Can circumcision impact the spread of HIV?
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Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they’ve been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn’t happen. We now have people calling circumcision a “vaccine” or “invisible condom”, and viewing circumcision as an alternative to condoms. 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”.
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.
ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms. 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".
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.
ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
In the state where i reside(edo state) females are circumcised!!…altho various women organisation has been fighting against it..the trend is still rampant!…..and the women that do these mutilations dont even care about their hygiene or sterilization of the instruments….therefore putting these innocent lives in danger even from their young age….so sad!!
Male
circumcision has long
provoked debate over its
pro.While for some it is a
cultural ritual for many
others its cosmetic procedure
that ensures a son will look
like his father.
As Canadian and U.S. health
authorities are perched to
issue major valuation on
circumcision and its potential
health benefits, the hullabaloo
over conserving an infant boy ’s
foreskin has reached a new
whirl.
The reconsideration by the
Canadian Pediatric Society and
the American Academy of
Pediatrics are being hailed by
pediatricians, who say the fresh
direction for parents is long
tardy. Critics, however, are
infuriated the procedure, which
they compare to genital
mutilation, is even being talked
about in medical circles.
“Proponents of circumcision have
been chasing rationales for the
last 150 years. You cannot be
cutting off healthy body parts
from healthy babies and
justifying it for some punitive
medical benefits down the line ”,
said Georganne Chapin,
Executive Director of the
advocacy group Intact America.
The procedure is not medically
necessary say the Canadian
Pediatric Society and the
American Academy of Pediatrics.
The deportment could alter in
light of recent studies that have
shown circumcised heterosexual
males are less expected to
indenture HIV and other sexually
transmitted infections than men,
whose foreskins are intact.
The most convincing study,
conducted in three countries in
Africa, swayed the World Health
Organization to state in Dec.
2009 that male circumcision is a
helpful interference for HIV
prevention. The studies also
pushed the U.S. Centers for
Disease Control to look at
circumcision as a probable
avoidance approach for HIV and
other sexually transmitted
infections.
However, another article states that, thirty-five articles
and a number of abstracts have
been published in the medical
literature looking at the
relationship between male
circumcision and HIV infection.
Study designs have included
geographical analysis, studies of
high risk patients, partner studies
and random population surveys.
Most of the studies have been
conducted in Africa. A meta-
analysis was performed on the
29 published articles where data
were available. When the raw
data are combined, a man with a
circumcised penis is at greater
risk of acquiring and transmitting
HIV than a man with a non-
circumcised penis (odds ratio
(OR)=1.06, 95% confidence
interval (CI)=1.01-1.12). Based on
the studies published to date,
recommending routine
circumcision as a prophylactic
measure to prevent HIV infection
in Africa, or elsewhere, is
scientifically unfounded.
I am of the opinion that d theory of circumcission,in men,as a preventive measure against HIV, is not empirical. I simply believe dat its healthy n besides that,its a biblical law which a christian must adhere 2.
-Researchers Demonstrate Traumatic Effects of Circumcision
A team of Canadian researchers produced new evidence that circumcision has long-lasting traumatic effects. An article published in the international medical journal The Lancet reported the effect of infant circumcision on pain response during subsequent routine vaccination. The researchers tested 87 infants at 4 months or 6 months of age. The boys who had been circumcised were more sensitive to pain than the uncircumcised boys. Differences between groups were significant regarding facial action, crying time, and assessments of pain.
The authors believe that “neonatal circumcision may induce long-lasting changes in infant pain behavior because of alterations in the infant�s central neural processing of painful stimuli.” They also write that “the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is therefore possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.”
