Male circumcision a 'surgical vaccine'

Jodi - posted on 09/19/2010 ( 46 moms have responded )

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The global fight against HIV/AIDS has found a powerful if unfashionable ally in male circumcision.

Research into the spread of the virus in Africa has revealed a reduced rate of transmission in those regions where male circumcision is the norm.

The practise rooted in religion and culture was increasingly seen as a "surgical vaccine" against HIV and must be part of efforts to curb the virus' spread, says harm minimisation advocate Dr Alex Wodak in a co-authored paper.

"A wealth of research has shown that the foreskin is the entry point that allows HIV to infect men during intercourse with an infected female partner," Dr Wodak said.

"Soon after the HIV pandemic was first recognised, much lower HIV prevalence was found in areas of sub-Saharan Africa, where more than 80 per cent of males had been circumcised than in areas where the circumcision rate was less than 20 per cent.

"Circumcision of males is now referred to by many as surgical vaccine against a wide variety of infections and adverse medical conditions over the lifetime."

Dr Wodak said Medicare statistics show the percentage of Australian boys circumcised annually from 1998 to 2009 increased, from 13 per cent to 19 per cent, and this was despite "official discouragement".

He said Australia should have a policy of promoting infant male circumcision, domestically and across the region, in the face of rising heterosexual transmissions of HIV.

Male circumcision offered a protective effect for men during sex with a HIV positive female partner.

It did not, however, alter the risk of transmission of the virus during sex between men.

The World Health Organisation (WHO) says there is "compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 per cent".

"The prospect of the availability of a (HIV) vaccine over the next 20 years is unlikely," Dr Wodak said.

"Condom use remains essential, with promotion of condom use plus circumcision of males being analogous to seatbelts plus airbags for reducing the road toll."

Dr Wodak, director of the Alcohol and Drug Service at St Vincent's Hospital in Sydney, co-wrote the paper along with Professor David Cooper, director of the National Centre in HIV Epidemiology and Clinical Research, and Professor Brian Morris, Professor of Molecular Medical Sciences at the University of Sydney.

The paper is published in the Medical Journal of Australia.

http://au.news.yahoo.com/a/-/latest/7972...

I am well aware everyone here has different views on circumcision, but I am curious as to your views on the basis of these findings. With HIV being such a prominent problem in many African nations and other third world countries, is it really so objectionable?

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Erin - posted on 09/19/2010

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Dr Wodak is a controversial Jewish doctor who has long been associated with the pro-MGM movement here in Australia. He has actually appeared on several Australian tv shows in paid circ advertisements, and his reputation is less than stellar amongst the Australian medical community.



This propoganda is not new. There has been talk of MGM reducing the incidence of HIV in Africa for several years, and yes, I do think it is entirely objectionable. When soap, clean water and CONDOMS could have the same effect on the reduction of HIV transmissions, using circ as a 'surgical vaccine' would be laughable if it wasn't so unsavoury.



There is already research showing a drastic decrease in new HIV infections in Africa recently (over 25% in some places). This has been attributed to awareness and education, not chopping off healthy organs. The use of condoms in Sub-Saharan Africa has doubled in the last 5 years



http://www.bbc.co.uk/news/world-africa-1...

Jessica - posted on 09/19/2010

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One of the MAIN reaons and probably the biggest contributing factor to the spread of AIDS is (particulaqly in Africa) the pope and the catholic church PROHIBITING the use of condoms. Instead of MUTILATING these people and spending hundreds of thousands of pounds on surgery and equipment for ALL MEN in Africa on a procedure that may or may not work, why don't we spend considerably less on distributing condoms and educating these people. They are human beings too and to suggest this surgery as the answer is suggesting they are less than us.

Jessica - posted on 09/19/2010

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Quoting Kati- i just don't understand the rationale behind dismissing this research.

Quoting Erin- Dr Wodak is a controversial Jewish doctor who has long been associated with the pro-MGM movement here in Australia. He has actually appeared on several Australian tv shows in paid circ advertisements, and his reputation is less than stellar amongst the Australian medical community.

This propoganda is not new. There has been talk of MGM reducing the incidence of HIV in Africa for several years, and yes, I do think it is entirely objectionable. When soap, clean water and CONDOMS could have the same effect on the reduction of HIV transmissions, using circ as a 'surgical vaccine' would be laughable if it wasn't so unsavoury.

