What are some good studies and links to give to friends who persist in the old HIV/AIDS reduction studies and arguments for circ?

To be honest, I'm not terribly familiar with the HIV propaganda, because I intend to teach my son abstinence as an alternative to amputation to prevent HIV. :)

The people that AIDS was first discovered in were the people born during the time when 90% of men were circumcised.How did it spread if circumcision prevented it?

pm me with your e-mail address and I'll send you copies of several good articles that refute the excuse.

Check out this thread, I had a lot to say about it here:

http://www.mothering.com/discussions/showthread.php?t=1065043

The study didn't say circ eliminated the spread of HIV. It said it somewhat reduced the chances of getting it. Those are incredibly different, and it's important to note that. It'd be irresponsible to to say that the study reportedg anything more than a risk reduction.

When AIDS was discovered, condom use was not as high as it is now. I suspect that probably had a lot more to do with it spreading than circ.

And I think it bears repeating that I'm not advocating circumcision. I don't agree with it at all, but I think evidence-based research can't be ignored, either, and this is the most recent study released (and again, it was a WHO study, which are usually very well done with proper controls).

I know.But saying that it reduces the risk by 60% to me still doesn't add up with such a high rate of circumcision at the time.And you add in the fact that more women were circumcised at the time it makes even less sense.

The study didn't say circ eliminated the spread of HIV. It said it somewhat reduced the chances of getting it. Those are incredibly different, and it's important to note that. It'd be irresponsible to to say that the study reportedg anything more than a risk reduction.


That is clearly an important distinction that I don't think is being understood. If we accept it as fact then to me the choices are as simple as:

A. You can get circumcised, but you must always be choosy about your sex partners and you must always wear a condom.

or

B. You don't need to get circumcised, but you must always be choosy about your sex partners and you mush always wear a condom.

I am not sure really, what did I buy getting circumcised? Nothing it seems to me and I think most rational thinkers would conclude the same thing. The problem is although most NGOs swear up and down this is the message they are delivering I don't think this is the message being heard. I think those in Africa are getting circumcised thinking that it will fully protect them, I have read numerous articles where men interviewed were quoted as saying this much. And if men think circumcision is protective, it will dis-empower women in a continent where they already have little power in these situations [This was actually brought up at the AIDS conference in Mexico but few paid it much mind.]. So if circumcision is protective, that protection will probably be frittered away in a combination of dis-inhibition of men and dis-empowerment of women. If it isn't protective then things will surely get worse. I have a feeling that either way they loose.



When AIDS was discovered, condom use was not as high as it is now. I suspect that probably had a lot more to do with it spreading than circ.


True.


And I think it bears repeating that I'm not advocating circumcision. I don't agree with it at all, but I think evidence-based research can't be ignored, either, and this is the most recent study released (and again, it was a WHO study, which are usually very well done with proper controls).

I don't think they were WHO studies, WHO interpreted the study but they weren't carried out or funded by WHO. In any case, several first world countries [pretty quickly] have correctly pointed out that due to very low prevalence there is no relevance, see my link to the other thread. Curiously, the US [where the situation is little different] hasn't said as much and it's now two years later.

I intend to teach my son abstinence as an alternative to amputation to prevent HIV. :)

:yeah:
You hit the nail on the head there! Abstinence is the ONLY way to prevent HIV/AIDS. Condoms break. Circumcision is NOT the answer, I won't even go into that. If we teach our children to be abstinent and monogamous once they find their life mate (spouse, etc.) they won't have to worry about stupid inaccurate studies that say they are at a higher risk of getting HIV because they have/are married to someone who has their foreskin intact.

The study didn't say circ eliminated the spread of HIV. It said it somewhat reduced the chances of getting it. Those are incredibly different, and it's important to note that. It'd be irresponsible to to say that the study reportedg anything more than a risk reduction.

When AIDS was discovered, condom use was not as high as it is now. I suspect that probably had a lot more to do with it spreading than circ.

And I think it bears repeating that I'm not advocating circumcision. I don't agree with it at all, but I think evidence-based research can't be ignored, either, and this is the most recent study released (and again, it was a WHO study, which are usually very well done with proper controls).

The research itself didn't say that circ eliminates the spread of HIV, but its founders and researchers certainly are on a media campaign to make it seem so! "CIRCUMCISION: THE ANSER TO THE HIV PROBLEM?" "SHOULD ALL MALES BE CIRCUMCISED?" "HOW MALE CIRCUMCISION CAN STAMP OUT THE HIV EPIDEMIC"

Those are the headlines that are dashed on news articles regularly and these articles tout this 60 percent protective benefit of HIV as a life-changing tool in the HIV epidemic. Of course, they slip in a sentence that, "Oh, you should still use condoms" for the people who point out that condoms are far more effective at preventing HIV.

