Study results: genital herpes drug does NOT dramatically HIV susceptibility (mentions circ)

[RestoredIntactivst]

In a SF Chronicle article about the new results of the Herpes drugs possibly reducing HIV susceptibility, they mention:

Scientists had a lot of reasons to think that the results of this study could be as exciting as the findings in 2005 and 2006 that adult male circumcision - the surgical removal of the foreskin - reduced by as much as 60 percent the risk that those men would contract HIV.

Yeah whatever... we all know those studies were flawed... not my point right now...

But later in the article, they state why these so-called "scientists" think circumcision might decrease the chances of HIV infection:

Circumcision is believed to lower HIV risk because the foreskin is rich in infection-fighting white blood cells that are targets particularly favored by the AIDS virus.

Can someone say "IRONIC"?....: Not that HIV isn't bad, because it is horrible, and we definitely need to be working toward a cure/prevention for it. HOWEVER, in this article, you get the rare admission that there are some immune system components in the foreskin. Logically, one can see that because circumcision removes the foreskin, naturally (or would it be unnaturally?) the immune system components contained within are also being removed.

So this begs the question, "Why would it be a good idea to remove a part of the body's immune system on a massive scale to a whole bunch of people at the same time?":

I have yet to hear a satisfactory answer. Especially since this "preventative treatment" is being pondered for the youth (even though this particular article doesn't mention that aspect.)

Most people will probably just skim through without giving it much thought, or think "I'm glad Johnny no longer has those bad white blood cells, now he won't get HIV", but hopefully : at least some people will actually read and ponder the sentence about "infection-fighting white blood cells" and start considering maybe it isn't such a good idea to remove them... I can hear those thoughts now... "Even though it might reduce the chances of getting HIV, maybe we'll pass on circumcision and instead simply teach Johnny to have a responsible, monogamous sex-life. This way he can have a whole penis and those wonderful white blood cells inside it. "

[jserral]

"Why would it be a good idea to remove a part of the body's immune system on a massive scale to a whole bunch of people at the same time?"

Because they are "favored by the AIDS virus" and circed guys penis dont need the infection fighting cells for other stuff because they arent unclean.... I'm sure that is pretty close to what a pro-circ person would say. ;P

[mamoma]

This seems to be the theory:

The majority of men who are HIV positive become infected through the penis during sexual contact. Recent studies have proven conclusively that uncircumcised men are at a much greater risk of becoming infected with HIV than men who are circumcised. In some studies, infection rate was 50 percent less in circumcised men. Experts offered several possible reasons why circumcision offers protection against HIV infection:

* the inner surface of the foreskin has a very high concentration of cells containing HIV receptors that act has a portal into the body when exposed to HIV-infected bodily fluids such as semen.

* the foreskin traps HIV in a moist environment near the surface of the penis, allowing the HIV to live longer

* small foreskin tears that may occur during intercourse provide an entryway for the virus.

[Fyrestorm]

Originally Posted by mamoma

This seems to be the theory:

The majority of men who are HIV positive become infected through the penis during sexual contact. Recent studies have proven conclusively that uncircumcised men are at a much greater risk of becoming infected with HIV than men who are circumcised. In some studies, infection rate was 50 percent less in circumcised men. Experts offered several possible reasons why circumcision offers protection against HIV infection:

* the inner surface of the foreskin has a very high concentration of cells containing HIV receptors that act has a portal into the body when exposed to HIV-infected bodily fluids such as semen.

* the foreskin traps HIV in a moist environment near the surface of the penis, allowing the HIV to live longer

* small foreskin tears that may occur during intercourse provide an entryway for the virus.

You do realize that this info comes from an African study that has been totally discredited...right?

[mamoma]

From what I can tell it's not from a study, it's just the prevailing understanding as to *why* studies show that circumcision might decrease susceptibility to HIV. I know that African studies are problematic because only certain religious groups circumcise, and their sexual behavior might vary from the general population. (And, for the record, I'm anti-circumcision regardless). I was just responding to this comment:

Because they are "favored by the AIDS virus" and circed guys penis dont need the infection fighting cells for other stuff because they arent unclean.... I'm sure that is pretty close to what a pro-circ person would say. ;P

[RestoredIntactivst]

Don't take this personally mamoma, because it is not meant as a personal attack on you. I'm not responding to you (I read your second post about being anti-circ), but rather the "reasonings" that have been suggested by these "experts" for the continuing discussion in this thread. Like you said, whether these reasons are actually given in the studies, they seem to be what people are (unfortunately) understanding as the "take home message" after reading the reports in the media.

Recent studies have proven conclusively......
.....offered several possible reasons why circumcision offers protection against HIV infection:

Being a biology major in college (pre-med level classes, though I didn't go that direction with my career), I've had my share of experience with research and writing many reports from that research. First, scientifically, things are rarely proven conclusively. And second if you have to give "possible reasons", then you don't really know for sure, and you haven't proven anything. You may have stumbled upon a correlation, but correlation does not necessarilly indicate causality.

the inner surface of the foreskin has a very high concentration of cells containing HIV receptors that act has a portal into the body when exposed to HIV-infected bodily fluids such as semen.