There is already research showing a drastic decrease in new HIV infections in Africa recently (over 25% in some places). This has been attributed to awareness and education, not chopping off healthy organs. The use of condoms in Sub-Saharan Africa has doubled in the last 5 years.

Also, the cost of circumcising EVERY man in africa is non-sustainable whereas the cost of distributing condoms and educating the population is significantly less. This means that the money that could be put aside for these 'operations' could go to improving the hygiene standard in Africa. I, personally, dismiss this research as frivolous, dangerous and a waste of time. It would suggest to a lot of men in Africa that they wouldn't need to use a condom once circumcised. Although this isn't being promoted, it would still have a significant and detrimental effect on the use of condoms. We also shouldn't be discussing chopping off any body parts of another person without their express, INFORMED, consent.

Jaime - posted on 09/19/2010

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It's such bullshit, because by that same reasoning we should be slicing and dicing our daughters whose genital folds would pose the same risk as foreskin for harbouring infections. I still say the best prevention for std's or infections is proper hygiene, comprehensive sexual education and common friggin' sense.

Charlie - posted on 09/20/2010

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Botswana news shows men who ARE circumcised to "prevent" HIV/Aids were more likely to participate in unsafe sex .

The three major studies done on circ as a HIV "vaccine " are flawed for a few reasons .
.All studies were halted early
.the durations of the experiment were short
.no long term follow has been or can be done
.a large number of participants were lost to follow up
.many infections appeared to be from non sexual sources

Campaigns on safe sex have shown a much higher success rate of infection reduction than the pushed mass circumcision based only on incomplete information , benefits of sex education not only show a higher rate of success it reduces complications in this procedure including death and reduces costs .

In the short piece of study available from these incomplete studies " 8 circumcised men and 9 uncircumcised men contracted HIV "Kenya trials , a fairly insignificant difference.

Circumcision in third world countries shows an increased risk of infection through contaminated medical tools .
The vaccine analogy is misleading and dangerous it gives a false sense of security with perception it gives near complete protection with little side affects , this could not be further from the truth .
The truth being those who participate in risky sexual behavior will be high risk of infection regardless of being circed or not .

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[deleted account]

I don't agree with circumcision full-stop, so to perform them with the simple reason to try and prevent AIDs is just crazy. Condoms prevent STDs NOT circumcision. The country's government should be doing more to provide better info/access to contraception.

Erin - posted on 09/20/2010

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I posted that article on my FB last night Loureen after I saw ANOTHER interview with this Wodak clown on tv.

I was actually speaking to one of the doctors I work for today about this. Her response.. and I quote.. 'It's bullshit! They can find a study to back up anything if they try hard enough'. She maintains clean water and wise sexual practices are the only way HIV is going to be contained in Africa, and simply laughed off the prospect of reintroducing routine male circ in Aus based on this research.

Charlie - posted on 09/20/2010

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"The United States has the highest rate of HIV infection and the highest rate of male circumcision in the industrialized world. Male circumcision, therefore, cannot reasonably be thought to prevent HIV infection.

There are many methods of HIV transmission, including:
* mother-to-child infection,
* transfusion of tainted blood
* infection with non-sterile needles used in health care,
* infection by homosexual and heterosexual anal intercourse,
* infection by needle sharing to inject illegal drugs,
* traditional African scarring practices,
* tribal (ritual) circumcision,
* female circumcision,
* male-to-female heterosexual transmission, and female-to-male heterosexual transmission

Male circumcision might only reduce infection by the last method, so the overall influence on the HIV epidemic in Africa, at best, would be likely to be slight, however, the risk of male-to-female transmission is much higher than that of female-to-male transmission, so a means of partial prevention that targets only the second means at the expense of the first would be counterproductive.

There is no indication that male circumcision would protect women. Viral load is the chief predictor of the risk of HIV transmission. Malaria infection increases viral loads, so enhances infectivity. Male circumcision would not reduce viral loads and would not reduce infectivity to the female partner."

funnily enough this blog just appeared on my facebook and i think it makes some great points .
http://www.drmomma.org/2010/04/doctors-r...

