HIV/AIDS
Researchers Call for Male Circumcision to Reduce Spread of HIV
By L.K. Regan
Published Aug 10, 2008
Published Aug 10, 2008
Male circumcision should be actively encouraged to fight the spread of HIV/AIDS in Africa, a non-profit group urged the XVIIth annual International AIDS Conference this past week. The conference, which took place in Mexico City, focused on current trends in HIV/AIDS prevention and treatment. The non-profit organization Population Services International, which investigates and advocates on behalf of the health needs of low-income populations in the developing world, presented new evidence in favor of circumcision programs, particularly for sub-Saharan Africa, where two-thirds of the world's 33 million HIV+ people live. The information once again puts the focus on a controversial and emotional area of HIV/AIDS prevention.
Circumcision is a controversial procedure even in the U.S., where roughly 60 percent of newborns are circumcised. In Africa, rates are much lower. Web sites like the Circumcision Resource Center have sprung up to voice a growing chorus of concerns that the practice of circumcision constitutes unnecessary genital mutilation; that it traumatizes infants; and that it reduces sexual pleasure for adult men. Over time, even American rates of circumcision, though still high, have fallen off somewhat as parents see less need for the procedure.
Yet for some time, it has also been clear that circumcision substantially lowers the risk of HIV infection. The World Health Organization asserts that, "There is now strong evidence from three randomized controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda and Orange Farm, South Africa that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%." Yet with regard to Africa, the list of concerns about circumcision broaden beyond the medical to the cultural and logistical, including questions about identifying safe practitioners to perform the procedure, the potentially subordinate social status of circumcised men, and the suspicious reactions of governments that see no purpose in the procedure. Last month, for example, the Elders of Kenya's Luo community chose to reject a Kenyan Ministry of Health program to encourage male circumcisions, citing doubt about the procedure's effectiveness and an unwillingness to disturb their traditional cultural practices, which did not include male circumcision.
PSI's presentation at the AIDS Conference attempted to overwhelmingly counter these concerns. Citing evidence amassed from several different studies, Dvora Joseph, Acting Director of PSI's HIV Department, and Dr. Robert Bailey of the University of Illinois, Chicago, who co-authored some of the relevant research, offered a host of reasons to press governments and communities—like the Luo of Kenya—to join circumcision programs. One major concern involves access to safe circumcisions. A program initiated by PSI in Zambia has, according to Joseph, had overwhelming success training low-level health workers to perform male circumcisions as part of a comprehensive prevention and education program. The idea is to create a broad base of qualified practitioners for the procedure, without putting strain on the existing medical system. "As news gets out about the efficacy of male circumcision, we need to meet that demand with quality services and a comprehensive HIV prevention approach, and scale up male circumcision as an ethical, human rights issue," Joseph said, pointing out that in Zambia there are waiting lists of up to two months for the procedure. This can lead to potentially dangerous procedures—a problem that will grow as the demand increases. "Just by word of mouth, the demand is so great that already men are going to unqualified practitioners and experiencing serious complications," Joseph said. "We must scale up our response rapidly to meet the demand for safe circumcision services."
Dr. Bailey, a researcher at the University of Illinois, Chicago, presented research related to the physical and social effects of circumcision. His research group in Kenya is presenting a report to the conference demonstrating the results of a study of 2,784 participants, comparing sexual function between circumcised and uncircumcised men over a two-year period. His conclusions are likely to be controversial. The research reports that, "Circumcision status was not associated with any sexual dysfunction or with specific sexual dysfunctions (premature ejaculation, pain during intercourse, erectile dysfunction) at follow-up visits." As Dr. Bailey elaborated at a press conference, "And in fact, circumcised men did report greater penile sensitivity after circumcision," countering the oft-reported decrease in sensitivity on the part of circumcised men. Bailey's research on sexual function post-circumcision comes on the heels of his research, reiterated at the PSI event, demonstrating that there is no increase in sexual risk-taking by men who have been circumcised. In a study published in the Public Library of Science, Bailey and his colleagues found that, after intensive counseling to warn them that they were still able to contract HIV, there was no increase in risk-taking among 1,319 recently circumcised men. When circumcision is accompanied by education and other forms of support, Bailey said, "the results of this study suggest that HIV risk behaviors are unlikely to increase. They may even decline as we saw in our study."
