Straight Talk about Male Circumcision


Adult male circumcision is being pushed as the latest magic bullet for the HIV pandemic. There is good reason
for the enthusiasm about a new use for the world’s oldest surgical intervention.
But let’s be clear about what circumcision will and will not offer a man and
his partner or partners.

Circumcision programs have captured the attention and funding of governments
in East and Southern Africa, global funders, and policymakers. Job postings for
"male circumcision specialists" are circulating, and the Bill and Melinda Gates
Foundation
and the President’s Plan for
AIDS Relief (PEPFAR)
, two of the largest funders of global HIV/AIDS
programs, have incorporated male circumcision work into their efforts.

First, the good news: Three
recent
trials
have shown that circumcised men are about half as likely to contract HIV from
unprotected vaginal intercourse as their uncircumcised counterparts. Circumcision
also protects against some other sexually transmitted infections (STIs).

But the reality is that circumcision offers only partial
protection. A circumcised man still has a significant risk of contracting HIV
and other STIs if he engages in unprotected sex with an infected partner. Circumcision
does not offer the man’s current female partners any protection from contracting HIV.

On a larger scale, the predictive
models
that show a significant reduction in the number of new HIV infections assume
that between that 80 to 100 percent of men are circumcised. Currently
approximately 30
percent of men worldwide are circumcised
, although this varies widely
between different communities and countries.

Surveys have shown that many
men are willing to be circumcised
, and the promise of surgical prevention
may bring throngs of men into local clinics that do not routinely use health
services. It would be shortsighted not to couple circumcision services with education
on HIV prevention and safe sex, provider-initiated
HIV counseling and testing
, and referrals to HIV/AIDS care and treatment.

But given the protection that circumcision provides, men may assume and assert that
they are "safe" and insist on having sex without condoms. There
are questions about whether newly circumcised men will be willing to abstain
from sex for the six weeks necessary for the wound to heal so as to not possibly
increase their or their partner(s) risk of contracting HIV or other STIs.

In the communities where the demand for circumcision is high and resources
are scarce, unqualified circumcisers may begin offering the surgery to meet men’s
demands. It would take only a very few unqualified safe surgeons to taint the
safety and acceptability of these programs. We cannot allow this to happen.

Clearly, circumcision is an imperfect solution to HIV prevention. Even
so, it promises to be one of the most effective strategies we currently have to
curb new HIV infections in men.

So, what about those of us who never had a foreskin?

By the most optimistic predictions, male circumcision will not translate
into fewer HIV infections in women for decades. The reality of HIV and the
epidemic is that women account for the majority of people living with HIV in
the most affected region, Sub-Saharan Africa. For biological reasons, a woman
is between two to eight times more likely than a man
to contract HIV during
vaginal intercourse with an HIV-positive partner.

On top of women’s biologic predilection to infection, gender inequalities
have sustained and feminized the epidemic by limiting women’s abilities to
negotiate safe sex, refuse unwanted sex, and ask their partners to be
monogamous. We must be cautious about how male circumcision may change these
realities.

Too often women are blamed for bringing HIV into the household. They are cast out of
their homes, subjected to discrimination and violence, and shunned by their
communities
. Will circumcised men be
more likely to blame their female partner(s) if either of them becomes
HIV-positive? As fewer men contract HIV, will it increasingly be seen as a
women’s disease and become more stigmatized? Will women living with HIV become more
vulnerable to violence and abandonment than they already are?

The Way Forward
Male circumcision offers new hope that more men can remain HIV-negative, and
this advance is good news for men and potentially good news for women. But it
would be inexcusable if we allow a potentially positive advance in HIV
prevention for men to harm women.

Women’s health advocates, including those who met at the Expert Consultation on Male Circumcision
and HIV Prevention: Implications for Women
, are recommending that
investments in male circumcision be matched by concurrent investments that
directly benefit women. Among these investments is sexuality
education
, which teaches young women and
men
how to communicate with their partners about safe sex, to establish
equality in relationships, and to respect the right to consent in sex and
marriage. And, in this age of rising HIV infections, it teaches young people how
to protect themselves and each other.

