onto and penetrate.

Other questions surrounding a circumcision campaign are the need to ensure that operations are done hygienically and with the full knowledge and consent of the male. Also unclear is what benefit, or otherwise, male circumcision has on women.


Mark Lyndon said...

Funny how none of the papers submitted to the anti-AIDS conference in Mexico were approved. People only seem to want to hear one side of the story.

The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the oft-reported 65%, and several of the subjects disappearing. The fact that one study described circumcision as "comparable to a vaccine of high efficacy" seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised. Daniel Halperin is the grandson of a mohel, and seems to think that "maybe in some small way (he's) destined to help pass along (circumcision)" so his objectivity is questionable.

Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of "dry sex".

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 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. That's six countries where men are more likely to be HIV+ if they've been circumcised.

Cameroon: table 16.9, p17 (4.1% v 1.1%)
Ghana: table 13.9 (1.6% v 1.4%)
Lesotho: table 12.9 (22.8% v 15.2%)
Malawi: table 12.6, p257 (13.2% v 9.5%)
Rwanda: , table 15.11 (3.5% v 2.1%)

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 not save them.

If you read those reports btw, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn't refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they'd be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.

Circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.

ABC works against HIV. Circumcision appears not to. Remember that circumcision won't make any difference unless someone is having unsafe sex with an HIV+ partner.

Female circumcision seems to protect against HIV too btw, but we wouldn't investigate cutting off women's labia, and then start promoting that.

For a good summary of the case against promoting circumcision in Africa, see this link:

Hugh7 said...

Your headline is utterly misleading. The new study says nothing about my AIDS risk or any other reader's. It was of some thousands of paid volunteers in a developing country with a high HIV incidence where concurrent sexual partners (and hence a high likelihood of exposure) are common.

Offering circumcision to the control group and carrying on with the study skews the result, because these men had previously volunteered on the basis that they wanted to be circumcised. Those who accept or refuse now are not a random selection. Meanwhile, reducing the numbers increases the inaccuracy.

Amazing claims about how circumcision can dramatically reduce HIV are nothing more than multiplying a tiny effect (if it is an effect) by the population of Africa, which should be dismissed as the nonsense they are.

Yet for some reason, there's something about circumcision (perhaps it makes circumcised men want to justify their own status) that causes people to lose their critical faculties. Why else are these beat-up stories still getting headlines?

I'm guessing Mark Lyndon meant "...none of the papers against circumcision submitted..."

It is more than "several" men who were lost from study: hundreds were, several times as many as the tens who give the study such significance as it claims. This is illustrated graphically here.


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