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#1 of 23 Old 02-26-2009, 03:02 PM - Thread Starter
 
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Ok, I'm sure this topic has been discussed many times here, but I'm new to this forum. I did a lot of research before DS was born to help convince DH against circing. But by accident, I just ran across this: http://www.who.int/bulletin/volumes/84/7/news10706/en/ and was shocked! Is this really true?!? It seems bogus to me, but the WHO supports it!

I'd love to know if there are any studies that show the opposite, or at least that circ DOES NOT affect HIV infection rates. Please help me clarify this!
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#2 of 23 Old 02-26-2009, 04:06 PM
 
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http://www.circumcisionandhiv.com/

Go through this site and read the archives. They've done a great job of tackling this issue and have tons of studies that show how shaky the ground is with regard to circumcision and HIV research.
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#3 of 23 Old 02-26-2009, 04:08 PM
 
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Originally Posted by slsurface View Post
Ok, I'm sure this topic has been discussed many times here, but I'm new to this forum. I did a lot of research before DS was born to help convince DH against circing. But by accident, I just ran across this: http://www.who.int/bulletin/volumes/84/7/news10706/en/ and was shocked! Is this really true?!? It seems bogus to me, but the WHO supports it!

I'd love to know if there are any studies that show the opposite, or at least that circ DOES NOT affect HIV infection rates. Please help me clarify this!
And yes, WHO does support it, but only in areas where the primary form of transmission is female-to-male intercourse and where the rate of HIV infection is at an epidemic level. In other words, this recommendation doesn't apply to 1st World countries and the WHO has admitted this. Even Halperin admitted that it wouldn't have much impact on HIV infection in the US, but he still thinks Americans should circ their baby boys anyway just because.
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#4 of 23 Old 02-26-2009, 04:17 PM
 
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There has been a huge lobbying effort by some pro-circ "researchers" to get the WHO to mention or endorse circ. Without HIV, they are some ignored university profs studying/promoting a declining "cultural tradition". Halperin (et al) has been looking for medical benefits to circ for decades - an medical benefit will do - hangnails, rare foreskin cancer, epilepsy, whatever. With the circ and HIV claims, the researchers make national newspapers, they get to go to big conferences, and they are at the center of attention. Some even get research funding. The biggest fear of a university professor is that no one will read their body of work.
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#5 of 23 Old 02-26-2009, 04:29 PM - Thread Starter
 
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Thanks for the link! Now it's time to read up.
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#6 of 23 Old 02-26-2009, 05:56 PM
 
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To me, the bottom line is:
1) Even if it's true, it shouldn't be forced on children who can't consent.
2) Even if it's true, condoms are still better protection
3) Even if it's true, I wouldn't want it (or rather, a female equivalent) so why would I advocate it for men?

That's aside from all the evidence that it isn't even true, anyway.
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#7 of 23 Old 02-26-2009, 06:30 PM - Thread Starter
 
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Originally Posted by Haselnuss View Post
To me, the bottom line is:
1) Even if it's true, it shouldn't be forced on children who can't consent.
2) Even if it's true, condoms are still better protection
3) Even if it's true, I wouldn't want it (or rather, a female equivalent) so why would I advocate it for men?
I agree.
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#8 of 23 Old 02-26-2009, 08:43 PM
 
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I posted this here a while ago so people would have a understanding of the proposition. I'll repost it for everyone's benefit. The thing is the WHO recommendation applies only to countries with high prevalence and not to countries like the US. And let me just explain to you why especially in the US, and other first world countries, the HIV argument is pretty much BS. It's also a stupid policy in Africa and will almost certainly be a long term failure but for other reasons.

Anyway, to determine the probability of not becoming infected you can use the following formula:

(1 - [chance of transmission from sex])^[sexual encounters]

Now for the estimates, let's assume that there is a risk reduction of 50% for circumcised men. This is the number most often banted around by the popular media and those clowns at the UN and WHO in their reports from Africa. The probability of infection in any one encounter with an HIV positive partner varies depending on viral load, co-infection, and numerous other reasons. For example, people are most infectious soon after being infected. Infectiousness lessens after a few weeks which is one reason HIV spreads so fast in Africa, read The Invisible Cure: Africa, the West, and the Fight Against AIDS by Helen Epstein to find out why it's so infectious in Africa but not anywhere else. Anyway, I've seen numbers for women infecting men range from 1/700 - 1/2500 but we'll estimate that the chance of infection is 0.1%. That means a male having unprotected sex with an HIV positive women has about a 1 in 1000 chance of being infected. The number of sexual encounters is important too. If we assume 1000, then the probability of not being infected after 1000 encounters with an HIV positive woman would be:

Base line risk intact men vs circumcised men 1000 heterosexual contacts/HIV+ partner.