That may well be, but to run this circumcision program nation wide or even just city-wide assumes that all people will come into contact with HIV-infected fluids. Would these "experts" appreciate it if I mandated that they be circumcised because I know they will be sleeping with at least one (but I think many) HIV-infected partners?

Also important to note there are several other fluids that can potentially be HIV infected - fluids such as blood maybe? Perhaps rather than mutilating every male in africa, we should be looking into ways of bringing their medical practices up to date, as well as getting more medical doctors on the ground.

This plan, if the study's findings actually do hold water, might work on individuals, but to subject EVERYONE to circumcision to prevent something that has such a narrow mode of transmission (not highly contageous like the flu or malaria) is going way overboard and IMHO unethical.

the foreskin traps HIV in a moist environment near the surface of the penis, allowing the HIV to live longer

The female labia can also help trap HIV in a moist environment.... should we remove those from all females as well?

small foreskin tears that may occur during intercourse provide an entryway for the virus.

And the circumcision wound itself, or the shaft-skin tears from an agressively tight circumcision, would not create an entryway?

Again, this might be a good idea for preventing a specific transmission path in a specific person, but I find no satisfactory reason for this to become a "routine" procedure on a mass populous.

[jserral]

You do realize that this info comes from an African study that has been totally discredited...right?

I wish that was the case, but unless something changed i don't know about, certain organizations still support the study (WHO, UNAIDS).... almost seems like more are trying to support it.

[jserral]

This plan, if the study's findings actually do hold water, might work on individuals, but to subject EVERYONE to circumcision to prevent something that has such a narrow mode of transmission (not highly contageous like the flu or malaria) is going way overboard and IMHO unethical.

Most definately true... but i think how it happens is the findings are pushed in areas that have HIV issues, it helps prevent the disease everyone fears, and by not getting your kid done, you are a "bad parent", which is amplified even more by others that get the procedure done. People may start doing it reluctantly, but after it has gone on long enough, it becomes part of the culture... and even if the medical reasons are disproven, going back to intact becomes, ugly, gross, unclean, etc... and less profitable. Sounds all to familiar to me...

[Fellow Traveler]

I think the first thing you have to realize is that this 50% that you refer to represents a relative risk reduction rather than an absolute risk reduction. So the question has to be asked, 50% of what? In the study area it was 50% of 3% over about 20 months. If it could be applied to the US (and it really can't) it might be 50% of 0.3% or 0.03% but possibly lower still. What we also know now is that in two or three other studies done this year that supposed protection wasn't realized for gay men, the highest risk group, nor was there any protection for women; in fact, a circumcised HIV+ man may be more likely to pass the infection to his HIV- wife posts here and here.

There are several things to keep in mind about the 'studies' in Africa. The first is what is meant by 50%, covered in paragraph one. Second, studies don't always travel well. For example these results from a study of the US Navy population published at the XV International AIDS Conference in 2004 found no significant difference in the HIV rates between intact and circumcised men. This seemed to confirm the results of a much larger study published in September 2007 which reviewed all electronic records of males attending the San Francisco municipal STD clinic between 1996 and 2005 which amounted to some 58,598 patients. Although the study authors don't bother to run the numbers, two of the respondents did; there is enough information there for you to cross check it if you are so inclined. In this case, 58,000 men in San Francisco, over 10 years there was no significant statistical difference found between circumcised or intact men with regard to HIV or Syphilis for any sexual orientation.

But it really doesn't matter. Circumcision, in America, has been a procedure looking for an excuse for nearly 100 years. The new blue ribbon champ, HIV, is an excellent example of this problem; if we just forget about the previous statistics and get down to the proverbial brass tacks the whole issue boils down to the following question: If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected? Clearly the answer is no. The critical point is you have only two options:

A. You don't need a circumcision, but you need to always wear a condom and be choosy about your sex partners.

B. You can get a circumcision but you need to always wear a condom and be choosy about your sex partners.

I think that the Australian Federation of AIDS Organization's had two excellent publications on this issue. Their July 2007 statement and this one that was distributed at at last year's International AIDS Society Conference. The second said in part: "How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection)."

And that is the thing, the primary advice simply doesn't change, you still need to always wear a condom and you must limit and be choosy about your sex partners. Along side condoms and selectivity, circumcision is not a fail-safe it is irrelevant. To consider circumcision in this way is to consider a situation where you might try and forgo the condom, for whatever reason, and presume that since you're circumcised it's fine. That is a dangerous assumption to make, especially if you live in a pandemic zone; you either wear the condom or you will die.

The thing is that if the study results are valid and if they were applicable in the US I might reduce my risk of infection from say 3 in 500,000 to 1.5 in 500,000 give or take an order of magnitude. But again it isn't really relevant because circumcision simply doesn't change my responsibility with regard to behavior that is true both here and in Africa. One of the additional problems with Africa is that it will divert money that could be better used buying condoms and drugs, which we know are in scandalously short supply. There are no short cuts, no silver bullets. The only way to deal with HIV in Africa is through safe sex, education, and pulling people out of poverty. We won't cut our way out of it and if we want to do them a favor we would buckle down and do the actual hard work that needs to be done. That is how we will solve this problem; I frequently wonder why people are deviating from that course.