Charlie - posted on 09/20/2010

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you know frontal lobotomy was once sited as a cure all too .......Just saying .

Lyndsay - posted on 09/20/2010

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I think they need to be careful with how they distribute this information because it seems like many people may mistakenly believe that being circumsized has been found to make them immune to HIV/AIDS. Obviously not the case, but some people aren't all that intelligent.

[deleted account]

"This is about Africa. Not the states or any other developed country."


Exactly! Yet Dr Wodak is using the information contained in this study to make recommendations for Australian males.
"He said Australia should have a policy of promoting infant male circumcision, domestically and across the region, in the face of rising heterosexual transmissions of HIV."
(from the original article).

Using epidemiology from one population study to make health recommendations for a completely different population needs to incorporate more in depth analysis of the study results and process, including ALL contributing factors and the difference of relevance and availability of ALL those contributing factors from one population to the next.

[deleted account]

Amie I was aware of that...I was commenting on how it works HERE because if it was AT ALL possible that things work in the same regard then that might help explain something? I have no reference to how circumcision is handled in Africa, I was basing my information off where I had experience and trying to relate, but thanks!

Amie - posted on 09/20/2010

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Erin L,

This is about Africa. Not the states or any other developed country.

[deleted account]

WTF? circumcision is barbaric IMO and will certainly not prevent AIDS/HIV from spreading... Not wearing condoms, not being tested for the disease, not being informed about sexual health are legitimate reasons. Give me a freaking break, a piece of skin isn't the damn problem.

[deleted account]

Ok so I understand if there are abrasions under the foreskin that could increase the risk of transmission BUT wouldn't the pee hole be the BIGEST site of trasmission? So I don't see how a circ. would seriuosly decrease transmission! I also do not see how soap and water would wash away the AIDS virus? You have bleach in that soap???

However! I would think about WHO is getting circ'd and who is not! Insurance doesn't cover circ's in the states so you have to pay for it upfront when you get the procedure...equating to ppl w/$$$ get a circ...Now ppl w/$$$ can probably also find a higher class whore to sleep with them? OR they are in commited relationships not increasing their risk of transmission! Some ppl have already mentioned that the circ'd men also got Sex Ed. which only makes me think that they have $ and would have less exposure to seedy ppl.

Jaime - posted on 09/19/2010

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Let me try and put this into perspective so that we might begin to see how this line of reasoning is flawed. Yeast infections affect women more than men. Yeast infections can also be an STD, but not always. So with that said, if a woman is prone to getting yeast infections frequently (at least once or twice per month), then wouldn't it be better to cut off her labia to decrease the amount of folds she has and reduce the risk of her getting so many yeast infections? Having said that, I realize that most women don't get yeast infections as a result of an STD but the infection itself is the same regardless of how it is acquired.

It's not the skin and tissue that is the problem...it is the lack of sexual responsibility or lack of proper hygiene practices or lack of sexual education. And educating men about the potential decrease in risk of HIV/AIDS if he is circumcised is NOT where the focus of information should be.

I will say again...by this study's line of reasoning, we should be slicing and dicing labias and vaginal folds which pose an exponentially greater risk of harbouring nasty infections. So to even consider the foreskin of a penis to be the culprit of centuries' worth of irresponsible sexual practices is just ludicrous!

Amie - posted on 09/19/2010

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The ones I've heard are:
In theory, that the HIV virus will stay around and survive longer because it gets trapped under the foreskin after sex. There is also the theory that an intact man is prone to abrasions/tears on his foreskin during sex.

Here's another article with good information:
http://www.norm-uk.org/circumcision_hiv....
(an excerpt)
Real World Applicability
Several lines of enquiry suggest that the findings of the research do not translate into any meaningful reduction of HIV in the real world:-

* Overall evidence of the relationship between circumcision and HIV in Africa is contradictory and does not show any overall reduction in HIV due to circumcision [20]
* The US is the only country in the developed world to circumcise most of its boys for non-religious reasons but this has not prevented it from becoming the developed nation most burdened with HIV.[21]
* More generally countries with a high level of circumcision compare badly in terms of HIV prevalence with European countries that have a low level of circumcision.
* A British study of gay men found a higher rate of HIV among those who were circumcised than those who were normal.[22]
* Any increase in male to female transmission due to male circumcision could negate the effect.
* In reality, circumcision in Africa is performed in a dirty setting. Medical instruments have been
shown to contribute to the spread of HIV in Africa. Mandating circumcision can only make the HIV problem worse.

