Circumcision and HIV/AIDS

[bluedaisy]

I work in development in a country where there is currently a big push for voluntary male (adult) circumcision to help in preventing the spread of HIV/AIDS.  They don't circumcise boys from 3 months to 9 years, but they will circumcise babies (although it is very rare here).

I'm just curious if anyone knows of any studies that show whether circumcision actually has an effect on HIV/AIDS rates.

My 1 year old son is not circumcised, and regardless of whether of not it can prevent HIV/AIDS I don't think it's justification to circumcise babies (I'm not trying to offer a pro-circ argument at all, just curious because it's really being pushed here).

[LorienIslay]

It's my understanding that the studies that showed a reduction in HIV infections in circumcised adults were deeply, deeply flawed.  The gist is that the control group (uncircumcised) had no information, no nothing -- just left to do their daily 'activities'.  The circumcised group were given information on safe sex and a supply of condoms.  So not exactly a surprise that the circ'd group had less HIV :P 

Further studies are actually showing that HIV is increased in circ'd men (and, given that the USA has one of the highest levels of circ'd sexually active men and also one of the highest STD/HIV levels in the developed world, no surprise there).  The cells in the foreskin actually protect against disease, as evolution intended.  

Here is an interesting study, and The Whole Network is full of information that isn't manipulated by pro-circ public policy makers.  http://www.thewholenetwork.org/14/post/2012/08/new-study-circumcision-increases-likelihood-of-sti-hiv-infections.html 

[Storm Bride]

Originally Posted by LorienIslay 

It's my understanding that the studies that showed a reduction in HIV infections in circumcised adults were deeply, deeply flawed.  The gist is that the control group (uncircumcised) had no information, no nothing -- just left to do their daily 'activities'.  The circumcised group were given information on safe sex and a supply of condoms.  So not exactly a surprise that the circ'd group had less HIV :P 

I've come across this once before. Also, I can't remember the study period, but I believe it was quite short. Since the men who had just been circ'd were likely to have abstained for some period of time, due to pain, that may have also skewed the results. One can't transmit or receive a disease sexually when one isn't having sex!

Further studies are actually showing that HIV is increased in circ'd men (and, given that the USA has one of the highest levels of circ'd sexually active men and also one of the highest STD/HIV levels in the developed world, no surprise there).  The cells in the foreskin actually protect against disease, as evolution intended.  

The fact that the US has a high AIDS rate, among an adult male group with a very high circ rate, seems to be conveniently overlooked by a lot of people. It's fascinating.

[ml66uk]

From a USAID report:
"There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

It seems highly unrealistic to expect that there will be no risk compensation.  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".
http://www.info.gov.za/issues/hiv/survey_2009.htm

It is unclear if circumcised men are more likely to infect women.  The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract

ABC (Abstinence, Being faithful, and especially Condoms) is the way forward.  Promoting genital surgery seems likely to cost African lives rather than save them.

[spacediver]

my thinking is that the HIV is another red herring. Even if genital cutting helped protect against HIV it would not be justification. The thought experiment to run in your head, and to present to others, is whether they would demand that baby females undergo genital cutting if it were shown to reduce the likelihood of reception and/or transmission of these pathogens.
 

[Mitchell756]

The United States has by far the highest number of circumcised males among the industrialized nations and also has the highest rate of AIDS. The majority of cases of transmissions come from the use of infected needles and this is also the largest cause of AIDS in Africa as well. Heterosexually transmitted AIDS through vaginal penetration is quite uncommon.

The practice of anal sex significantly increases the risk of potentially transmitting AIDS through sexual activity. The evidence that shows that the amputation of the foreskin decreases the amount of sexual pleasure a male is capable of experiencing is overwhelming and conclusive and has been for a long time. This is the reason for the obsession of many males in the United States with vaginal tightness and is also why significantly more Americans report having engaged in anal sex then compared to other industrialized nations. According to the latest accurate information in the United States from the National Survey of Family Growth 30% of sexually active females have reported engaging in anal sex. The data from another industrialized nation indicates much lower rates. A survey conducted in Sweden ( where very few males are circumcised ) in 1996 showed that only 20% of sexually active females have reported in engaging in anal sex. This represents a 50% increase in the rates of practice of anal sex between American women and Swedish women. The reason for the much higher rates of practice in anal sex among American women is very highly likely the result of decreased sexual satisfaction through normal sexual intercourse for circumcised males, which likely leads them to attempt to pressure their female partners into engaging in anal sex.

