"Tinderbox" author on Fresh Air discussing HIV and circumcision in Africa

[arb]

I came here expecting lots of talk about this--did I miss it? I am curious. Can one reconcile being pro-circumcision for Africa and anti-circumcision for "us"? Has it made anyone here reconsider? Serious questions, not trying to ruffle feathers. 

http://www.npr.org/2012/02/27/147491878/tinderbox-how-the-west-fueled-the-aids-epidemic

"Many African countries initially ignored the AIDS crisis, but some nations — like Uganda and Zimbabwe — were successful in providing public health information and slowing the spread of the disease. Timberg says when Western countries later became serious about fighting the African AIDS epidemic, international AIDS groups didn't follow Uganda's model — and overlooked some relatively simple and inexpensive approaches proven to stem the spread of HIV.

One of their errors, he says, was overlooking the effectiveness of male circumcision. Circumcised men are at a much lower risk of becoming infected with HIV through sexual transmission.

"When you look at the parts of not just Africa but the world where HIV is worse, it is almost inevitably societies that don't circumcise," he says. "The science on this began emerging in the 1980s and it became terribly politicized. People were uncomfortable with the subject, and the whole discussion became incredibly controversial. It took almost 20 years for the scientific community and the community of policymakers to really do enough science and enough research to realize how important this was."

 

[McGucks]

I heard the interview this morning also.  It was a very good interview and also made me think about MDC's stance, which I support and understand.

I don't have anything to say in particular other than I did hear the piece.  I don't think the benefits of circumcision for the population to whom the author referred can be dismissed. 

eta:  While I understand that there could be a perceived danger in an "us" and "them" mentality and I also realize there is danger in one society making recommendations for another, this author clearly had lived and researched so extensively in Africa that he certainly had a world of knowledge regarding the population about whom he'd written.  As a white woman living in America, I don't think it's my right to say that Africans ought not to circumcise. 

Edited by McGucks - 2/27/12 at 6:01pm

[A&A]

I think it smacks of colonialism and racism to tell them to chop off body parts when we could be spending the time and money on massive condom campaigns (which would protect against other STDs as well as pregnancy, and would protect women against AIDS, as well.)

[helloall]

Oh look, the major country in the world that primarily circumcised for decades is conviently left out here. You know the country with high percentages of sti's and yet has a high circ population.....

Oh lawd.

[philomom]

Wow, that guy is so wrong. He completely overlooked that the United States have very high HIV transmission rate and most of our adult males are cut.

[jessjgh1]

I heard it too and it was only the one author stating this information and he didn't really offer much proof. . He stated the foreskin was more sensitive tissue and therefore more prone to HIV - he stated research results but not specific information. It was not discussed as an ethical issue or a controversial issue. There was no questioning of his information at all.

He repeatedly stated that AIDS transmits differently in Africa because of cultural reasons and differences. Primarily cultures accepting of multiple sex partners. often these are long term partners, so there is a typical lack of condom use.

My biggest problems w this information are:
1) w/o changing sexual practices and increasing condom use substantially even if circ is 70% effective- it is not going to solve the crisis.

2) the data doesn't make sense (comparing US data (circed) to European data ( intact) so it shouldn't be applied across the board. Btw other studies have shown the foreskin is protective or that intact areas have less HIV

3) it's unethical to promote circ for babies.

4) the known problems in the African studies claiming that circ us like a 'vaccine' have been discussed

Btw, Female circumcision was never brought up - could this be why Africa's transmission rates are unexpectedly high?

If male circumcision was not common and considered an allowed/ acceptable medical procedure in the US we would never invent and suggest it. It would simply be considered as unethical as suggesting female circumcision or the removal of any other normal body part.

I do hope it is a hard sell because I agree that westerners coming over to Africa and suggestion every male have their penis cut sounds pretty crazy. Maybe it just is.

Jessica

[jessjgh1]

Sorry for the poor formatting/writing above. such a pain to post from a phone, but hearing this in the car today was a little upsetting

Jess

[philomom]

Be sure and comment.

[Greg B]

You need to listen very carefully to what they say.  Then compare it with what the research actually says.  You will find that they are taking things out of context and using words that are not accurate.

The studies in Africa, even if you accept the methodology never said circumcisioon would prevent HIV, instead they said it would help reduce the transmission.  There is a big difference between "prevent" and "reduce the transmission."  If you read the studies carefully, you will find, down at the end what they really are saying.

A circumcised man has to do everything an intact man has to do to prevent HIV.  He has no additinal protection.  He must use condoms and do all the other safe sex practices, if he wants to prevent HIV.  So what exactly does he get from circumcision?

He gets a chance to have more condom failures, or he gets to have more unsafe sex acts, before he aquires HIV.  Circumcision, according to the studies (which are in dispute over probably faulty methodology) simply make it less likely that he will aquire HIV.  To put the numbers in the correct context, circ’d men had a 1.6% chance of contracting aids, while the intact men had a 3.4% chance. Or if you were circ’d you had an incidence of 16 men out of a 1,000, while intact men had an incidence of 34 men out of 1,000.

And you should note that they never talk about the value of a foreskin.  Listening to them, it sounds like a foreskin is all bad.  But it is poor decision making to limit yourself to one small benefit and ignore everything else.  Instead they should, if they wanted to be objective and fair, explain the trade offs.

A circ'd man loses the most important part of his sexual anatomy for sexual feeling and function.  His partner will also have her sexual feelings and pleasure reduced dramatically.  And he needs to use condoms and practice safe sex all the time.  And he will likely be less inclined to use condoms, because his feelings are so diminished.  But, if his condom breaks, or he chooses to have unsafe sex, he will probably be able to do that more times before he aquires HIV.

An intact man keeps the most important part of his sexual anatomy.  He and his partner will enjoy the best sexual feelings and functioning possible.  Even with condoms, they will have better feelings, so they will probably be more likely to use condoms.  And they will have to wear condoms and practice safe sex in order to prevent HIV.  And if the condom breaks or they choose to practice unsafe sex, they will probably aquire HIV in fewer occasions.

It is easy for me to see what the preferred choice is.  I would never choose to amputate the most valuable sexual tissue on my body for this minor benefit.  Far more effective, and a far better choice would be to get more condoms and education out there.  But you need to have it all spelled out accurately in order to see this.  Those promoting this seem to only care about one thing, reducing HIV.  They do not seem to care about anything else.

Regards

[nia82]

/sarcasm -> But we can't do education and condom use promotion. People and parents cannot be educated, they are all stupid, so it's better to just cut off everyone's foreskins. /sarcasm end

Sadly, this is how many medical professionals think about everything.