Kate CP - posted on 09/19/2010

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Kati: Studies are misleading simply because one person can look at it and see proof of their argument while another can look at the exact same study and find a way for it to prove THEIR argument. Anything can be twisted around to accommodate one's views.

Kate CP - posted on 09/19/2010

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I don't even understand how this works...how does being circumcised help protect against HIV?

Amie - posted on 09/19/2010

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Kati,

Mine wouldn't, because they know. They are as open with me as I am with my children. I know my children and I know what I am teaching them.


Ju Leah,

"I question if the results seen were about circumcision alone."

Exactly! They weren't either. The men who were offered circ'ing were also offered sex ed.

Rosie - posted on 09/19/2010

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amie, i'm not trying to imply that your daughters will end up being promiscuous, but how do you know that they won't? my parents sure would be surprised if i told them the number of people i've had sex with.

i do agree that there are better ways to be spending money, but that wasn't mentioned in the OP. i don't find it objectionable to give everybody every bit of information to arm themselves against HIV, other STD'S.

as for the research you could be right, but it has been enough to change the WHO's stance on circumcision for males in africa. doesn't seem like it's too much of a stretch to believe that it's good research.

[deleted account]

As with Ju Leah, I also question the co-factors in this research. What are the circumstances of the individuals in the study, circumcised or not and regional locality aside, there are also individual factors of education, religion, tribal beliefs and rituals, socio-economic status, access to hygiene and medical facilities, cultural history, country of origin, more detailed sexual history and practices etc etc that are not incorporated into this study. While it is an interesting look at ONE aspect that MAY lead to reduction of HIV transmission in a certain population, it is dangerous and insulting to the intelligence of all people to encourage the belief that circumcision as a "surgical vaccine" is an appropriate response to HIV transmission.

JuLeah - posted on 09/19/2010

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I think the issue is bigger. Prevention of infections like HIV involve many factors, good hygiene, education, access to medical care ..... I question the co-factors in this 'research'

In areas where circumcision is more common, is there also a difference in the overall education level, the acess to clean water, the access to medical care?

I question if the results seen were about circumcision alone. And, even as a Jew, I don't believe circumcision is the right thing to do to a boy or girl.

Amie - posted on 09/19/2010

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This debate is getting turned around. This is not about our son's and daughter's.



This is about Africa. Without proper hygiene, proper education, proper precautions, proper medical checks this is going to fail. A quarter of the men who have agreed to undergo circumcision (it's in one of the links here on the thread I believe) have refused the basic sex ed as well. They believe circ'ing is the answer. It's NOT.



So AGAIN, this is not the answer. It is a waste of time and money. Find a way to get them the proper education, proper medical attention, proper precautions and THEN we can talk about circ'ing.



And Kati, this precaution is not necessary if my daughter's do not sleep around, use protection every time and go their to regular check ups. Whether the man they are sleeping with is circ'd or not does not matter.

Jessica - posted on 09/19/2010

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Hi Kati, I was talking about the adults who would be having the surgery. Concerning children, it is their parents decision and it should still be well informed. Now you may choose have your sons circumcised. That is your decision and I don't hold an opinion/objection to that. I'm absolutely positive, given you first post, that you researched the pro's and con's and made a very well informed decision. My main point, that I will always pt across, is the cost and effectiveness of the surgery. Not only is their not enough money for this type of project but their is not a good enough standard of hygiene or education in doctors to allow this to go forward. Another point I have to make is, why go for the extreme option of surgery when basic hand and genital hygiene, education and condoms will do MORE than the surgery at an immensely smaller cost. Why spend that much money on something that isn't as effective as education, hygiene and condoms when you could use that money to increase not only hygiene levels, but education, food income into the country and the health service for illness that can't be controlled with (again) hygiene, education and condoms. I see this as very bad prioritizing concerning the well being of these people.