PSI emphasizes that circumcision should be part of a broad-based prevention program, and should be encouraged in the hardest-hit parts of the world. "Based on the existing body of evidence, and our experience implementing male circumcision to strengthen our prevention efforts, we are asking the international community to help national governments and their partners to introduce male circumcision wherever HIV prevalence is greatest and circumcision rates are lowest—in the nations of eastern and southern Africa," said Joseph. Widespread use of male circumcision in sub-Saharan Africa could, the researchers estimate, prevent two million infections in the next 10 years and save as many as four million lives over the next 20 years.
The implications of the circumcision discussion for gay men and the West remain unclear. As the Centers for Disease Control and Prevention report, "Studies to date have demonstrated efficacy only for penile-vaginal sex, the predominant mode of HIV transmission in Africa, whereas the predominant mode of sexual HIV transmission in the United States is by penile-anal sex among MSM [men who have sex with men]." The American Foundation for AIDS Research complained about a gay-straight HIV information gap at the conference this week, pointing out that 44 percent of countries worldwide have failed to provide any statistical data on AIDS and gay men, despite the fact that gay men are 19 times more likely to contract HIV than their heterosexual counterparts. For gay men, the current research indicates that the efficacy of circumcision will depend in part on the sex practices each man engages in. According to the CDC, "Receptive anal sex is associated with a substantially greater risk of HIV acquisition than is insertive anal sex. It is more biologically plausible that male circumcision would reduce HIV acquisition risk for the insertive partner rather than for the receptive partner, but few MSM engage solely in insertive anal sex." Given the lower infection rates in the U.S., and the demographic concentration of infections in the gay community, calls for widespread circumcisions are likely to continue to focus on Africa for the time being.
Circumcision is a controversial procedure even in the U.S., where roughly 60 percent of newborns are circumcised. In Africa, rates are much lower. Web sites like the Circumcision Resource Center have sprung up to voice a growing chorus of concerns that the practice of circumcision constitutes unnecessary genital mutilation; that it traumatizes infants; and that it reduces sexual pleasure for adult men. Over time, even American rates of circumcision, though still high, have fallen off somewhat as parents see less need for the procedure.
Yet for some time, it has also been clear that circumcision substantially lowers the risk of HIV infection. The World Health Organization asserts that, "There is now strong evidence from three randomized controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda and Orange Farm, South Africa that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%." Yet with regard to Africa, the list of concerns about circumcision broaden beyond the medical to the cultural and logistical, including questions about identifying safe practitioners to perform the procedure, the potentially subordinate social status of circumcised men, and the suspicious reactions of governments that see no purpose in the procedure. Last month, for example, the Elders of Kenya's Luo community chose to reject a Kenyan Ministry of Health program to encourage male circumcisions, citing doubt about the procedure's effectiveness and an unwillingness to disturb their traditional cultural practices, which did not include male circumcision.
PSI's presentation at the AIDS Conference attempted to overwhelmingly counter these concerns. Citing evidence amassed from several different studies, Dvora Joseph, Acting Director of PSI's HIV Department, and Dr. Robert Bailey of the University of Illinois, Chicago, who co-authored some of the relevant research, offered a host of reasons to press governments and communities—like the Luo of Kenya—to join circumcision programs. One major concern involves access to safe circumcisions. A program initiated by PSI in Zambia has, according to Joseph, had overwhelming success training low-level health workers to perform male circumcisions as part of a comprehensive prevention and education program. The idea is to create a broad base of qualified practitioners for the procedure, without putting strain on the existing medical system. "As news gets out about the efficacy of male circumcision, we need to meet that demand with quality services and a comprehensive HIV prevention approach, and scale up male circumcision as an ethical, human rights issue," Joseph said, pointing out that in Zambia there are waiting lists of up to two months for the procedure. This can lead to potentially dangerous procedures—a problem that will grow as the demand increases. "Just by word of mouth, the demand is so great that already men are going to unqualified practitioners and experiencing serious complications," Joseph said. "We must scale up our response rapidly to meet the demand for safe circumcision services."