Sexuality education takes us part of the way by equipping women with the
skills to negotiate safe sex, but we must also ensure women have access to male
and, in particular, female condoms. As the only existing woman-initiated method
of HIV prevention, female condoms offer women a way to protect themselves when
faced with a circumcised partner who refuses to use a male condom. Current
supplies of male and female condoms do not satisfy the global demand. But the female
condom shortage is particularly dire: there are 700 male condoms for every
female condom. Protecting women in a climate of male-focused prevention means we
must make a meaningful commitment to promoting and widely distributing the
female condom.

Although the main beneficiaries of male circumcision will be men in the near
and medium term, we must not lose sight of the fact that women are stakeholders
in these programs. Before these programs ramp up, women’s health groups,
including women living with HIV, should be involved in the analysis of how
circumcision will affect women. Once the programs kick off, they should be
closely monitored and evaluated in collaboration with these women’s health
groups. We must also initiate new research into what biomedical, structural,
and behavioral interventions can best help women protect themselves from HIV
infection such as microbicides.

Perhaps the most important thing we can do before the snipping begins is to communicate
honestly about what male circumcision will, and won’t, do for a man and his female
partner(s). We should undertake public education campaigns and individual and
couples counseling to ensure that women and men understand that:

  • Circumcision does not completely protect men
    from HIV. Circumcised men should continue using condoms to protect themselves
    and their partner(s) from infection.
  • Having sex with a circumcised man does not
    protect his female partners from HIV. Partners of circumcised men should
    continue to insist on safe sex.
  • Men must abstain from sex for a full six weeks
    after circumcision to protect themselves and their partners.
  • A man who is already circumcised is not
    necessarily HIV-negative, and if he is, there is no guarantee he will remain
    so.

Male circumcision is not a vaccine, and it is not a
cure-all. It is simply one of the best ways to prevent HIV infections in men,
right now. But we cannot overlook the fact that circumcised men, and their
partners, are still vulnerable to HIV.

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  • invalid-0

    I am an American of Swedish descent who was circumcised at birth. When I became aware of what circumcision was around age 14, I began investigating the matter. I now regard circumcision as male genital mutilation, and I have been an activist toward people I know against routine neonatal circumcision. The reasons I believe this aren’t terribly relevant to this post, but they are stated by many online.

    Of course, the matter is complicated when studies come out showing circumcision could make a difference in the HIV crisis in Africa for heterosexual men (and eventually as you said women).

    I have not reviewed the research so I cannot comment on it at all.

    My initial reaction is surprise that people are willing to go along with this practice. From what I had heard, education efforts in Africa were largely failing due to preconceived notions about sexual health in Africa (for example, a friend of mine who went on a medical mission in South Africa told me of a belief that a man with AIDS could cure himself by having sex with an infant, which were sometimes kidnapped from orphanages, raped, and murdered because of the rape for that purpose).

    I think one thing people don’t ever talk about–maybe for lack of optimism–is that AIDS COULD be eliminated in a SINGLE generation if everyone having sex used condoms. There IS a solution–better than circumcision–that has been rejected.

    So, my question is: why is this new choice not being rejected? And is the belief of Africans really as tempered as yours? Or do they believe this is a cure?

    Of course, the research is another matter, I will need to investigate.

  • http://www.nocirc.org invalid-0

    If circumcision mattered in HIV transmission, one would expect there to be a difference in HIV infection rates between Europe (where few men are circumcised) and the U.S. (where a majority are circumcised).

    There is a difference: The HIV rate is slightly higher in the U.S. Not what the circumcision advocates would have predicted.

    Please do investigate further. Peer reviews have shown the African studies to be seriously flawed and their conclusions dubious.

  • http://myspace.com/saynathespiffy invalid-0

    I’m shocked and disgusted that RHReality Check is actually condoning genital mutilation based on a few dubiosu studies. This is a disturbing new change in direction away from previous articles on the subject. It bothers me to see what I once considered an informative and reasonable blog so casually express support for something so poorly supported and that calls for nothing less than emcouraging people to cut off part of their gentials.
    < /br>
    Correlation does not equal causation. There could be other factors affecting these results. And, as Michael Smith’s comment points out, there doesn’t even seem to be a real correlation.
    < /br>
    While it’s important to reduce the spread of AIDS, I don’t think that it’s reasonable to expect men to dramatically alter and desensitize their genitals just because it might make them a little less likely to transmit it. Would you be encouraging female circumcision if studies suggested that perhaps it prevented the spread of AIDS? Hey, less mucus membrane and nerves is less mucus membrane and nerves! Would you suggest women part with their equivalent prepuces based on a couple of studies? Something makes me think not. I’ll quote that RHRC article from this same week last year:

    Even American public health officials admit that the arguments for circumcision are, at best, debatable. Still, proponents believe that they are doing something to counter AIDS. Bucking America’s frustratingly puritanical aversion to condom-based HIV education, they may even feel comparatively progressive for taking a pro-circumcision stance. Nonetheless, most, if not all, of these proponents don’t know what they themselves are missing, cannot understand what is lost to circumcision, and cannot appreciate how this loss may compromise other HIV prevention strategies. For them, the procedure is quick, easy, cheap—a potentially major impact derived from minor surgery.
    < /br>
    But how minor, exactly? Look again at your index card, and imagine that amount of tissue being cut from anywhere on your body.
    < /br>
    Minor surgery, so the quip goes, is surgery performed on somebody else.

  • invalid-0

    The pimps of perversion are up to their same old lies again. These are the same lies they told back in the 1890’s. Only the diseases have changed, the lies remain the same. Back then their perversion was supposed to prevent syphilis & gonorrhea & schizophrenia & masturbation & feeble mindedness & every other bad thing on Earth. Some of them implied that their crime was holy & got you a free ticket to heaven on judgment day. This crop of crap that they are pimping has another motive behind it.

  • http://TLCTugger.com invalid-0

    MOST of the US men who have died of AIDS were circumcised at birth. Does circumcision somehow prevent AIDS? Tell that to the dead men.

    In fact, virgin African boys who had been circumcised were found MORE LIKELY to already have AIDS than their intact counterparts, and the HIV+ cut men in the African trials which started this ridiculous craze were found MORE LIKELY to infect their female partners than the HIV+ men who did not get cut.

    THINK.

  • http://www.doctorsopposingcircumcision.org/info/HIVStatement.html invalid-0

    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 disappeared. 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. 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.

    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.

    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

  • invalid-0

    If you are worried if women will be the ones now blamed for bringing HIV into the home, I have an easy solution. CIRCUMCISE the women!!! Oh wait! Female circumcision is considered barbaric but male circumcision is a good, old Jewish and American custom that must be perpetuated onto the rest of the world.
    While I sympathize with the HIV/AIDS issue in Africa, I can’t in good faith believe circumcision will solve it. If I understand the research numbers correctly, plenty of circumcised men got HIV also. I’m guessing the uncircumcised men had a higher HIV rate because they didn’t have the “down time” post surgery that the circumcised men had. So the time of exposure/risk wasn’t the same. If these men in Africa choose to get circumcised, more power to them. But if they would wear a condom and practice monogamy they would find the rates of new HIV cases plummet. A pen*s not wearing a condom is going to catch HIV regardless of whether it’s circumcised or not.

  • http://www.circumstitions.com invalid-0

    “Three recent trials have shown that circumcised men are about half as likely to contract HIV from unprotected vaginal intercourse as their uncircumcised counterparts.”
    They got 10,800 men altogether who were HIV- and willing to be circumcised. They circumsised 5,400. After less than two years, 64 of the circumcised men and 137 of the non-circumcised control group had HIV. What they don’t tell you is that the tests –
    * were not double-blinded
    * were not placebo-controlled
    * had a significant drop-out rate – 5 times as many as were known to be infected.

    The portion of the orange bars below the fine dotted lines represents the men “protected” by circumcision. (And if you had endured a painful and marking operation “to protect against AIDS” and then tested positive elsewhere – as they were encouraged to do, because it was considered “unethical” to tell them they were HIV+ – would you go back to the people who had done that to you?)
    * ignored non-sexual transmission
    * gave the experimental group more safe-sex warnings than the control group
    * One of the three trials used a method that removed significantly less tissue than the others, yet the “protection” was the same.

    Something very strange is going on.

    “Circumcision also protects against some other sexually transmitted infections (STIs).” No, the latest study, of a birth cohort of 500 men in Dunedin, New Zealand, found no such protection, but for some strange reason it didn’t get nearly as much publicity as the study you are probably thinking of, with fewer circumcised men, that did.