The tissue in the walls of the rectum are much more sensitive to damage then the walls of the vagina and the anus does not produce any form of natural lubrication as it did not evolve to be penetrated. The resulting abrasions in the walls of the intestine and the outer rectum serve as excellent transmission vectors for the HIV/AIDS virus, which is why those who engage in anal sex are at a much higher risk for contracting the AIDS virus.

The reason given by some of the individuals involved in these efforts for the belief that amputating the foreskin would lower the risk of contracting AIDS is that the immune responses in the foreskin could serve to increase the chance of contracting the AIDS virus. Interestingly, females also have corresponding immune response features in the labia and clitoral hood. If they believe that amputating the foreskin of males could reduce the risk of contracting the AIDS virus among men and are implementing this policy as a means to reduce the risk of contracting AIDS, then the implementation of practices of amputating the labia and clitoral hood of females would likely see similar results and would prove as a very effective addition to the campaign against AIDS taking place in Africa.

It is important to remember though, that the studies which these findings were based on were flawed and clearly favored the circumcised males. Initially, all of the men that took part in these surveys were intact. As the study began half of them were circumcised. These males required a six weeks recovery period before they would be able to engage in sexual activities. The intact males were not placed under any restraints during this time period and were free to engage in whatever sexual practices they wished. This gave them six more weeks to engage in sexual activities and potentially contract the AIDS virus. Also, after the circumcised males had recovered from their surgeries, they were provided with condoms during their check ups, which is something that the intact males were not provided with. Finally, there was no control in these studies for the types of sexual practices that the males that took part in it had engaged in.

In addition to the above information, the United Nations chief expert on circumcision, David R. Tomlinson, is also the inventor of several new and improved circumcision devices, particularly the Accucirc circumcision device, many of which have been very heavily used in the campaign to circumcise males throughout the African continent.

In conclusion, the campaign to circumcise males in Africa is likely the result of human greed and the launch of massive indoctrination campaigns in the regions that have been targeted. It serves to take advantage of a largely weak, poverty stricken, and uneducated region of the world and exploit it for personal financial gain. It also serves to provide further excuses for those that support circumcision in the United States to hide behind, which will serve to shield them and their personal economic, social, cultural or sexual interests from the intensive scrutiny that is clearly justified.

[KOTFrank]

Pediatrician Anne Lindboe says it to best in a short 7 minute video on youtube by bonobo3D. Dr. Lindboe is Norway's Children's Ombudsman.

[Greg B]

There is a lot of misleading information out there in support of circumcsion to reduce HIV.  But if you think it through, even accepting the African studies as true, the decision to circumcise is a bad one.

Look at it from the value based decision making stand point.  We value reducing HIV.  We also value human rights, the right to bodily integrity, the right to have a fulfilling sex life, minimizing pain and suffering.  We must, if we are to make a good decision, weigh all of these objectives, or values when deciding.  So, with that in mind, look at the decsiion of whether to circumcise to reduce HIV.

Ther African studies themselves say that circumcsion will not prevent HIV.  But they hide that information and say it is misleading ways.  But if you read carefully, you will find that all they really say is that circumcsion will reduce the chances of aquiring HIV by a small amount.  So they also say that men who are circumcised must still use condoms and practice safe sex to prevent HIV.  In other words, they have to do everything an intact guy has to do.  What they do not do is put that in perspective, because if they did, it would not sound compelling.  But if you think it through, what they are saying is a circumcised man will, on average, be able to have unprotected sex more times, or have his condom break more times, before he is likley to aquire HIV. 

OK, now lets get back to making the decision.  So the decision is whether to have a circumcsion to reduce you chance of aquiring HIV.  You have two alternatives.

Alternative 1:  Stay intact.  If you choose this alternative, he can have great sex and lead a normal life.  To prevent HIV he will need to practice safe sex, especailly wear condoms.  But sex with condoms on will feel very good if you have a foreskin, so he will likley not find that much of a burden.

Altenrative 2:  Circumcise.  The patient will have great pain, his human rights will be compromised, his body will no longer be whole, his sex life will be compromised dramatically ( the foreskin has great value for sexual function and feeling for both him and his partners), he will be at risk for complications, death, disfigurment.  To prevent HIV he will need to practice safe sex, especailly wear condoms.  But sex with condoms takes away a lot of sensation for a circumcised man, so he will be less likely to use them.

Seems like an easy decsioon to me.  Keep him intact.

Regards