Dr. Bailey, a researcher at the University of Illinois, Chicago, presented research related to the physical and social effects of circumcision. His research group in Kenya is presenting a report to the conference demonstrating the results of a study of 2,784 participants, comparing sexual function between circumcised and uncircumcised men over a two-year period. His conclusions are likely to be controversial. The research reports that, "Circumcision status was not associated with any sexual dysfunction or with specific sexual dysfunctions (premature ejaculation, pain during intercourse, erectile dysfunction) at follow-up visits." As Dr. Bailey elaborated at a press conference, "And in fact, circumcised men did report greater penile sensitivity after circumcision," countering the oft-reported decrease in sensitivity on the part of circumcised men. Bailey's research on sexual function post-circumcision comes on the heels of his research, reiterated at the PSI event, demonstrating that there is no increase in sexual risk-taking by men who have been circumcised. In a study published in the Public Library of Science, Bailey and his colleagues found that, after intensive counseling to warn them that they were still able to contract HIV, there was no increase in risk-taking among 1,319 recently circumcised men. When circumcision is accompanied by education and other forms of support, Bailey said, "the results of this study suggest that HIV risk behaviors are unlikely to increase. They may even decline as we saw in our study."
PSI emphasizes that circumcision should be part of a broad-based prevention program, and should be encouraged in the hardest-hit parts of the world. "Based on the existing body of evidence, and our experience implementing male circumcision to strengthen our prevention efforts, we are asking the international community to help national governments and their partners to introduce male circumcision wherever HIV prevalence is greatest and circumcision rates are lowest—in the nations of eastern and southern Africa," said Joseph. Widespread use of male circumcision in sub-Saharan Africa could, the researchers estimate, prevent two million infections in the next 10 years and save as many as four million lives over the next 20 years.
The implications of the circumcision discussion for gay men and the West remain unclear. As the Centers for Disease Control and Prevention report, "Studies to date have demonstrated efficacy only for penile-vaginal sex, the predominant mode of HIV transmission in Africa, whereas the predominant mode of sexual HIV transmission in the United States is by penile-anal sex among MSM [men who have sex with men]." The American Foundation for AIDS Research complained about a gay-straight HIV information gap at the conference this week, pointing out that 44 percent of countries worldwide have failed to provide any statistical data on AIDS and gay men, despite the fact that gay men are 19 times more likely to contract HIV than their heterosexual counterparts. For gay men, the current research indicates that the efficacy of circumcision will depend in part on the sex practices each man engages in. According to the CDC, "Receptive anal sex is associated with a substantially greater risk of HIV acquisition than is insertive anal sex. It is more biologically plausible that male circumcision would reduce HIV acquisition risk for the insertive partner rather than for the receptive partner, but few MSM engage solely in insertive anal sex." Given the lower infection rates in the U.S., and the demographic concentration of infections in the gay community, calls for widespread circumcisions are likely to continue to focus on Africa for the time being.
dcarm wrote:
Good lord. Conspiracy theorists much?
xanadude: the reason the study looks at heterosexual men is because, in Africa, where the study was performed, it is the most common way of getting infected.
Wide: "hack off half a guys dick" is hyperbole, plain and simple.
Rowing Ant - You say the science is considred dubious and biased in Europe and Scandanavia, but fail to mention who sees it that way, and why they see it that way.
Mike: No-one said it was a complete preventative, the studies indicate a 60% lower chance of obtaining HIV from penile/vaginal sex for a circumcised male. No-one said the foreskin was a "cause" it is considered an avenue for infection, a risk factor.
Why would there be a need to have a town-by-town breakdown? Consider that the study is searching for an overall statistical benefit for the treatment in general, rather than as applied to a specific group. The News does not report everything the Scientific Community tells them, they're after a quick headliner punch and the information is pretty inconsequential. You have to wash a cut dick, yes, but you do not have to retract foreskins etc.
Is there anyone saying that we should apply this to Western Nations? No.
I have seen the word "encourage" but never "enforce" in this or any similar article.
The study they're talking about here in this article is one which suggests that there is no association between sexual dysfunction and circumcision. They also mention his study that men do not take more risks after circumcision, many take fewer.
Finally, you all talk about the WHO and NIH, but fail completely to mention PSI who are spearheading this particular call. Do they have a bad reputation as well? Where from?
Aug 13 3:03 AM
xanadude wrote:
I have commented on this in other forums on RJ, but I find it interesting that all of the pro-circ posters are from the U.S. where it is done routinely, and generally for aesthetic reasons (ironic that many the population think that the natural state of the penis is unnatural). As for smell/hygiene? We live in the western world, we have ample access to soap & water. It is also the only elective surgery (when done for non-medical reasons) that is done without the patient's consent. We would never think of young girls having their labia trimmed for "a better look" (not to be confused with female circumcision, which is undeniably a human rights violation, not to mention potentially dangerous). As for patients in Africa, even if this were a possibility you have to consider that men: (a) may get infections due to unsanitary conditions, (b) may not wait to heal before having sex -- unprotected or otherwise -- which could cause problems with the wound and/or lead to getting infected with HIV or another STD through that wound. PLUS this only looks at hetrosexual men and penis/vagina intercourse. As others have said, the answers lie in education, condoms & abstinance.
