After the highly publicized halting of research trials looking at the impact of circumcision on HIV infection among African men (the trials were stopped because early data showed such a large protective effect that it was deemed unethical not to immediately circumcise all the participants) researchers have been analyzing the data for more clues as to why male circumcision offers such a dramatic reduction in risk of HIV transmission.
The methodological and ethical questions about the research remain unanswered and as far as I've read unaddressed, which in some ways makes it even more important for us to keep following the research.
Last week researchers at Johns Hopkins University published a paper in PLoS Medicine, parsing out one aspect of the protection, the relationship between circumcision, genital ulcers, and the herpes simplex virus that causes sores (HSV-2). From the study:
Genital ulcer disease, particularly when caused by HSV-2, is thought to increase a person's risk of acquiring HIV, so could male circumcision reduce HIV transmission rates because of its beneficial effects on genital ulcer disease rather than through its removal of foreskin tissue with its rich source of HIV target cells?
The researchers analyzed data from the study including which men came into the study with and without herpes, which men got herpes during the study, and which men who developed genital sores (sometimes caused by herpes, sometimes not) during the study. The men were examined at 6, 12, and 24 months during the study.
They found that circumcision cut risk of genital ulcers almost in half, whether men had herpes at the beginning of the study or not. They also found that while circumcision reduced the risk of HIV in men without herpes it didn't reduce the risk of acquiring HIV in men who had herpes at the beginning of the study.
Their analysis leads them to suggest that circumcision protects against genital sores mostly by reducing the risk of sores developing from "mild trauma during intercourse" and that the protective effect of male circumcision against HIV is primarily due to the removal of what they call "vulnerable foreskin tissue containing HIV target cells" and not because circumcision protects against other STDs which in turn increase the chances of acquiring HIV.
This is interesting stuff, even if it's early on in the theorizing of it. It would be nice if the researchers pursued a parallel agenda of addressing the ethical concerns raised by such highly racialized research (or you know, at least acknowledged it).
Read more - Gray RH, Serwadda D, Tobian AAR, Chen MZ, Makumbi F, et al. (2009) Effects of Genital Ulcer Disease and Herpes Simplex Virus Type 2 on the Efficacy of Male Circumcision for HIV Prevention: Analyses from the Rakai Trials. PLoS Med 6(11): e1000187. doi:10.1371/journal.pmed.1000187
Related - About Herpes ; About HIV/AIDS
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These trials should never have been made, as it is outrageous to suggest cutting functional tissue off somone is a good treatment for anything. This is all particularly outrageous as this is pleasure gving erogenous tissue. The foreskin is not just skin and does not just protect the glans(head). Circumcision is now known to ablate the most sensitive parts of the male genitals. This surgery takes away the main male pleasure zones with about 20000 fine touch and stretch nerve endings amputated. The foreskin has several parts including the ridged band that is great for ones pleasure (that is why nutters like Kellogg wanted to chop em off, to curtail masturbation), Masturbation is important for a mans physical and mental health. The ridged band directly contacts the vagina for very great pleasure all around. The dynamics of sex and the actual mechanism of the penis are drastically changed by circumcision. The foreskin can normally be slipped all the way, or almost all the way, back to the base of the penis, and also slipped forward beyond the glans. This wide range of motion is the mechanism by which the penis and the orgasmic triggers in the foreskin, frenulum, and glans are stimulated
The only touch organ possessing as rich erogenous innervation as the foreskin is the clitoris. Circumcision deprives man of 2/3ds of the main erogenous zone constituted of the foreskin and the glans.
The rest of the world wants to keep therir genital parts. Stop with the circumcision obsession!
The whole idea of male circumcision to prevent HIV is misguided and completely unethical. If female circumcision was found to remove HIV target cells from them, would that procedure be any more acceptable? Would we see the WHO and CDC start promoting removal of healthy female tissue?
These studies themselves actually admit in the fine print that other preventative measures need to be followed regardless of circumcision status. But that is never published. Another fact rarely published is that this research only looks at the risk of the male becoming infected – there is no reduction in the risk of the positive male infecting his partner.
Those studies (most of which are just retroactive paperwork reviews from the same handful of ‘real’ research projects) are bogus. From your last paragraph, I get the feeling that you are somewhat aware of the ethical concerns of these claims. What you should be publishing is the risks and trauma associated with circumcision. How about starting with that was halted early, but this time because it was considered TOO TRAUMATIC:
“…found circumcision so traumatic that doctors ended the study early rather than subject any more babies to the operation . . . not only severe pain, but also an increased risk of choking and difficulty breathing.”
And before you say that the HIV studies are regarding adults not infants, .
“…considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.”
Babies are not sexually active and have ZERO risk of acquiring HIV through sex….. But they do run the risk of being infected with HIV and other diseases through contaminated blood or instruments from the circumcision procedure itself – we all know that an open wound has an increased the risk of any type of infection.
Why are we still obsessively trying to find a justification for a procedure (infant circumcision) that destroys healthy tissue of another person and was never justified to begin with?!
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 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.