And just because WHO has been bought and sold by these studies doesn't mean they are air-tight. There's plenty to criticize about the studies and many researchers have done so in the Lancett and other pubs!

I don't believe evidence-based research can be ignored either but when evidence-based research doesn't play out in real life then I question the validity of that research.

I just always say that I don't care what the "studies" say. My child will not have his foreskin cut off so that he can have crazy, risky sex with anyone he meets. He will be taught how to be responsible with sex...so it's a moot point. If his lack of foreskin is the only thing protecting him from not getting HIV then he's screwed.

Of course, they slip in a sentence that, "Oh, you should still use condoms" for the people who point out that condoms are far more effective at preventing HIV.

I agree, they seem to slip that sentence in as an after thought. It's kind of like the fine print in a credit card agreement or that fast taking announcer at the end of car and financing ads. You know what they say, the big print giveth the small print taketh away.

Circumcision and AIDS/HIV
http://www.circumstitions.com/HIV.html
http://www.cirp.org/library/disease/HIV/
http://www.cochrane.org/reviews/en/ab003362.html
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html

Comparison of North America to other non-circ countries HIV status
http://www.avert.org/america.htm
http://www.avert.org/worldstats.htm

If you teach condom use that is what is needed not cutting off a very important body part.

Since it is not 100% foolproof protection against HIV, why not let the boy weigh the costs and benefits and make the decision for himself when he is old enough to face the issue?

A handout on arguments in re: the HIV/circumcision issue.
http://www.coloradonocirc.org/files/handouts/HIV_Talking_Points.pdf

USA = highest circumsision rate
USA = Highest HIV transmission rate

Finland = Lowest circumcision rate
Finland = Lowest HIV transmission rate

Do the math

I've been having an argument with someone about this issue and pointed out the fact that Europe has lower circ rates + HIV prevalence and their argument was that in countries where circ is not practised there is a greater heterosexual risk and where circ is practised the biggest risk groups are MSM and drug users. Looking at the figures on Avert, this seems to be mostly true, I did uncover a few exceptions looking at other sites namely Japan and Ethiopia..Japan has a very low circ rate and low risk of heterosexual transmission and Ethiopia the opposite.

The other issue is they point out that the groups in the US with high HIV rates are blacks and hispanics who tend not to circ. I have said that they also have disproportionate rates of poverty which may affect sexual education etc. But it's a difficult argument to win.

Since it is not 100% foolproof protection against HIV, why not let the boy weigh the costs and benefits and make the decision for himself when he is old enough to face the issue?

This is where we wound up. We determined it simply wasn't our decision to make. By the time Ds is old enough that it matters there will likely be more info and he can make his own decision.

This is where we wound up. We determined it simply wasn't our decision to make. By the time Ds is old enough that it matters there will likely be more info and he can make his own decision.

ITA. And in a first world country, there isn't enough of a risk to warrant amputation. I wasn't even aware of how low that chance is until reading that post by jwhispers - I think a lot of people think it's pretty much a 100% risk of contracting HIV if you have sex with an infected person without a condom. Reducing that by 60% sounds great until you look at the actual chance of transmission.

If he's engaging in risky practices later on that's his decision to make if the info shows it's worth doing then.

My argument about HIV and circumcision is that if I find out my DS is out there having unprotected sex with anyone he's not in a committed relationship with AND made sure both of them have had multiple negative HIV tests before knocking boots, that I will kick his butt from here to Timbuktu. Gross. :Puke

I hope and pray DS has a marvelous sex life with marvelous people someday. But if I catch the little nut out there bareback, he's going to be in big trouble no matter how old he is!!! I'll never be too old to get him. :lol

I also intend to talk about condoms as soon as he's ready.

I've been having an argument with someone about this issue and pointed out the fact that Europe has lower circ rates + HIV prevalence and their argument was that in countries where circ is not practised there is a greater heterosexual risk and where circ is practised the biggest risk groups are MSM and drug users. Looking at the figures on Avert, this seems to be mostly true, I did uncover a few exceptions looking at other sites namely Japan and Ethiopia..Japan has a very low circ rate and low risk of heterosexual transmission and Ethiopia the opposite.