Aug 12 5:44 PM
RyanReBoRn wrote:
Mutilation my eyebrows! -.-
I was circumsized as a baby and I have no recollection of any "trauma", whatever you meant by that. Why so defensive about circumsicion anyway? Most of these anti circumcision arguements complain it's a violation of the patient's(the baby's) right/choice. Are you gonna scream this same tune at parents who cut their childrens hair against their will? Or at parents who vaccinate their babies, also against the patient's(baby's) will?
Grow the hell up already.
Aug 11 6:44 PM
Rowing_Ant wrote:
Im Europe and Scandinavia this "science" is seen as very dubious to say the least, and also very biased. The best way to prevent the spread of HIV is not circumcision but abstinance and condoms.
Aug 11 9:12 AM
MaximForLife wrote:
That is the funniest picture for that article. Bravo!
Aug 11 4:13 AM
TheFreeman wrote:
I take amusement from those on this website - a gay community - who call circumcision a perversion; in those who call it a mutilation in the face of piercings, tattoos, kidney stone removals, tooth removals, fingernail clippings, haircuts, and shaves; and in those who say that circumcision traumatizes babies - I will have to see the study that shows that uncircumcised children lead a happier infancy.
Let the parents decide what happens with the kids' johnson. It's not the end of anybody's life.
Aug 11 1:36 AM
matt45710 wrote:
I have to agree. This isn't the best article for RJ to put up, as there are too many biases in it. Why should men feel that they've got to cut of part of their bodies?
Aug 11 1:26 AM
KauaiMike wrote:
How ridiculous! Safe sex, NOT mutilation!
Aug 11 12:05 AM
Mike31408 wrote:
The only reason people recommend circumcision is typically for so-called cosmetic effect. It smells funky, therefore it must be a hiding place for STD-causing viruses and bacteria is now being hyped, not researched for this purpose. It's also interesting that again a minority, low-income population is having their bodies controlled by so-called "advanced society". How do we know these same researchers will not at some point in future recommend sterilization as a cure based on their shoddy research and experiments?
Again, the research does not include any controls because STD's primary reason for spreading is promiscuous sexual activity, period--cut or uncut. If circumcision were the primary cause of STD's, then why would any circumcised man need a condom for reasons other than birth-control?
I recall that the WHO and NIH at one time assumed HIV was a "gay disease" and ignored its previous existence in African nations long before it became a "white man's problem". Not much has changed in regard to their approach to solving word health issues--guess, first, research later.
Aug 10 10:08 PM
WideReceiverNet wrote:
This is poor experimental design. Somewhere a long the line, someone want to create an excuse to mutilate boys and men not currently under their control and have a "medical" reason to do it - repeat after me, "Researcher Expectation". These third world populations barely have a grip on desentery let alone a keeping an open wound free of infection after they hack off half a guy's dick.
Aug 10 6:52 PM
slapaho18 wrote:
How about you just cut that shit cuz it looks gross lol.
Aug 10 5:49 PM
Youngin06 wrote:
In the studies that they talk about that confirms hiv is lower in circumcized men, they stopped the studies early and there hasnt been any follow ups on it. The studies have been critized because they lump all the populations together and they dont break down town by town. And they fail to mention that many villages dont practise circumsision and they have a low hiv rate. Also, the foreskin produces enzymes that kill bacteria and viruses like hiv.
Its funny that the news always highlights towns and villages that have lower rates of hiv who circumcize but they never even menttion the ones that dont practise circumsion and have low hiv rates.
And another thing, you have to care for a cut dick too, oils and dirt and all that fun stuff accumulate on those dicks as well.
Aug 10 4:32 PM
slimdad1 wrote:
I think circumcision is a perversion, regardless of what the "experts" think (or what some religions "believe"). The simplest and most correct solution is that a man be taught the proper hygiene to care for his uncircumcised penis. In poorer countries (and quite a few rich countries), men simply do not keep their "hoods" clean and consequently harmful bacteria, etc. proliferate. Also, and sorry to say, too many men don't even know how to USE their "tool" correctly, let alone keep it clean. But, enforced circumcision? Nah, it isn't going to solve the problem of HIV transmission.
Aug 10 4:04 PM