  • http://www.circumstitions.com invalid-0

    Sorry the graph was too wide for the final page.

  • scott-swenson

    Sayna,

    We’re not endorsing any specific ideas, but providing space for people who have different views on a topic in which there is much interest and study. About the only ideas we “endorse” are that people should have evidence-based information so that they can be well informed and make the best choices for themselves. We provide space for many people to write and don’t necessarily endorse every idea presented here, other than those we author.

    We hope more people interested in the issues we cover will contribute their ideas, engage the dialog in comments, submit ideas and continue building a lively community in which differing perspectives are welcome.


    Be the change you seek,

    Scott Swenson, Editor

  • invalid-0

    Male circumcision is male genital mutilation. There are no absolute proven benefits of male circumcision. There are disadvantages and complications from the procedure. The studies you refer to are flawed. Monogamy and condom usage would certainly be more effective and cheaper. To what lengths should we go to save those who pursue risky, unsafe behaviors?

  • invalid-0

    Looking at the actual numbers instead of the percentages takes the air out of it. Out of 10,400 men in one study 137 who were not circumcised became HIV positive but 64 men who were circumcised also became HIV positive. One can see how the results could change with a few variables added into the mix.
    Like for example who had anal sex with an infected female partner and who didn’t ( and who would admit to it? ).The foreskin makes anal sex (penetrating non-lubricated areas) easier.
    Has anyone ever wondered why advanced countries like Denmark, Sweden and Japan (just to name a very few) DO NOT CIRCUMCISE their boys and somehow manage to avoid all the mythical infections and problems foreskin is supposed to cause? Something stinks here and somehow I don’t think it is the foreskin.

  • invalid-0

    Well, it’s a good thing we have an army of anonymous internet “experts” to prove that the WHO and other health organizations are so wrong about this issue! And who can deny the credibility of their claims when unbiased websites support their claims?

  • invalid-0

    No health organization in the world ( including WHO ) inside or outside the USA recommends routine infant circumcision. None. Nowhere. Get it?

  • invalid-0

    I just happened to attend a lecture today about HIV/AIDS given by Dr. Eric Daar, a nationally renowned expert on infectious diseases and also chief of HIV medicine at Harbor-UCLA Medical Center in Los Angeles. We discussed this very topic at some length; I find the commentary on this article disturbing.

    This is the crux of the idea, from what Dr. Daar explained today:
    The underside of the foreskin has cells which are particularly susceptible to HIV. Therefore, the removal of the foreskin (i.e. circumcision) is simply a way to decrease the ability for a man to contract HIV during intercourse with an HIV positive female. Obviously, this is not 100%, and does not in any way indicate that all a heterosexual male must do is get circumcised. That is not what is proposed. However, in areas of the world such as sub-Saharan Africa, where an estimated 22 million people are infected with HIV/AIDS (out of an estimated 30-40 million in the world), ANY way to decrease transmission is seen as big progress in HIV/AIDS research. In an area of the world where teaching condom use is difficult and almost futile, not to mention the ideological turn PEPFAR is taking in funding contraception education and distribution in Africa (i.e., the push for a ridiculous “abstinence only to combat AIDS” campaign, utterly useless in that area of the world), this sort of basic way to even SLIGHTLY stymie the transmission of this deadly pandemic is absolutely reasonable and should be given serious consideration on implementation.

    Now, keep in mind that circumcision has no effect on MSM (men who have sex with men). And, women are still just as likely to contract HIV from a circumcised man as from a non-circumcised man. However, in Africa, HIV many times enters a family from the men having sex with women outside his marriage and then subsequently bringing it home to his wife, who passes it on to her children as she breast-feeds them. If circumcision can reduce the transmission of HIV into that family by the male not contracting it in the first place, many lives may be saved.

    It is not about genital mutilation. It is about trying to slow down the epidemic of HIV/AIDS in which almost 2 million people of sub-Saharan Africa are infected with EVERY YEAR. This is the perspective this situation must be regarded in.

  • invalid-0

    The African studies are seriously flawed and demonstrate the desire of the US funders to push the cut.