Rosie - posted on 09/19/2010

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and amie there is plenty of evidence to suggest that circumcision helps reduce cervical cancer. i do agree that regular checkups are essential as well. http://www.cfpc.ca/cfp/2003/sep/vol49-se...

i don't feel that circumcision is the be all end all to the fight against disease, but it certainly does help, there are numerous studies out there to prove this. being educated on all aspects of this issue is critical IMO. it seems like some want to walk around with blinders on to this info. what is so wrong with having this information out there? i know alot of people are for comprehensive sex ed that are against circumcision. to me this ties into sex ed. it needs to be known, so people have ALL the information they need to make an INFORMED decision on what to do with their child. i'm completely at a loss as to why you (in general) don't want people to be informed. it almost reminds me of those opposed to abortion don't want it mentioned to the mother at all. well as we all know that is not giving the mother the full story of what she can do. just because someone is told about abortion doesn't mean someone is going to get an abortion. just as someone is completely informed about circumcison doesn't mean everyone is going to start having their boys circumcised.

Rosie - posted on 09/19/2010

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but jessica this doctor isnt the person who conducted these studies, so what does it have to do with his reputation?

you also state a child having informed consent-which i find the only valid reason to not circumcise your child. however i am his mother and i make decisions for him all the time that they might not like. if your child needed his tonsils out, or tubes in his ears if they say they don't want that would you just say "ok. i know it will help you, but since you don't want too, we;ll just not do it ..." people put all sorts of toxins into their children whether it be by vaccinations, or food, and the child has no say in that either. we do what we think is best for our children, i think this is best for my children. :)



and lucy, i have wondered about that, i always hear that in these debates (which i'm ususally the lone avenger, lol), and honestly my answer (which is only my opinion, not some study or whatever) is this: the groups that are most affected with HIV in the united states is men who have sex with men, IV drug users, and african americans. this research doesn't affect homosexual men because most homoseuxal men are "givers and takers" when it comes to insertion. this only protects the "giver". second IV drug use has nothing to do with sex, so obviously that has no effect, and african americans are generally a poorer race in our nation. the plague of poverty in this country is riddled with children who don't have access to information about sex, and condoms. or they are involved with drugs (IV drug use) and drug use is also associated with unprotected sex.

lack of proper sex education in this country is huge. we have federal funding for abstinence only sex ed. if condoms are mentioned in sex ed it is usually to tell our children how ineffective they are at preventing std's or birthcontrol. it's ridiculous.

last, our rates of NEW HIV infection rates are lower than they have been. there have been some awesome advances in the medical field with regards to HIV/AIDS. people are living longer with the disease, so the people aren't dying, and new infections are adding to the numbers.

Amie - posted on 09/19/2010

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"and it;s not only HIV in men, it also helps protect our daughters too from spreading other STIS, some oof which can cause cervical cancer, or infertility. this is a win win situation all around and i just don't understand the rationale behind dismissing this research"

Kati this is unfounded. It will not protect our daughters if they are having unprotected sex. Only a good sexual education, taking the proper precautions and getting regular (yearly) check ups will prevent this.

I have 3 daughters and I have thought about this.

Lucy - posted on 09/19/2010

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The US has the highest rate of HIV infection among men in the western world, along with one of the highest rates of circumcision. On the basis of this information, it simply makes no sense to suggest that circumcision contributes in any significant way to controlling the spread of HIV.

Amie - posted on 09/19/2010

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To get it out of the way. I do not support routine (there is a difference so mothers who have had it done for a medical reason, don't get in a huff) circumcision. There is no need for it. At all. I have yet to hear a compelling argument to change my mind.

My son is not circumcised, nor is my husband, nor are the males in my family. None of these men have had any issues in their entire lives.

Onto this debate. I find this to be very misleading. There are other factors to consider when thinking about Africa.

