HIV and circumcision

I haven’t been working on this blog for that long (I just looked, and my first public post is from June 26!), but I’ve learned a lot, about all kinds of things.  I’ve also run into some interesting surprises.  One of these is the fact that circumcision is a much bigger issue to some people than I would have guessed.

I don’t have a whole lot of background knowledge on circumcision — as an HIV risk-reduction strategy or in any other context — so I’ve been caught somewhat unprepared by the number and intensity of comments attracted by the few posts dealing with circumcision on this site.  Seeing that this issue is attracting a lot of interest on the blog, I want to make some basic resources available, focusing on a few very mainstream, widely-recognized sources for HIV/AIDS info.

I’ve divided this up into a few different pages just so it’s not one long document.  I hope this info will be helpful.  If you know of some other good info sources for this issue, let me know and I’ll check it out.

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~ by h.e.g. on August 1, 2008.

One Response to “HIV and circumcision”

  1. The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect 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, and Tanzania. That’s six countries where men are more likely to be HIV+ if they’ve been circumcised.

    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%)

    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.

    If you read those reports btw, the level of knowledge about HIV is quite frightening. 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.

    Circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.

    ABC works against HIV. Circumcision appears not to. Remember that circumcision won’t make any difference unless someone is having unsafe sex with an HIV+ partner.

    Female circumcision seems to protect against HIV too btw, but we wouldn’t investigate cutting off women’s labia, and then start promoting that.

    For a good summary of the case against promoting circumcision in Africa, see this link:
    http://www.doctorsopposingcircumcision.org/info/HIVStatement.html

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