    If there is a really is a change in the chance of men getting HIV, that really does not solve the Africa HIV problem and may actually make it worse. Men in Africa are running to get cut and some will get HIV or worse from the cut. The studies of male to female transmission are not discussed much. The data shows male to female HIV transmission is higher with circumcised African men than natural intact African men. People theorize it may be having sex too soon but who knows. The alleged fix may raise the transmission rate.

    Female circumcision is also shown to lower transmission (male to female transmission). Hey feminist@uva are you going to get circumcised for the slow HIV transmisison cause? Yes the parts removed during FGM also remove the cells that people theorize may be attacked by HIV. Why should it be only men you want to mutil;ates for the cause? Also, there really is no science behind this yet. How about if those cells are actually really important?

    People that have no foreskin do not understand that this is the best and most sensitive part of the pe is. Of couse most people would not want to lose this. The part does certainly help one get an errection and helps maintain an errection (and of course it facilitates masturbatuion). So if getting African men to use condoms is difficult now, it will be much more difficult when they have less sensation more dysfunction issues and think thay cant get AIDS.

    End this practice. Don’t push it overseas and lets stop mutilating baby boys.

  • http://myspace.com/saynathespiffy invalid-0

    Female circumcision is also shown to lower transmission (male to female transmission). Hey feminist@uva are you going to get circumcised for the slow HIV transmisison cause? Yes the parts removed during FGM also remove the cells that people theorize may be attacked by HIV. Why should it be only men you want to mutil;ates for the cause? Also, there really is no science behind this yet. How about if those cells are actually really important?

    I’ve said it before and I’ll say it again: The only reason that tissue would be any more susceptible to HIV infection would be because it is full of moisturizing, lubricating components. If it’s a good idea to cut these useful, sex-enhancing parts off of a male, what’s wrong with cutting it off of a female? Perhaps not severe FGM, but just removing some of the inner labia or the clitoral prepuce? That would be the equivalent.

    Hey, if preventing AIDS is more important than informed consent, genital integrity, bodily domain and sexual pleasure, we should be encouraging people to cut the entire thing off! Maybe we’d wait until they’ve already bred, but come on, it’s a great idea! They’d never have sex at all. That’d keep the (sin, hysteria, “solitary vice”, insanity) HIV transmission rate down! Everyone knows that reproductive rights and lubricating mucus membranes are only for the people lucky enough to be born in countries where they have access, can afford it, and don’t have such a bad AIDS epidemic.

    People that have no foreskin do not understand that this is the best and most sensitive part of the pe is. Of couse most people would not want to lose this. The part does certainly help one get an errection and helps maintain an errection (and of course it facilitates masturbatuion). So if getting African men to use condoms is difficult now, it will be much more difficult when they have less sensation more dysfunction issues and think thay cant get AIDS.

    Don’t have a penis here, but I’d guess that the “best” part is actually the glans. The foreskin just enhances this feature.

    You make a great point, though: Men who already have issues with sensitivity loss are probably not going to be too happy about the idea of putting on a latex barrier. Add to that the fact that the reason they got circumcised was because they were told that it eliminates (or greatly reduces) their chance of getting HIV and they are probably going to be much less likely to use condoms.

    I can understand that the sensitive, moist skin of the glans may be an easier place for HIV to get in. It sounds plausible and reasonable. But I don’t think that they key to eliminating this problem is to go around cutting this sensitive, moist skin off. It’s much safer, less invasive, and proven to be more effective to protect this skin with a condom. And the condom (save for severe latex allergies) involves no harm being done to important, senitive parts of people’s bodies.

  • http://myspace.com/saynathespiffy invalid-0

    Hmm… Well, while we’re at it, maybe we should bring in some pro-life perspectives. As long as there are no medical inaccuracies, these controversial opinions might make discussion a lot more lively.

  • invalid-0

    Sayna,

    It probably is wrong for me to say anything is the best part. So this is a good point. I like the entire package that I was bron with and it is all connected and works as a package.

    However, the glans is not as sensitive as the rigid band/mucosal region (foreskin). In fact when errect, the glans kind of goes numb (for pain/ overwork protection says a study). The foreskin is one of the most sensitive if not the most sensitive parts of the male human — especially to temperature and relative movement and TOUCH. I think the circ culture has greatly undersold the pleasure that is involved here.