[1 - 0.001]**1000 ~= 36.76 ~= 63% ~= 3/5
[1 - 0.0005]**1000 ~= 60.64 ~= 40% ~= 2/5

But, the HIV distribution in the US population is 5 in 1000 or 1/200 so the odds when I add that wheel, the numbers are:

1/200 * 3/5 = 3/1000 = 1/333.3 ~= 1 - 0.003 ~= 99.7%
1/200 * 2/5 = 2/1000 = 1/500 ~= 1 - 0.002 ~= 99.8%

That's is what circumcision bought you, big deal. Of course there are some caveats to this. First, the 1/200 is quite high since 75% of the HIV positive population are men. Women only account for about 1/4 of the total which reduces that to between say 1/700 or 1/1000. And I am not even making any attempt to figure in regular condom use which essentially reduces your risk at least one but proabably two orders of magnitude. Also the probability of infection may be higher or lower depending on other factors. The bottom line is the numbers don't really make a good case for infant circumcision particularly in industrialized countries.

If a man finds himself in a higher risk group and think the incremental benefit is worth it then he is free to get circumcised. But for the vast majority of the population there is no practical benefit, a difference on the order of hundredths perhaps thousandths of a percent.

As an aside, keep in mind that the US does in fact have the highest prevalence rates of all STDs as compared to other industrialized countries (which don't circumcise their boys BTW). And not by a little, by a lot. Here is a sample from Advocate for Youth.
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#9 of 23 Old 02-28-2009, 01:58 AM
 
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-Over 450,000 circumcised, American men have died of AIDs in our country.

-The US has the single highest rate of all countries of transmission of STDs.

Those two statements alone should tell you just how effective circ is at preventing HIV and STD transmission.

Even if it were true, which it is not, your baby won't be engaging in intercourse for quit some time.
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#10 of 23 Old 02-28-2009, 06:33 AM
 
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Jwhispers, I LOVE that analysis. I think a lot of people assume the risk of transmission is 100% when having unprotected sex with a HIV positive partner, they keep the actual risk very quiet don't they?
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#11 of 23 Old 02-28-2009, 07:19 AM
 
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JWhispers that looks like a very interesting Aids in Africa book, I looked at an excerpt on Amazon. Sounds like she spent quite a bit of time in Africa and really got an inside look at things.
I'm going to check it out from the library.
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#12 of 23 Old 02-28-2009, 11:27 AM
 
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Originally Posted by Claire and Boys View Post
Jwhispers, I LOVE that analysis. I think a lot of people assume the risk of transmission is 100% when having unprotected sex with a HIV positive partner, they keep the actual risk very quiet don't they?
They keep it quite because it can be quite variable. There are many factors to consider such as what stage of the infection you're in and whether you have any additional STDs which might increase the risk. The first is one of the reasons why HIV is so pervasive in Africa, many African societies maintain large concurrent sexual networks. Interestingly, you're almost most infectious shortly after you've been infected. So a newly infected individual can more easily spread the infection even though it might be weeks before they can be diagnosed with HIV. Since we in the West practice serial monogamy, you're more likely to learn of your status or move to a state where you're not nearly as infectious before moving on to another partner. We could contain HIV pretty easily, there are mathematical models which show that using existing technology it could be eliminated in 50 years but it would require a social change that most aren't willing to discuss.
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#13 of 23 Old 02-28-2009, 11:28 AM
 
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JWhispers that looks like a very interesting Aids in Africa book, I looked at an excerpt on Amazon. Sounds like she spent quite a bit of time in Africa and really got an inside look at things.
I'm going to check it out from the library.
It was a very good read. I strongly recommend it to anyone who wants to know more about how HIV is spread and why Africa is hardest hit. Unfortunately, she does promote the idea of circumcision in Africa briefly twice in the book.
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#14 of 23 Old 02-28-2009, 02:31 PM
 
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circ to prevent hiv is pretty BIZARRE! It is just such a distraction to practice unprotected sex. They will expose the male sexual part to even more diseases, pretty irresponsible to me :

Latina Mama of 3 and Wife of a great man since 1997
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#15 of 23 Old 02-28-2009, 02:44 PM
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"There is ample cause to question this conclusion. First, a hard reckoning: Several African countries with some of the highest rates of HIV/AIDS in the world (Nigeria, Ethiopia, the Ivory Coast, Gabon) already circumcise at rates exceeding that of the United States.