-----------------------------------

Randomized controlled trials. After the failure of observational studies to show a clear protective effect, circumcision advocates obtained funding from the United States National Institutes of Health to conduct randomized controlled trials (RCTs) in Africa. Three RCTs to study the value of male circumcision in reducing HIV infection have been conducted in Africa since the publication of the Cochrane Review. The studies were intended to find out if circumcision is an effective intervention to prevent female-to-male HIV infection. A RCT under the supervision of Bertran Auvert, French circumcision proponent, was carried out in Orange Farm, South Africa;11 a RCT was carried out in Kenya under the supervision of North American circumcision proponent Robert C. Bailey and Stephen Moses;12 and a RCT was carried out in Uganda under the supervision of North American circumcision proponent Ronald H. Gray.13 Dr. Auvert has been a circumcision proponent since at least 2003.14 Professor Moses has been an advocate of circumcision at least since 1994.9 Professor Bailey has been a circumcision advocate since at least 1998.15

All three studies found that non-circumcised males contract HIV infection more quickly than circumcised males.11-13 This may be because the circumcised males required a period of abstinence after their circumcision. All three studies were terminated early, before the incidence of infection in circumcised males caught up with the incidence of infection in the non-circumcised males. If the studies had continued for their scheduled time, it is probable that there would have been little difference between the circumcised group and the non-circumcised group. Mills & Siegfried point out that early termination of such studies cause the benefits to be exaggerated.16 Dowsett & Couch (2007), even after publication of the RCTs, found insufficient evidence exists to support a program of circumcision to prevent HIV infection.17

Risks, complications, and drawbacks. The reported complication rate of 1.7 percent seems unreasonably low. Williams & Kapila estimated the incidence of complications at 2-10 percent;22 In the survey by Kim & Pang, 48 percent reported decreased masturbatory pleasure, 63 percent reported increased masturbatory difficulty, and 20 percent reported a worsened sex life after circumcision.23

Effectiveness. Circumcision does not prevent HIV infection. The Auvert study in South Africa reported 20 infections in circumcised males.11 A study in Kenya reported 22 infections in circumcised males. Brewer & found higher rates of HIV infection in circumcised virgins and adolescents.24 The United States has the highest rate of HIV infection and the highest rate of male circumcision in the industrialized world. Male circumcision, therefore, cannot reasonably be thought to prevent HIV infection.

There are many methods of HIV transmission, including:

* mother-to-child infection,
* transfusion of tainted blood25
* infection with non-sterile needles used in health care,25
* infection by homosexual and heterosexual anal intercourse,26
* infection by needle sharing to inject illegal drugs,
* traditional African scarring practices,
* tribal (ritual) circumcision,24
* female circumcision,27
* male-to-female heterosexual transmission, and
* female-to-male heterosexual transmission.

Male circumcision might only reduce infection by the last method, so the overall influence on the HIV epidemic in Africa, at best, would be likely to be slight, however, the risk of male-to-female transmission is much higher than that of female-to-male transmission, so a means of partial prevention that targets only the second means at the expense of the first would be counterproductive.

There is no indication that male circumcision would protect women. Viral load is the chief predictor of the risk of HIV transmission.28 Malaria infection increases viral loads, so enhances infectivity.29 Male circumcision would not reduce viral loads and would not reduce infectivity to the female partner. One study, however, has shown female circumcision to be strongly protective.30

Effect on condom use. Male circumcision removes nerves from the penis32 and causes significant loss of sexual sensitivity and function.33 For this reason, many circumcised men are reluctant to use condoms. A program of mass circumcision may reduce condom usage and have an adverse effect on the overall HIV infection incidence.

Vaginal abrasion. "Dry sex" is practiced in sub-Saharan Africa.10 34 Women place various drying agents in their vagina to absorb vaginal lubication. This practice may itself cause abrasion and fissures that provide a portal for the HIV virus.10 28 Circumcision also reduces vaginal lubrication, curtails the gliding action, increases friction and vaginal abrasions,35 so, when combined with "dry sex", may increase the risk of female HIV infection through abrasions. The combination of dry sex and circumcision appears to sharply increase the risk of male-to-female transmission of HIV. A recent preliminary report found that the female partners of circumcised males experience higher rates of HIV infection.36

Relevance to developed nations. These African studies were carried out in HIV “hot-spots”—places where the incidence of HIV infection in the population is high and where the method of transmission is heterosexual intercourse. They are not relevant to developed nations, such as the United States, where the incidence of infection is low and where the predominant methods of transmission are through homosexual anal intercourse or through needle-sharing by drug addicts.37

http://www.doctorsopposingcircumcision.o...
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This article is specifically about the HIV/Aids epidemic in Sub-Saharan Africa and the recommendation of circ'ing males. There are many factors to consider and those factors can not be brought over to debate it for a developed nation. Which is why people need to really do their research. A lot of the guidelines and studies done have not been done in developed nations. The fear mongering that has gone, the amount of parents that have bought into it, boggles the mind. Circ rates in developed nations vary but I do believe (I'll have to look for it later) the United states has the highest circ'ing rates of all of them. With it sitting close to 50/50.

