Originally Posted by Jenne
Okay, irl I have a job where I deal with statistics and causality all the time. There can be statistical correlation that is NOT causality! Just because there is a correlation between an increase in school shootings and the popularity of Elmo as a Sesame Street character however Elmo did not CAUSE the school shootings. Reports like the NYTimes and Men's Health/MSNBC just infuriate me!
Does anyone have any research showing US men and circumsion rates vs STD/HIV rates? Not that what happens in Africa isn't generalizable to the rest of the world but since Africa STD/HIV rates are so much higher than the US I would think that would effect their study results some how.
I don't haven anything solid in mind that I can pass along right now but I can give you some places to look: CIA world fact book will give you the adult prevalence of HIV in each country. You can even sort a table on this, we come in at around #80. All first world countries are well ahead of us by 2 - 6x and none of them circumcise.
Here is a link to an MSNBC article
that mentions that according to the CDC the US is well ahead of the other first world countries in all stds.
Here is a link to two Australian Articles the first is a scare article the second is a rebuttal but it gives you some information on HIV in Australia. Actually, just read my post on it here
Important info on circumcision and HIV by the French National Council on Aids (Conseil national du SIDA
) and the Australian Federation of AIDS Organization
For the French I would skip on to the last pages where it says, data from African trials can't be applied in the context of countries with low prevalence.
Here is my figuring on the 'potential' HIV benefit in the first world US BTW:
Based on an earlier post at C&HIV and some recently released estimates regarding per-exposure risk. From the previous post we can estimate the probability of not becoming infected with 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. In a recent publication in the Lancet of Infectious Diseases and reported at Aidsmap, the risk of an HIV infected woman infecting her male partner at 0.04% in first world countries. According to Aidsmap this included places like the US and Europe so it would seem that the average, circumcised or not is somewhere near 0.04%.
|Researchers conducting a meta-analysis of studies of the risk of HIV transmission during heterosexual sex have found that, in high-income countries prior to the introduction of combination therapy, the risk per sexual act was 0.04% if the female partner was HIV-positive, and 0.08% when the male partner was HIV-positive. However these rates were considerably higher in lower-income countries, if the source partner was in either the very early or the late stage of HIV infection, or if one partner had genital ulcer disease, write the researchers in the February issue of The Lancet Infectious Diseases.
|Pooling the data from studies in high-income countries, the researchers calculated that the risk of transmission from an HIV-positive man to his female partner was 0.08% per sexual act: in other words, it was likely to occur once every 1250 sexual acts. When it was the female partner who was HIV-positive, the male partner’s risk of acquiring HIV was 0.04% per sexual act – in other words, once every 2500 sexual acts.
It has been well known that people were more infectious in early and late stages or if they had genital ulcer diseases I am not sure why they included it. Also note that they said prior to the introduction to therapy which means the true rate may actually be lower now but we'll go with it.
So based on that, we'll start the estimate that the chance of infection is 0.06% a bit higher than published in the Lancet article. That means a male having unprotected sex with an HIV positive women has about a bit more than 1 in 1800 chance of being infected. Base line risk intact men vs circumcised men 1 heterosexual contact with an HIV+ partner.
[1 - 0.0006]^1 99.94% ~= 0.06%
[1 - 0.0006 * 0.5]^1 ~= 99.97% ~= 0.03%
But the HIV distribution in the US population is about 5 in 1000 or 1/200 so, in general, there is only a 1 in 200 chance that one will encounter someone who is HIV positive. Actually, the risk is much lower but we'll discuss that in a bit. Given that the HIV prevalence in the general population is about 1/200, a closer estimate of the risk of becoming HIV infected after the 1 random heterosexual encounters is more like:
The chance of event A (encountering an HIV positive individual in the general population) * the chance of event B the likely hood of getting infected during that encounter.
1/200 * 0.0006 = 0.000003 --- 1 - 0.000003 = 99.9997% = 0.0003%
1/200 * 0.0003 = 0.000006 --- 1 - 0.0000015 = 99.99985% = 0.00015%
Now, the number of sexual encounters is important too. For 1,000 encounters, the difference is 1.5 hundredths of a percent. That's is what circumcision bought you, big deal. Over the course of 1,000 random encounters, on average, an intact guy in the US has 1.5 hundredths of a percent larger chance of becoming HIV positive. Circumcised guys, party on!
Of course, there are some caveats to this. First, your per-exposure risk might change based on other factors as was previously discussed. Also, it's not clear from the Aidsmap article if their estimation include some level of condom use. If that is the case, the over all benefit is in general very small if the per-exposure estimate doesn't include condom use, considering that fact into these numbers would decrease them at least one order of magnitude. Perhaps most importantly, the 1/200 is quite high since over 75% of the HIV positive population are men (according to avert.org). If women only account for about 1/4 of the total, this reduces the 1/200 to between say 1/700 or 1/1000. This is what it looks like when we adjust the prevalence among women:
1/700 * 0.0006 = 0.0000008571 --- 1 - 0.0000008571 ~= 99.99992% = 0.00008%
1/700 * 0.0003 = 0.0000004286 --- 1 - 0.0000004286 ~= 99.99996% = 0.00004%
That's a whole order of magnitude and now we're talking about a difference of 4 thousandths of a percent if we have 1,000 random partners. Party on.
For Doctors, especially in the US, to entertain the notion that circumcision is going to in anyway impact a boys chances of acquiring HIV is very misleading, not truthful, or ethical. The commonly cited 50% has to be understood in context. Circumcision as a prophylaxis for any STD is, if it is even true, over stated especially in first world countries like the US that is how one thinks rationally about circumcision and HIV.
Also on the point of HPV I might ask her why circumcise when we've known
that for the last three years there has been not one but two very effective (90-100%) vaccines which target the two types of HPV linked to more than 70% of cervical cancers. Research recently released indicates that it is also at least 40% effective at the next two most common types as well as 25% effective against at least 8 others. This vaccine, Gardasil, is currently in the process of getting FDA approval for boys in the same age range as girls. Trials completed last year demonstrated
that Gardasil was estimated to be about 90% efficient in preventing infection with four HPV types, as well as genital warts and precancerous lesions. Interestingly, part of the debate over approval is whether it is right to ask boys to take a vaccine that clearly is really only beneficial for women. Why on earth would one consider circumcision when we have a far more effective vaccine as an option? I think only an American doctor would suggest that.
Originally Posted by Jenne
One reason this is hitting close to home right now is that my DH is getting ready to send my bil/sil a bunch of information on circ and since sil is in the medical field I am concerned that this trash will outweigh anything we might present. So any ammo the contradicts would be great.
I hope that helps I can discuss this further if you want but I don't have the time for more detail right now.