Moreover, efforts to export American genital norms expose a glaring hypocrisy: The United States has both the highest HIV infection rate and the highest circumcision rate of any industrialized nation. By comparison, Australia, New Zealand and the Netherlands could take a more plausible “intactivist” stance. Their predominantly uncircumcised men have some of the world’s lowest HIV infection rates.

Many developing countries, such as India, Thailand and Brazil, have successfully combated AIDS not through circumcision but through aggressive health- and condom-education programs. While hardly rid of HIV, these nations have dodged the devastating mortality rates of, say, Uganda or Botswana."


http://www.poz.com/articles/2023_12145.shtml

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#16 of 23 Old 02-28-2009, 05:48 PM
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Originally Posted by slsurface View Post
Ok, I'm sure this topic has been discussed many times here, but I'm new to this forum. I did a lot of research before DS was born to help convince DH against circing. But by accident, I just ran across this: http://www.who.int/bulletin/volumes/84/7/news10706/en/ and was shocked! Is this really true?!? It seems bogus to me, but the WHO supports it!

I'd love to know if there are any studies that show the opposite, or at least that circ DOES NOT affect HIV infection rates. Please help me clarify this!

Langerhans cells that are present in the foreskin are behave as ‘natural barrier’ to HIV.
Bellow are the links.

http://www.womenshealth.gov/news/english/602421.htm
http://www.washingtonpost.com/wp-dyn...030500357.html
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=17334373

Another study shows no HIV protection from circumcision
http://www.jaids.org/pt/re/jaids/abs...195628!8091!-1

Outside of Israel, the U.S. is the 2nd highest circumcising country in the world and after Africa, has the 2nd highest infection rate. Plus the fact that more than 80% of the world's men are "uncircumcised" and countries in Europe have an extremely low HIV+ rate.

And this is just in case if your dh comes up with a cancer protection argument. This shows that cancer can grow in circ scar:

http://www.ncbi.nlm.nih.gov/sites/en...t_uids=3944860

The tumors involved the prepuce (n = 1), prepuce and distal shaft (n = 1), circumcision scar line (n = 2), circumcision scar line and distal shaft
http://www.ajsp.com/pt/re/ajsp/abstr...195629!8091!-1
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#17 of 23 Old 03-03-2009, 06:36 AM
 
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there is a lot on the circumstitions site at

http://www.circumstitions.com/HIV-SA.html#uganda

In Rwanda (and some other countries) the rate of HIV is higher amongst circed men than intact men. Ethiopia has a lot of HIV and almost all men there are circed.
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#18 of 23 Old 03-04-2009, 12:55 PM - Thread Starter
 
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Originally Posted by Yulia_R View Post
Langerhans cells that are present in the foreskin are behave as ‘natural barrier’ to HIV.
Bellow are the links.

http://www.womenshealth.gov/news/english/602421.htm
http://www.washingtonpost.com/wp-dyn...030500357.html
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=17334373
Yes, this is always what I had heard and read, which was why I was so taken aback by the studies that showed the opposite. From a logical standpoint, it seems that being intact should decrease the chance of contracting both HIV and STDs.
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#19 of 23 Old 03-04-2009, 06:56 PM
 
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"Since we in the West practice serial monogamy, you're more likely to learn of your status or move to a state where you're not nearly as infectious before moving on to another partner."

I'm not sure where you're getting that generalization...I know plenty of people here in the West that have a lot of sex with a lot of partners...let's be careful about how we compare our behaviors here in the "West" with those in "Africa." This comes off a bit "holier than thou." Just as we in the West are not a homogenous group, neither is "Africa," which is made up of many different countries and cultures and subcultures.
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#20 of 23 Old 03-04-2009, 07:30 PM
 
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Originally Posted by sakartvelogirl View Post
"Since we in the West practice serial monogamy, you're more likely to learn of your status or move to a state where you're not nearly as infectious before moving on to another partner."

I'm not sure where you're getting that generalization...I know plenty of people here in the West that have a lot of sex with a lot of partners...let's be careful about how we compare our behaviors here in the "West" with those in "Africa." This comes off a bit "holier than thou." Just as we in the West are not a homogenous group, neither is "Africa," which is made up of many different countries and cultures and subcultures.
I did not make up that generalization on my own. If you're interested in the subject you should read the book I recommended which is where many of these cultural issues are discussed. Again it was The Invisible Cure: Africa, the West, and the Fight Against AIDS. By Helen Epstein. Chapter three if you don't want to read the whole book, page 56

Quote:
A key difference between Uganda and the United States, Morris found, is that although heterosexual Americans tend to have several long term relationships over a lifetime, they usually have them sequentially, not concurrently.
What this means is that the infection tends to remain trapped within the pairing of individuals for months or years until the relationship breaks up. Even if someone strays it doesn't mean as much because the odds of transmission are relatively low to begin with. Where you run into trouble is when you have multiple concurrent sexual relationships. The reason why this is problematic is because HIV tends to be most infectious during the first few weeks after someone acquires it. So if you're in a concurrent relationship you are more likely to be having sex more often with different partners greatly increasing the risk of transmission.