As a few other mothers have said in this thread. There is no need for routine circumcision and it is very misleading to imply that it will protect against the HIV/Aids virus. Especially in a nation where they are undereducated and do not have the resources we do to make sure they are making the right choice.

Rosie - posted on 09/19/2010

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but he (whoever he is) didn't do these studies. he's just reporting on the finding of these studies. while i completely agree that the message needs to be out there that condoms and proper hygiene still need to be taken as seriously as ever, i don't see the harm in getting this information out there. in case some of you missed it there is a 60% decrease in the transmission of HIV in circumcised men. that is HUGE in the fight against AIDS.
and it;s not only HIV in men, it also helps protect our daughters too from spreading other STIS, some oof which can cause cervical cancer, or infertility. this is a win win situation all around and i just don't understand the rationale behind dismissing this research.

Lucy - posted on 09/19/2010

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Kati, I don't think this is a straight forward pro circ vs anti circ debate, there are so many more complicated issues involved.

Whether you agree with circumcision or not, it is not safe to be spreading the message to men who would really rather not wear a condom that, as long as they are circumcised, they don't have to. Nobody, even the doctor who is espousing the virtues of this research, would claim that circumcision alone will protect anybody from HIV or any sexually transmitted infection. Thorough personal hygiene is about as effective as circumcision as the lone method of preventing infection. Yes, it helps. No, it will not solve the problem completely.

In some countries in Africa there is serious, culturally ingrained resistance against using condoms by men, and pressure not to use them by the Catholic Church. Any suggestion that there is a method of protection which negates the need for condoms will reverse the increased use of them in Africa and increase the spread of HIV.

Even if I was a supporter of male circumcision in general (which I am not, for the record) I am pretty certain I would still find Dr Wodak's research dubious, and his self publicising irresponsible.

Rosie - posted on 09/19/2010

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i agree with this 1,000% !! i completely do not not understand why people are sooooooo opposed to circumsion, with all of the health benefits that it has. and as a mother who has had all 3 of her boys circumcised it's not a procedure that i would consider big. my oldest son getting tubes in his ears, and his eye ducts poked open caused me (and my son) more stress than his or my other boys circ.



if you want to rely on your child cleaning themselves thoroughly all the time, AND wearing a condom all the time that's great. i on the other hand am more realistic when it comes to that, and i will do whatever i deem acceptable to my child to help protect himself from diseases that can KILL him.



to me that's like those opposed to vaccination saying their kids will wash their hands and avoid sick people so their kids don't need a vaccination. well, sorry but that's a health risk for my child that i'm not willing to take, nor am i willing to expose an unvaccinated child to the general population, and don't understand the rationale of those that don't vaccinate, and choose to put the rest of the population in greater risk.



Lack of circumcision:

• Is responsible for a 12-fold higher risk of urinary tract infections in infancy. Risk = 1 in 20 to 1 in 50 for uncircumcised infants and 1 in 200 to 1 in 500 for circumcised infants. Higher risk of UTI at older ages as well. Overall lifetime cumulative prevalence of UTI = 1 in 3 for uncircumcised males compared with 1 in 20 for circumcised males, respectively.



• Confers a higher risk of death in the first year of life (from complications of urinary tract infections: namely kidney failure, meningitis and infection of bone marrow).



• One in ~400–900 uncircumcised men will get cancer of the penis, which occurs more than 20 times more commonly in uncircumcised men. A quarter of these will die from it and the rest will require complete or partial penile amputation as a result. (In contrast, invasive penile cancer never occurs or is extraordinarily rare in men circumcised at birth.) (Data from studies in the USA, Denmark and Australia, which are not to be confused with the often quoted, but misleading, annual incidence figure of 1 in 100,000).



