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Hi, I'm doing some research about the recent African studies that suggest that circumcision decreases the rate of HIV transmission. Can anyone point me towards any resources that critique that position? Or does anyone have a link to a good article about pros or cons of bringing that recommendation to this country?<br><br>
Any help would be appreciated!<br><br>
thanks,<br><br>
S
 

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If you do a search you will find several threads in this forum on this issue including one I put up that has links refuting the hiv/circ thing. I will see if I can find them and bump them up for you.
 

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You can check out: <a href="http://www.doctorsopposingcircumcision.org" target="_blank">http://www.doctorsopposingcircumcision.org</a><br><br>
There's also a study that the Langerhan cells, which circumcision eliminates, could be helpful in fighting HIV. There were some studies that found circ to not be linked the HIV infection as well, if someone could post them, I don't remember where I read everything.<br><br>
Also the Brazilian health minister has come out against WHO's recommendation, calling it "scary". The Luo tribe of Kenya has also said it doesn't buy what WHO is selling.
 

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I couldnt find the threads but I do have the links saved on my pc here they are.<br><br><br><a href="http://www.circumstitions.com/HIV.html" target="_blank">http://www.circumstitions.com/HIV.html</a><br><a href="http://www.cirp.org/library/disease/HIV/" target="_blank">http://www.cirp.org/library/disease/HIV/</a> <a href="http://www.cochrane.org/reviews/en/ab003362.html" target="_blank">http://www.cochrane.org/reviews/en/ab003362.html</a><br><a href="http://www.doctorsopposingcircumcision.org/info/HIVStatement.html" target="_blank">http://www.doctorsopposingcircumcisi...Statement.html</a>
 

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Discussion Starter #5
I looked for previous threads too but couldn't find them, so thanks for the links!<br><br>
Papai I'm especially interested in what you posted - I need good, scientific, factual stuff for a paper I'm writing. thanks for the tips - I'll go check them out.
 

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Here's the text from a Reuters article, unfortunately the link has expired:<br><br>
Scientists Discover 'Natural Barrier' to HIV<br>
By E.J. Mundell<br>
HealthDay Reporter<br><br>
MONDAY, March 5 (HealthDay News) -- Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that "eats up" invading HIV -- possibly keeping the spread of the AIDS more contained than it might otherwise be.<br><br>
...<br><br>
When HIV comes in contact with genital mucosa, its ultimate target -- the cells it seeks to hijack and destroy -- are immune system T-cells. But T-cells are relatively far away (in lymph tissues), so HIV uses nearby Langerhans cells as "vehicles" to migrate to T-cells.<br><br>
For decades, the common wisdom was that HIV easily enters and infects Langerhans cells. Geijtenbeek's team has now cast doubt on that notion.<br><br>
Looking closely at the interaction of HIV and Langerhans cells, they found that the cells "do not become infected by HIV-1, because the cells have the protein Langerin on their cell surface," Geijtenbeek said. "Langerin captures HIV-1 very efficiently, and this Langerin-bound HIV-1 is taken up (a bit like eating) by the Langerhans cells and destroyed."<br><br>
In essence, Geijtenbeek said, "Langerhans cells act more like a virus vacuum cleaner."<br><br>
...<br><br>
"We are currently investigating whether we can enhance Langerin function by increasing the amount of Langerin on the cell surface of Langerhans cells," he said. "This might be a real possibility, but it will take time. I am also confident that other researchers will now also start exploring this possibility."<br><br>
The discovery might also help explain differences in vulnerability to HIV infection among people.<br><br>
"It is known that the Langerin gene is different in some individuals," Geijtenbeek noted. "These differences could affect the function of Langerin. Thus, Langerhans cells with a less functional Langerin might be more susceptible to HIV-1, and these individuals are more prone to infection. We are currently investigating this."<br><br><br><br>
Here's an article about how promoting circ as a form of HIV prevention in Africa is dangerous:<br><br><a href="http://allafrica.com/stories/200704091186.html" target="_blank">http://allafrica.com/stories/200704091186.html</a>
 