The other issue is they point out that the groups in the US with high HIV rates are blacks and hispanics who tend not to circ. I have said that they also have disproportionate rates of poverty which may affect sexual education etc. But it's a difficult argument to win.

In the end, behavior seems to be the key to the whole thing. I think you are dead on when it comes to disproportionate rates of poverty and sexual education. People in a lower socio-economic bracket are more likely to engage in riskier behavior that includes sexual practices. As you said, in the US, the biggest HIV risk groups are MSM and drug users. Even by the most favorable interpretation of the RICs, it's clear that circumcision has no prophylactic effect within those two groups. Therefore, its promotion to curb HIV in the US is not backed by any relevant research. What you mentioned about Japan and Ethiopia is interesting because it demonstrates that all kinds of factors have to be considered (that were not taken into account by the RCTs) when one tries to ascertain "real world results" from controlled experiments. It would be also interesting to see how the European heterosexual risk compares to the US risk. I have a hunch that the difference is not statistically significant. In any case, I once remember reading about HIV prevalence in two South African groups, one that circumcises and one that does not. Statistically, there was no difference. I know one of the groups was the Zulu (don't circumcise). I forgot the other one. Anyway, what this example shows is that behavior, not circumcision status determine the spread of HIV, even for high-risk groups. While perhaps they may be some prophylactic effect given by circumcision, it seems to be negated pretty quickly once behavioral factors are taken into account.

you can look up all the transmission stats on Avert. Most of the European countries have a higher risk of heterosexual transmission overall vs MSM. But, I am not sure how relevant this is when the actual HIV prevalence in the country as a whole is much higher as it is in the united states.

Isn't there a school of thought out there that circumcised men tend to engage in riskier behavior as well (due to loss of sensation)?


Behavior. It is documented that circumcised adult males exhibit a greater tendency to engage in risky sexual behavior. Hooykaas and colleagues (http://www.cirp.org/library/disease/STD/hooykaas1/) reported that circumcised men in the Netherlands engage in more risky sexual behavior and have markedly higher rates of STDs.3 (http://www.cirp.org/library/disease/STD/#n3) Laumann and colleagues (http://www.cirp.org/library/general/laumann/) reported more risky sexual behavior amongst circumcised men in the United States and have higher rates of STDs.9 (http://www.cirp.org/library/disease/STD/#n9) Michael et al. reported more variability in sexual behavior, less condom usage, and more STD amonst the predominantly circumcised population of the United States as compared with the predominantly non-circumcised intact males of the United Kingdom.12 (http://www.cirp.org/library/disease/STD/#n12)


http://www.cirp.org/library/disease/STD/

I've been having an argument with someone about this issue and pointed out the fact that Europe has lower circ rates + HIV prevalence and their argument was that in countries where circ is not practised there is a greater heterosexual risk and where circ is practised the biggest risk groups are MSM and drug users. Looking at the figures on Avert, this seems to be mostly true, I did uncover a few exceptions looking at other sites namely Japan and Ethiopia..Japan has a very low circ rate and low risk of heterosexual transmission and Ethiopia the opposite.

The other issue is they point out that the groups in the US with high HIV rates are blacks and hispanics who tend not to circ. I have said that they also have disproportionate rates of poverty which may affect sexual education etc. But it's a difficult argument to win.

You have to be careful about how those figures are interpreted. There are always caveats aren't there? :) We don't know how things are defined and they may be defined differently between countries. One of the terms used by Avert is 'high risk heterosexual sex' this is defined as having sex with someone who is or is at a high probability of infection.

I took the liberty to dig through the US and UK numbers a bit and this is just a napkin kind of estimate but here it goes. According to Avert (http://www.avert.org/usa-transmission-gender.htm), the number of US men who are thought to have acquired HIV through heterosexual contact was about 11%, I think that is a bit more than 4,500 give or take in 2007 and that is a 34 state estimate only but lets just say that this is a good representation.

In the UK, there were an estimated (http://www.avert.org/uk-statistics.htm) 7,734 new cases in 2007. The total number of heterosexual transmissions in 2007 were 3,614 found here (http://www.avert.org/uk-transmission-route.htm). Also found in the previous link was that in 2007 an estimated 152 were thought to be via IV drug use (You'll see why this is important in a second). Female acquired HIV in 2007 (note this is almost ALWAYS via heterosexual sex) is found here (http://www.avert.org/uk-race-age-gender.htm): 2,846. Now females could have gotten HIV from IV drug use but even if all IV drug users diagnosed were female it would amount to even 10% of the female diagnoses. So let's say half (but I am willing to bet that more than half of the IV drug diagnoses were men).