- Early Adverse Experiences May Lead to Abnormal Brain Development and Behavior
Self-destructive behavior in current society promotes a search for psychobiological factors underlying this epidemic. The brain of the newborn infant is particularly vulnerability to early adverse experiences, leading to abnormal development and behavior. Although several investigations have correlated newborn complications with abnormal adult behavior, our understanding of the underlying mechanisms remains rudimentary. Models of early experience, such as repetitive pain, sepsis, or maternal separation in rodents and other species have noted multiple alterations in the adult brain, correlated with specific behavioral types depending on the timing and nature of the adverse experience. The mechanisms mediating such changes in the newborn brain have remained largely unexplored. Maternal separation, sensory isolation (understimulation), and exposure to extreme or repetitive pain (overstimulation) may cause altered brain development. (Circumcision is described as an intervention with long-term neurobehavioral effects.) These changes promote two distinct behavioral types characterized by increased anxiety, altered pain sensitivity, stress disorders, hyperactivity/attention deficit disorder, leading to impaired social skills and patterns of self-destructive behavior. The clinical importance of these mechanisms lies in the prevention of early adverse experiences and effective treatment of newborn pain and stress.
- International Observational Studies
A systematic review and meta-analysis that focused on male circumcision and heterosexual transmission of HIV in Africa was published in 2000 [5]. It included 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study. A substantial protective effect of male circumcision on risk for HIV infection was noted, along with a reduced risk for genital ulcer disease. After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at sexually transmitted disease (STD) clinics, for whom the adjusted relative risk was 71% lower for circumcised men.
Another review that included stringent assessment of 10 potential confounding factors and was stratified by study type or study population was published in 2003 [6]. Most of the studies were from Africa. Of the 35 observational studies in the review, the 16 in the general population had inconsistent results. The one large prospective cohort study in this group showed a significant protective effect: the odds of infection were 42% lower for circumcised men [7]. The remaining 19 studies were conducted in populations at high risk. These studies found a consistent, substantial protective effect, which increased with adjustment for confounding. Four of these were cohort studies: all demonstrated a protective effect, with two being statistically significant.
Ecologic studies also indicate a strong association between lack of male circumcision and HIV infection at the population level. Although links between circumcision, culture, religion, and risk behavior may account for some of the differences in HIV infection prevalence, the countries in Africa and Asia with prevalence of male circumcision of less than 20% have HIV infection prevalences several times higher than those in countries in these regions where more than 80% of men are circumcised[8].
- International Clinical Trials
Three randomized controlled clinical trials were conducted in Africa to determine whether circumcision of adult males will reduce their risk for HIV infection. The study conducted in South Africa [9] was stopped in 2005, and those in Kenya [10] and Uganda [11] were stopped in 2006 after interim analyses found a statistically significant reduction in male participants’ risk for HIV infection from medical circumcision.
In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a few men who had been assigned to be circumcised did not undergo the procedure, and vice versa. When the data were reanalyzed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised. The Uganda study investigators are also examining the following in an ongoing study: 1) safety and acceptability of male circumcision in HIV-infected men and men of unknown HIV infection status, 2) safety and acceptability of male circumcision in the men’s female sex partners, and 3) effect of male circumcision on male-to-female transmission of HIV and other STDs.
- Male Circumcision and Male-to-Female Transmission of HIV
In an earlier study of couples in Uganda in which the male partner was HIV infected and the female partner was initially HIV-seronegative, the infection rates of the female partners differed by the circumcision status and viral load of the male partners. If the male’s HIV viral load was <50,000 copies/mL, there was no HIV transmission if the man was circumcised, compared with a transmission rate of 9.6 per 100 person-years if the man was uncircumcised [7]. When viral load was not controlled for, there was a nonsignificant trend toward a reduction in the male-to-female transmission rate from circumcised men compared with uncircumcised men. Such an effect may be due to decreased viral shedding from circumcised men or to a reduction in ulcerative STDs acquired by female partners of circumcised men [12]. A clinical trial in Uganda to assess the impact of circumcision on male-to-female transmission reported that its first interim safety analysis showed a nonsignificant trend toward a higher rate of HIV acquisition in women partners of HIV-seropositive men in couples who had resumed sex prior to certified postsurgical wound healing and did not detect a reduction in HIV acquisition by female partners engaging in sex after wound healing was complete [13].
Thanks for the wonderful and informative session.
It is an occasion wen a baby is been circumcised as a part of a religious ceremony,especially wen an unsterilised object is been used,which d hiv den tranfer 4rm 1 person 2 anoder,&later becomes aids(acquire immune deficiency syndrome).nice write up.kudos.