It may be true that you know people who live that kind of life style but it's not really endemic in western society the way it is in many countries in Africa. If you're really interested you should read the book and we could discuss it.
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#21 of 23 Old 03-05-2009, 12:37 AM
 
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I will add the book to my reading list. I actually work in int'l public health (including on projects working on HIV and AIDS prevention and treatment in several African countries) so the topic is interesting for me.

I'm still uncomfortable with any analysis that attempts to specifically link a community's problems with its culture. It's a dangerous precedent from which to operate. There are many cultures that have relatively low HIV transmission numbers (outside of the African continent) where men having more than one sexual partner is either accepted or encouraged, so it's sort of hard for me to fully accept the soundbite you've quoted.

I'll have to read the book to see if it somehow changes my mind.

For the record, I'm appalled by the public health community's embrace of the whole circumcision-prevents-HIV-transmission thing.

Thanks for the book suggestion.
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#22 of 23 Old 03-05-2009, 12:54 AM
 
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I will add the book to my reading list. I actually work in int'l public health (including on projects working on HIV and AIDS prevention and treatment in several African countries) so the topic is interesting for me.

I'm still uncomfortable with any analysis that attempts to specifically link a community's problems with its culture. It's a dangerous precedent from which to operate. There are many cultures that have relatively low HIV transmission numbers (outside of the African continent) where men having more than one sexual partner is either accepted or encouraged, so it's sort of hard for me to fully accept the soundbite you've quoted.
I understand the hesitancy, you'll have to read the whole book to get the complete context. Considering your work, I think you would really enjoy it. It's been over a year since I read it and she does touch on a number of issues (though she focuses on concurrency) to discuss in particular why HIV is so much more prevalent in parts of Africa than in most of the rest of the world. Even similarly poor countries in other parts of the world aren't impacted nearly as much. She goes in to a number of issue, but I won't ruin it for you. I do have at least one personal theory on why things are as they are in Africa (as opposed to other places you might know where concurrent relationships are encouraged) which I'll discuss with you if you're interested.

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Originally Posted by sakartvelogirl View Post
I'll have to read the book to see if it somehow changes my mind.

For the record, I'm appalled by the public health community's embrace of the whole circumcision-prevents-HIV-transmission thing.

Thanks for the book suggestion.
I think it will, she has really done her research and has been working in those areas and HIV research since the early 90s. I am glad to hear your stance on the circumcision advocacy. Considering your work I think you would have a lot to contribute to this board, why do you only have 3 posts? Also if you're interested in the circumcision/hiv topic visit circumcisionandhiv.com, a weblog (where I contribute) and where we discuss the problems with it and its advocacy.

ETA: I add this only because you mentioned you worked in that area but one of the things she also cites as problematic is Western agencies trying to impose their solutions on the problem without really understanding the culture. Something that continues even today vis-a-vis circumcision. Another example is that in many places the push for condoms was misinterpreted to be understood that HIV was only a problem with prostitutes and others on the lower rung of life. She believes it has to be the Africans themselves who develop the strategies. Something Uganda did successfully.

When you do read it, if you want to exchange ideas on it, let me know.
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#23 of 23 Old 03-06-2009, 04:14 PM
 
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I will definitely read it, thanks. Why do I only have three posts? I don't know -- I guess I sort of go through phases where I'm online more or online less. I'm in an "online more" phase at the moment.

I will also check out the weblog, thanks for sharing it.

As for the bit about Western agencies not always getting it right -- yes, that's really the thorn in the side of all "development" work. There is an interesting book coming out on 3/17 by Dambisa Moyo called Dead Aid. She's an African (from Zambia I think) economist and the book talks about why aid to Africa hasn't worked very well...I won't try to summarize the book anymore because I haven't read it...but the NYT magazine did an interesting profile on her a few weeks ago. I think you can google it.

It's a difficult topic to argue because aid isn't just given out for humanitarian reasons -- there's foreign and economic policy goals embedded throughout -- so foreign aid probably won't ever go away. Whether or not one agrees with that, for me the question is how can we get it right within the existing paradigm.

Anyway, thanks again for the book title -- looking forward to reading it.
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