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<a href="http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030078" target="_blank">http://medicine.plosjournals.org/per...l.pmed.0030078</a><br><br>
Male Circumcision and HIV Control in Africa<br><br>
Michel Garenne<br><br>
Male Circumcision and HIV Control in Africa<br><br>
Michel Garenne1<br><br>
1 Institut Pasteur Paris, France<br><br>
Competing Interests: The author has declared that no competing interests exist.<br><br>
Citation: Garenne M (2006) Male Circumcision and HIV Control in Africa. PLoS Med 3(1): e78 doi:10.1371/journal.pmed.0030078<br><br>
Published: January 31, 2006<br><br>
Copyright: © 2006 Michel Garenne. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.<br><br>
E-mail: <a href="mailto:[email protected]">[email protected]</a><br><br>
In a recent article, Auvert and colleagues present the results of their randomized controlled trial on male circumcision to prevent HIV transmission [1]. They conclude that male circumcision reduced the risk of HIV infection by some 60% (95% confidence interval, 32%–76%). The trial was certainly well conducted, and it nicely confirmed observational studies, which came to the same conclusion [2]. However, a number of their concluding statements deserve a comment.<br><br>
Auvert and colleagues claim a “degree of protection equivalent to a vaccine of high efficacy” [1]. This is obviously overstated. A vaccine of high efficacy is expected to offer long-term protection of 95% or above. Smallpox was eradicated with such a highly efficient vaccine. If control of tetanus, measles, and poliomyelitis has been largely achieved in the world, it has been a result of high-efficacy vaccines. Furthermore, the analogy with vaccines appears misleading. A 96%-efficient measles vaccine means that 96% of vaccinated persons exposed to measles are indeed protected against infection. Protection lasts for many years, and revaccination permits dealing with loss of immunity over time. What Auvert and colleagues show is different: they show a 60% reduction in disease incidence over an 18-month period among circumcised men compared with uncircumcised men with similar exposure. To our knowledge, this does not mean that those men are really “protected” against HIV, especially in the case of repeated exposure. It simply means “reduced risk,” or reduced probability of contamination.<br><br>
A closer analogy of the “reduced risk” offered by male circumcision is that offered by contraception. Modern and efficacious methods such as hormonal contraceptives (pill, injectables, implants) or intra-uterine devices (IUDs) do offer high protection, usually 99% or above for women who are exposed repeatedly (every month) to risk of pregnancy. Highly efficacious methods do protect these women against unwanted pregnancy. On the contrary, a less efficacious method such as rhythm method (periodic abstinence) reduces fecundity by some 50%, but offers little protection against unwanted pregnancy. Even though women using consistent rhythm methods will have a lower number of pregnancies over their lifetime than women who use no contraceptive methods at all, they will be unlikely to achieve their desired family size, as could women using highly effective methods.<br><br>
Similarly, for persons who are highly exposed to risk of HIV infection, as are the young men of South Africa, a 60% reduction in annual risk will ultimately protect only a smaller proportion. Basic probability calculations show that in discordant couples exposed for 30 years, some 74% will contract the HIV virus if circumcised, compared with 97% if uncircumcised (with incidence of 11% per year)—a small reduction indeed if compared with a highly efficacious vaccine (comparable figures would be 4% versus 97% for children vaccinated against measles who are exposed between 1 and 15 years of age).<br><br>
One could argue that the population effect could exceed the individual risk for a variety of reasons ranging from herd immunity to prevention of other sexually transmitted diseases (STIs). If all men are circumcised, then prevalence among women will be lower, and men will have lower risk of being exposed and infected. However, several natural experiments do not confirm this argument. For instance, Tanzania has some 110 ethnic groups, some groups using universal male circumcision, others not circumcising. After controlling for urbanization, there was no difference in male HIV prevalence between the two groups: in urban areas, HIV seroprevalence was 9.5% in circumcised groups and 9.7% in uncircumcised groups, and conversely, 4.6% and 5.2%, respectively, in rural areas—none of the differences being significant [3]. In South Africa, the KwaZulu-Natal province, where few are circumcised, has a higher HIV seroprevalence than other provinces, reaching 37% among antenatal clinic attendants in 2003. But, in the Eastern Cape, where circumcision is the rule, the dynamics of the epidemic are almost the same, simply lagging a few years behind, increasing from 4.5% in 1994 to 27% in 2003. Finally, it was argued that the large epidemic in Abidjan, Côte d'Ivoire, and surrounding areas in the late 1980s was largely due to the lack of male circumcision of the local ethnic groups. This, however, did not impede the rapid increase in HIV infection among migrant workers from Burkina Faso and Mali living in Abidjan, who were circumcised.<br><br>
For highly exposed men, such as men living in southern Africa, the choice is either using condoms consistently, with extremely low risk of becoming infected, or being circumcised, with relatively high risk of becoming infected. This is quite similar to women's choice to either use a highly efficacious contraceptive method or use a folk method. Some women make the second choice for religious reasons, with the obvious consequences. Is there a rationale for promoting the idea of circumcision when better choices are available? Regular condom use was found to be protective at the individual level and also effective for stopping HIV epidemics, as in Thailand [4,5].<br><br>
Concluding that “male circumcision should be regarded as an important public health intervention for preventing the spread of HIV” [1] appears overstated. Even though large-scale male circumcision could avert a number of HIV infections, theoretical calculations and empirical evidence show that it is unlikely to have a major public health impact, apart from the fact that achieving universal male circumcision is likely to be more difficult than universal vaccination coverage or universal contraceptive use.<br><br>
1. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Med 2:e298 DOI: 10.1371/journal.pmed.0020298. Find this article online<br>
2. Weiss HA, Quigley MA, Hayes RJ (2000) Male circumcision and risk of HIV infection in sub-Saharan Africa: A systematic review and meta-analysis. AIDS 14:2361–2370. Find this article online<br>
3. Tanzania Commission for AIDS, National Bureau of Statistics, ORC Macro. (2005) Tanzania HIV/AIDS indicator survey 2003-04. Calverton (Maryland): Tanzania Commission for AIDS, National Bureau of Statistics, ORC Macro. Available: <a href="http://www.measuredhs.com/pubs/pdf/FR162/00FrontMatter.pdf" target="_blank">http://www.measuredhs.com/pubs/pdf/F...rontMatter.pdf</a>. Accessed 15 December 2005.<br>
4. De Vicenzi I (1994) A longitudinal study of human immunodeficiency virus transmission by heterosexual partners. N Engl J Med 331:341–346. Find this article online<br>
5. Zenilman JM (2005) Behavioral interventions: Rationale, measurement, and effectiveness. Infect Dis Clin North Am 19:541–562. Find this article online<br><br><span style="color:#FF0000;">Full text published, as it's creative commons.</span>
 