So the number of males who acquired HIV via heterosexual sex has to be:
(3614 - (2846 - 76)) = 844. If there were 7,734 new cases of HIV in the UK then male heterosexually acquired HIV made up about 11% of the new cases. That is the same as the US. :wink I should also point out that on the same page, Avert points out that:

he major component of the rapid increase in recent years has been in heterosexually acquired infections. Although around 80% of these are contracted in countries with high HIV prevalence, infections acquired within the UK have also risen.

That can't be stressed enough, 80% of the 3,614 new cases in 2007 were thought to have been acquired in high-risk countries. That means that only about 700 were acquired locally. It's not really enough to draw any conclusions on. This could be immigrants from Africa or a husband traveling to Thailand to be unfaithful and contract a VD for is wife. It might be that immigration to Europe from those high risk places is higher than the US. I don't see a similar declaration about the US number so I don't know how many are home grown infections versus somebody immigrating to the US and then getting diagnosed (where most of the UK and probably European numbers are coming from). I want to say that you noticed that Japan was different, I would point out that immigration to Japan is nearly impossible no matter where you come from.

So what you say isn't necessarily true, that is the US isn't really doing any better than the UK despite our embrace of circumcision.

And for another example, you can check out Australia (http://www.theaustralian.news.com.au/story/0,25197,25177994-23289,00.html).

Professor Murray goes on to point out that of the 854 Australians men diagnosed with HIV in 2006, only about 77, about 9%, were thought to have acquired it through heterosexual contact. While this is an increase since 2000 (62), a close look at the statistics reveal that the average age of HIV infection for these 77 men was 46, most of the increase (10) were in men 60 and over, and none of the men were younger than 24. The vast percentage of new infections therefore were in men of a generation that was already circumcised.

Australia is also concerned with the importation issue, they believe most of those 77 were also acquired in high risk countries. I think you'll find that a close look at the rest of Europe will yield numbers that were similar.

ETA: I also want to point out that for whatever reason minorities, particularly African American minorities are dis-proportionally affected in both countries. And not by a little, by a lot between 70-80%.

I've been having an argument with someone about this issue and pointed out the fact that Europe has lower circ rates + HIV prevalence and their argument was that in countries where circ is not practised there is a greater heterosexual risk and where circ is practised the biggest risk groups are MSM and drug users. Looking at the figures on Avert, this seems to be mostly true, I did uncover a few exceptions looking at other sites namely Japan and Ethiopia..Japan has a very low circ rate and low risk of heterosexual transmission and Ethiopia the opposite.

The other issue is they point out that the groups in the US with high HIV rates are blacks and hispanics who tend not to circ. I have said that they also have disproportionate rates of poverty which may affect sexual education etc. But it's a difficult argument to win.

So what is the person you're arguing with saying? That it's better to have your largest risk group be gays and drug users as opposed to heterosexuals???

It just feel so inappropriate to make such a irrevocable decision in the name of my son, why would I do such a thing - It's like saying that he is going to be an irresponsible adult when it comes to sex and hygiene practices, so let's whack off part of his penis. So okay, if I have a family history of breast cancer should I cut off my boobs? :eyesroll

jwhispers, once again, you rock. :thumb

something else to think about as well, that I read somewhere else and I think is a good point - if someone took part in a study, had some sex education and was circumcised, 1) they had a period of abstinence while the wound healed and 2) they have a constant reminder of the whole ABC thing every time they have sex because of the physical difference. I think it would be likely to remind them to use condoms. Do we know if there was any difference in safe sex practices between the circumcised and intact groups in those studies after circumcision?

nevermind

jwhispers, once again, you rock. :thumb

I just want to reiterate that I don't think the numbers really mean too much. It's too hard to get a real feel for what is going on. For example, in the UK numbers 80% of the heterosexually acquired HIV was contracted overseas from high risk countries. Meaning they are probably importing it by immigration. So only 700 heterosexual infections were thought to be locally acquired. Canada's numbers had only about 2 or 300 heterosexual infections in 2007 I don't know how many were local and Australia only had like 200. So it's hard to do anyting with these figures except to say that the risk of heterosexual infection is VERY VERY low.

I recall reading somewhere that the HIV-circ research was done in a predominantly Muslim country where people tend to stick with their wifes instead of sleeping with multitudes of strangers and that in itsself reduced the risk of HIV infection tremendously. Don't quote me on that though. :wink

Last week there was some doctor or another speaking on the news about since using condoms the rate of HIV infection here in South Africa has actually increased. It also connects to your lifestyle and sexual habits, sorry I can't find the exact right words. What it boils down to is that people think condoms are a free pass to life promicuously and to sleep with everyone and that risky behaviour has actually increased the rate at which HIV is being transmitted in South Africa.

