ml66uk

The figures for HIV and circumcision come from the Demographic and Health Surveys http://www.measuredhs.com/ http://www.measuredhs.com/aboutdhs/whoweare.cfm Cameroon http://www.measuredhs.com/pubs/pdf/FR163/16chapitre16.pdf table 16.9, p17 (4.1% v 1.1%) Ghana http://www.measuredhs.com/pubs/pdf/FR152/13Chapter13.pdf table 13.9 (1.6% v 1.4%) Lesotho http://www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf table 12.9 (22.8% v 15.2%) Malawi http://www.measuredhs.com/pubs/pdf/FR175/FR-175-MW04.pdf table 12.6, p257 (13.2% v 9.5%) Rwanda http://www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf , table 15.11 (3.5% v 2.1%, but they've just launched a national circumcision program) Tanzania http://www.measuredhs.com/pubs/pdf/FR173/13Chapter13.pdf not comparable Swaziland http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf table 14.10 (21.8% v 19.5%, but they're about to start a nationwide circumcision program) "In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms." This is in table 11.2 of the Malawi report. Note that I incorrectly copied the figures for women only. The corresponding figures for men are 75.5% and 80%. The usual proposed mechanism for a protective effect is that the foreskin contains many Langerhans cells, and these may provide an entry point: http://www.bmj.com/cgi/content/extract/320/7249/1592?view=full&pmid=10845974 This seems to be speculative, and I've also seen it suggested that Langerhans cells protect against HIV ( http://jcb.rupress.org/cgi/content/full/177/1/5a ). A 1993 paper in the Israeli Journal of Medical Sciences suggested that uncircumcised men might be more prone to HIV because they didn't have enough Langerhans cells: http://www.ncbi.nlm.nih.gov/pubmed/8454447?dopt=Abstract It's also been proposed that uncircumcised men have a moist environment for the HIV virus to survive, but this would also apply to women. Circumcised men who are HIV+ appear to be more likely to infect women than intact men who are HIV+ btw: http://www.medpagetoday.com/MeetingCoverage/CROI/8221 An extra eight additional women appear to have been infected during that study solely because their partners had been circumcised for the study, but more importantly, it suggests that men who are HIV+ should not be circumcised, as it will make them more infective. This is not the first time that HIV in women has been linked to partner circumcision: History of multiple sexual partners, history of STD, high household income, partner circumcision, and past oral contraceptive use remained strongly associated with HIV-1 infection even when simultaneously controlling for other covariates. http://ije.oxfordjournals.org/cgi/content/abstract/23/2/371 Female circumcision seems to protect against HIV too btw, but we wouldn't investigate cutting off women's labia, and then start promoting that. ( http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138 ) Rwanda has not far off double the rate of HIV in circed men than intact men, yet they've just started a nationwide circumcision campaign: http://www.plusnews.org/Report.aspx?ReportId=79085 Rwanda has more than nine million people, but only one doctor for every 50,000 people and one nurse for every 3,900 people, so why would they want to waste their medical resources operating on intact Rwandan men who are less likely to be HIV+ than circumcised Rwandan men? Something is very wrong here. I believe there are people promoting male circumcision in Africa whose primary interest is not in fighting HIV, but rather in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives.

They have proposed a mechanism, but there's very little evidence to back it up, and there are real problems with the studies themselves. Not one of them was finished, despite the protective effect appearing to decline well below the oft-reported 65%, and several of the subjects disappearing. The fact that one study described circumcision as "comparable to a vaccine of high efficacy" seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised. Daniel Halperin is the grandson of a mohel, and seems to think that "maybe in some small way (he's) destined to help pass along (circumcision)" so his objectivity is questionable. Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of "dry sex". The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circed men than intact men, yet they've just started a nationwide circumcision campaign. Other countries where circumcised men are *more* likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, Swaziland, and Tanzania. That's seven countries where men are more likely to be HIV+ if they've been circumcised. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Cameroon, the HIV rate is 4.1% among circumcised men, but only 1.1% among intact men. Something is very wrong here. These people aren't interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them. ABC (Abstinence, Being faithful, Condoms) is the way forward. I believe that promoting genital surgery will cost African lives, not save them. It's not like we've actually tried the things that do work. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn't refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they'd be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.