• Higher risk of prostate cancer (50–100% higher in uncircumcised men)



• Is associated with 3-fold higher risk of inflammation and infection of the skin of the penis. This includes balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), balanoposthitis (inflammation of glans and foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin that will not return after retraction). Up to 18% of uncircumcised boys will develop one of these by 8 years of age, whereas all are unknown or much rarer in the circumcised. Risk of balanoposthitis = 1 in 6. Obstruction to urine flow = 1 in 10–50. Risk of these is even higher in diabetic men.



• Means increased risk of problems that may necessitate 1 in 10 older children and men requiring circumcision later in life, when the cost is 10 times higher, the procedure is less convenient, and the cosmetic result can be lesser, as stitches or tissue glue are required, as compared with circumcisions done in infancy.



• Increases by 2–4 fold the risk of thrush and sexually transmitted infections such as human papillomavirus (HPV), genital herpes (HSV-2), syphilis, chancroid, Trichomonas vaginalis and thrush.



• Is the biggest risk factor for heterosexually-acquired AIDS virus infection in men. 2 to 8-times higher risk by itself, and even higher when lesions from STIs are added in. Risk per exposure = 1 in 300.



• In the female partners of uncircumcised men lack of male circumcision is associated with an up to 5 fold higher incidence of cervical cancer (caused by sexually transmitted HPV), genital herpes, Trichomonas vaginalis, bacterial vaginosis (formerly called “Gardnerella”), and possibly Chlamydia (which is a cause of pelvic inflammatory disease, infertility from blockage of fallopian tubes, and ectopic pregnancy).

Lucy - posted on 09/19/2010

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So long as you have a scientific study to back up your findings, Kylie, Dr Wodak should be on your team. Why not give him a ring and see if you can get on telly too?;p

Kylie - posted on 09/19/2010

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why stop at the foreskin why not chop the whole penis off that will reduce the risk by 100% wont it?

[deleted account]

The only way to prevent HIV/Aids is safe sex. My concern is that a circumcised man might be given false sense of safety which could even lead to an increase in HIV/Aids. Did these studies in Africa take other variables into account? If a similar study was done in the western world, would the results be the same? Does the largely uncircumcised Europe have a higher rate of infection than the USA where circumcision is more common? I don't know the answer to that, but I highly doubt it.

Petra - posted on 09/19/2010

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Talk about one step forward, two steps back... Undo all the past and present efforts at education by promoting the idea of a "surgical vaccine"... not cool. The resistance to wearing condoms, the only protection from AIDS/HIV outside of complete sexual abstinence, is only going to to increase if people think that circumcision really is an effective vaccine. This is crazy! Educate!

ME - posted on 09/19/2010

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We talked to several doctors and experts before making the decision not to circ. our son 2 years ago...I KNOW that this is nonsense, and I agree with the other women here...it's DANGEROUS nonsense, racist nonsense, and completely unnecessary nonsense...When education and condoms are helping the problem, why would MGM even be considered!

Lucy - posted on 09/19/2010

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This is not only nonsense, but dangerous nonsense.

The original research that links a lower rate of HIV with circumcision relates to two groups- One which were circumcised AND given sexual health education including the use of condoms. The other "control" group were not circumcised and given NO sexual health education. I know why I think the circumcised group were less likely to get HIV, and it's got nothing to do with the anatomy of their genitals.

By calling circumcision a "surgical vaccine" which, even if the research WEREN'T a load of bunkum would be seriously misleading, these doctors undermine teaching about the importance of using condoms. As Erin mentions, the use of condoms in sub-Saharan Africa has increased through the hard work and education of some authorities and medical agencies, but there is still resistance. Culturally, most men would rather not wear them, so if they feel there is no longer any need if they are circumcised, all the education will be undone in much less time than it has taken to get to this point.

Louise - posted on 09/19/2010

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I think this needs to be looked at closer and hey if anything can help cut the numbers of people infected with this terrible disease then go for it. I really don't like the idea of circumsicion and I think the whole idea is barbarik but in this instance in a third world country that has struggled with escalating numbers of this disease it may be something to look into. I think my issue with this procedure is that it is done in some dirty hovel rather than a hospital sterile environment. I think we have tried education about safe sex and that has had some success but there are always going to be men in this world that will not use condoms and we women are stupid enough to let them get away with it. Maybe we should put some money into investigating this more seriously.

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