What really irked me was when I read on a South African forum how males were setting up appointments all over the place to get circ'ed because they believed it will increase their (and their partner's) sexual pleasure. Can you say uninformed? Someone mentioned the HIV-circ research and one woman said "I can't wait until everyone is FORCED to circ their baby boys because it will STOP HIV spreading." :irked:

You know, I have been sitting here reading and thinking about the HIV/HPV/HSV2 etc issue, and it seems to me that circumcising a son because you want to prevent these diseases is so demeaning as to be abusive, even when ignoring the reality of what you are physically doing to the child's penis. It seems on the surface to be a decision a parent would make because they want to do "everything they can" to protect their son from the disease. This seems to be in the child's best interest and noble, right? But then, when you think about it, the same thing can be accomplished when the boy is old enough to understand and choose the circumcision for himself. So it seems to me, what circumcisers who make this choice for their sons are saying is, "I fear that you may not choose this for yourself when you are older. I think this is the best course of action. You may disagree someday. So, I must cut you now." And IMO, this simply cannot be justified.

you know, i have been sitting here reading and thinking about the hiv/hpv/hsv2 etc issue, and it seems to me that circumcising a son because you want to prevent these diseases is so demeaning as to be abusive, even when ignoring the reality of what you are physically doing to the child's penis. It seems on the surface to be a decision a parent would make because they want to do "everything they can" to protect their son from the disease. This seems to be in the child's best interest and noble, right? But then, when you think about it, the same thing can be accomplished when the boy is old enough to understand and choose the circumcision for himself. So it seems to me, what circumcisers who make this choice for their sons are saying is, "i fear that you may not choose this for yourself when you are older. i think this is the best course of action. You may disagree someday. So, i must cut you now." and imo, this simply cannot be justified.


ita

It's actually not an old argument. A new study performed in Uganda with WHO funding just came out a few weeks ago confirming previous studies.

Also, it's my understanding that this was NOT a new trial. It was the same trial as before, just analyzed for different outcomes. So, the same issues with the HIV journal papers would pertain to the HPV/HSV-2 paper. The trial number is ANRS 1265.

http://clinicaltrials.gov/ct2/show/NCT00122525

If my son wants to be promiscuous and ignore safer sex practices, the presence of a foreskin is the least of his (and my) worries.

He can choose to be circumcised as an adult. Why should I make the choice for him--forever altering his body and his future sexual function?

I hope it is ok that I revive this thread with a related question.

Can someone help me better understand the study methodology? How was the post-op recovery period (and what I would assume would be fewer sexual encounters during that period) controlled for?

Seeking Joy: There was no allowance for the healing period and less sex during that. That's only one flaw in these "conclusive" (or should I say conclusionary) studies.

Dave2GA, how long is the typical healing period?

Are where can I find some credible written critiques of the study?

A friend mulling over this decision was on the fence until the AIDs study came out and I am trying to provide her with more information to inform her decision.

I think your best bets are www.circumcisionandhiv.com and www.cirp.org. The circumcision policy statement at www.doctorsopposingcircumcision.org should deal with the issue. Also check www.circumstitions.com., particularly http://www.circumstitions.com/HIV.html.

Are where can I find some credible written critiques of the study?

A friend mulling over this decision was on the fence until the AIDs study came out and I am trying to provide her with more information to inform her decision.

Mothering published a good, well-documented critique last summer. See:
http://mothering.com/articles/new_baby/circumcision/the-truth-about-circumcision-and-hiv.html
May not be the type of medical journal article that she might find most credible, but really does a good job on the arguments and includes interviews with credentialed medical professionals.

Also, there was a very good, and readable, rebuttal article published a year ago in the medical journal Future Medicine. You can access it at: http://www.futuremedicine.com/doi/pdf/10.2217/17469600.2.3.193?cookieSet=1

Also you can refer her to a summary sheet developed by COlorado NOCIRC on the arguments against using the African HIV studies as a reason to circumcise babies in the US here:
http://www.coloradonocirc.org/files/handouts/HIV_Talking_Points.pdf
Breaks it down in simple bullet points.

Or the NOCIRC brochure on HIV and circumcision here:
http://www.nocirc.org/publish/11-HIV.pdf

Other resources are compiled here:
http://www.coloradonocirc.org/hiv.php

Gillian