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NOCIRC has a new inforrmational pamphlet out on circumcision and HIV thing:<br><a href="http://www.nocirc.org/publish/11-HIV.pdf" target="_blank">http://www.nocirc.org/publish/11-HIV.pdf</a><br><br>
Here are a couple other good rebuttal articles:<br><br>
"HIV inffection and circumcision: Cutting Through the Hyperbole"<br><a href="http://www.cirp.org/library/disease/HIV/vanhowe2005a/" target="_blank">http://www.cirp.org/library/disease/HIV/vanhowe2005a/</a><br><br>
"Science Fact or Science Fiction? COuld Circumcision Really Prevent AIDS?"<br><a href="http://www.nocircofmi.org/AIDS.pdf" target="_blank">http://www.nocircofmi.org/AIDS.pdf</a><br><br>
There is much more to say about the lack of relevance of the AFrican studies to the situation of babies or public health in the US. But I have to get ready to go to work, so don't have time now. Please dig back of the first few pages of threads,, and you can find a lot more info.<br><br>
Good Luck with your paper!<br>
Gillian
 

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I don't know anything about the research, and frankly, I don't really need to. Even *if* it were true that circ reduces HIV transmission by 60% (or whatever it is supposed to be), thats really nothing. What, you're gonna have unprotected sex b/c now you only have a 40% chance of contracting HIV?<br><br>
Thats just stupid.
 

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<div>Originally Posted by <strong>gus'smama</strong> <a href="/community/forum/post/7912685"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I don't know anything about the research, and frankly, I don't really need to. Even *if* it were true that circ reduces HIV transmission by 60% (or whatever it is supposed to be), thats really nothing. What, you're gonna have unprotected sex b/c now you only have a 40% chance of contracting HIV?<br><br>
Thats just stupid.</div>
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That figure is so misleading as well. It's not a "60 percent protection" rate in general, circed men are supposedly 60 percent less likely than intact men to contract HIV according to that study.<br><br>
Of course the numbers in that study were 23 of the circed men contracted HIV while 43 of the intact men contracted it. I believe the percentages were 1.8% of circed men got HIV and 3.8 % percent of intact men got it. Not very impressive numbers, so they had to manipulate statistics and the media selectively reported what it wanted.
 
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