Halting the trials early also increases the uncertainty of the finding. The question arises, would the results have stayed significant if the trials had continued? Halting the trials for “ethical reasons” means it is now impossible ever to hold another such trial. After circumcising a total of 5,400 men, “only” 64 circumcised men had contracted HIV (and 132 of the non-circumcised control group). Meanwhile 327 of the circumcised men were lost from study, their final HIV status unknown. That is the sum total of the evidence that “circumcision reduces HIV infection by up to 60%” and “mass circumcision could prevent millions of cases”.
The researchers have tried to have their cake and eat it by continuing one of the trials after it was “stopped” but since circumcision has been offered to all the control group and they accepted or not according to unknown criteria, they are no longer a random sample. And they were never a random sample of the population, being all paid volunteers for circumcision.
The “snowball” method of recruitment also raises a concern: it means that many of the volunteers would have been known to each other and so shared the same sex partners. If those women tended to give or withheld their favours based on circumcision status, that would also skew the results.
This study is the latest step in a coordinated and well financed agenda to promote infant circumcision in The US. It is likely totally fraudulent. To understand, you have to look at the evidence.
First, look at the players. Gray is a long time and strident promoter of infant circumcision. He is trying to build on the fraudulent evidence of Robert Bailey and Daniel Halperin, both circumcision promoters for more than 25 years.
The (partial) evidence: Gray refers to the study by Bailey and Halperin. The studies (purportedly) found a 60% reduction in infection rates. This is deception by statistic. In fact, there was a 1.8% difference in infection rates in hard numbers. In medical science, anything less than a 3% difference is considered insignificant as factors that can not be accounted for can easily cause this differential.
The studies were halted less than half way through (11 months vs. 24 months) and rumor has it that the infection rate among the circumcised men was rapidly approaching that of the uncircumcised men and if allowed to continue, would have surpassed that of the uncircumcised men. That is likely as the circumcised men were “out of action for 6 weeks of the study while they were healing. Also, the circumcised men were given counseling on ABC, Abstinence, Be faithful and Condom use that the uncircumcised men may not have received.
Furthermore, Bailey is an epidemologist and understands the routes (vectors of transmission) that communicable diseases take and should know from his professional training that his claims are refuted by the evidence. For instance, we can compare Bailey’s claims against the intervention in the polio epidemic of the first half of the 20th century, the polio vaccine. The polio vaccine has a 70% efficacy yet managed to wipe this highly contagious viral disease from the populace in a single generation. If male circumcision were actually 60% effective in preventing the initial infection, HIV would be conspiciously absent from predominately circumcised populations. This effect is not seen anywhere in the world. Indeed, here in The US where 80% of sexuall active males are circumcised, we have the highest infection rate among the industrialized nations. None of the other industrialized nations have significant circumcisiion rates. If circumcision were effective, at least a few of those countries would have rampant HIV infection rates. Indeed, the demographic with the highest circumcision rate here also has the highest infection rate by far. African Americans circumcision rates have exceeded that of other demographic groups for decades thanks to Medicaid yet they represent 48% of all male infectees and 80% of all female infectees. Further evidence is presented in Swaziland where the male circumcision rate is 98% and the HIV infection rate is 22% and growing. This is the elephant in the living room that Bailey, Halperin and Gray deny although it is clearly visible.
The effects of this agenda have been devastating in Africa. African men are circumcised during the summer and winter circumcision “seasons.” During the winter circumcision season, 58 men died of injuries following their circumcisions. Already in the summer circumcision season (it is summer in South Africa now) two men have died and the season has just started. This elevates the agenda to the level of a felonious crime. Those perpetrating this assault should be held responsible for their actions in the deaths of these men.
These studies are of little importance in The US where the infection rate is well below that of Africa. A study found that of the different transmission methods, sexual transmission rates a distant third. This is the only place circumcision would have an effect. Indeed, an infant male circumcision campaign would result in approximately the same number of deaths as HIV. Three separate studies conducted over a 20 year period have shown that approximately 230 infants die each year from their circumcision procedure.
As Bailey and Halperin’s flurry of press releases has lost column space, others have take up the call with equally false and deceptive studies. The infant circumcision rate in The US has fallen precipitiously in the last decade, falling from near 90% to slightly over 50% now. This is the trend that these agendists are trying to turn around. Their zeal suggest a sexual fetish with circumcision.
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Condoms and monogamy are the best protection against STDs. What they are doing is the same as shortening gun barrels to prevent firearm injuries. These doctors seriously need their heads checked. I would strongly suggest that these doctors are as irresponsible as the aid workers who injected children with the aids virus a few years ago. What they are doing is cosmetic rather than preventative medicine. So you got 10% less chance of getting aids if you are circumcised that doesn’t improve the odds much does it? The women still could have other V-Ds. They doctors say
“Hey guys we’ll just circumcise you and you can go around having as much unprotected sexual intercourse as you like with whoever you like, I think you’ll have less chance of getting hiv if you don’t have herpes to start with!”
So circumcision prevents penis cancer or urinary tract infections or herpes because that dirty little foreskin is off your shaft, good luck to them.