  • http://www.circumstitions.com invalid-0

    …with Anonymous’s sarcastic appeal to the authority of the WHO, and that’s the scare-quotes around the word ‘experts’. His second sentence should read, “And who can deny the credibility of their claims when they can be confirmed by referring back to the actual studies themselves?” Has Anonymous done that? I have. (I doubt that many in the WHO have, just listened to experts like Daniel Halperin who thinks his descent from a ritual circumciser means “maybe in some small way I’m ‘destined’ to help pass along [circumcision] to people in [other] parts of the world … .”)

    (Thinker and I both slightly misremembered the total number of men enrolled in the three African trials. It’s 10,908)

  • http://www.circumstitions.com invalid-0

    The claim that “The underside of the foreskin has cells which are particularly susceptible to HIV.” is largely based on the work of Prof. Roger Short on a few foreskins cut off the bodies of old men, in petri dishes. (This is the same Prof. Short who went around the world touting lemon juice in the vagina as the magic bullet against AIDS, and is now touting topical oestrogen with the same claim.) He has a picturesque turn of phrase about the Langerhans cells of the foreskin reaching out like octopuses to grasp the HIV to their bosoms. On the contrary, Dutch research suggests that the Langerhans cells are a valuable part of the immune system.

  • invalid-0

    This blog isn’t endorsing male circumcision. It’s higlighting some of the issues that this procedure, which has gotten a lot of attention as of late in the scientific and global health communities, raise about HIV prevention.

    Whether you agree or not, a discussion is warranted. To conflate the initiation of such a conversation as a pro-life

  • invalid-0

    Actually, perhaps it should read, “And who can deny the credibility of their claims when they can be confirmed by referring back to the actual, carefully-selected studies which only affirm their position while ignoring those that are contrary?”

    Or, “And who can deny the credibility of their claims when they can be confirmed by referring back to the actual studies with extreme bias?”

    Or maybe we could just read websites full of dubious editorial comments highlighted with red text?

    Or, best of all, we can just refer to anonymous blog comments for all of our information.

  • invalid-0

    Even IF there were strong evidence that male circumcision reduces the risk of HIV infection (and I’m not convinced by the evidence I’ve read), in general, cutting off body parts is not how we generally reduce disease risk.

    We could dramatically reduce breast cancer in the U.S. if we gave all teen girls prophylactic mastectomies, but no health expert would recommend doing so.

    We may be able to reduce HIV by removing foreskins — we could undoubtedly reduce HIV much further with full castration.

    There’s an interesting article, “The Truth About Circumcision and HIV: Some argue that recent studies support universal circumcision. The evidence disagrees,” in the current issue of Mothering magazine (July/August 2008).

  • invalid-0

    Let’s REALLY talk straight about circumcision.
    Starting with common sense. If the supposed HIV related “benefit” of circumcision is not enough to eliminate the need for another method of protection, then there’s no reason to employ it. Condoms are up to 99% effective when used properly, and cost relatively little. The supposed benefit of circumcision is still only (depending on which report you’re reading) at most 70%, and the cost is astronomical. So why loose a body part if you still have to wear a condom? It’s a moot point then.

    That’s giving the science credit, which, in reality, it doesn’t deserve. I’m not the first to say it: It’s bad science. http://www.doctorsopposingcircumcision.org/info/HIVStatement.html

    We should all be wondering why something with such a HIGH COST would be pushed and favored when it’s not the most effective. Clue: when there’s a cost, someone is getting PAID.

    Most importantly this issue is not about who has decided it sounds good enough to go ahead and why, it is about those who are being mislead, and those who won’t get a choice. Once this benefit is “proven”, and circumcision is removed from cosmetic status, circumcision advocates (who have been trying to prove a benefit since the 1800’s http://www.circumcisionquotes.com) will advocate universal (at some point possibly involuntary) circumcision of every male.

    It’s sooooooooooooooo incredibly disappointing to see such sexism from feminists. MEN are the real victims of this HIV circumcision B.S. Of course women will suffer too, but wow, who’s the one being coaxed into loosing sexual tissue? Who’s the real victim? http://www.NORM.org

    
We’re all supposed to be PRO CHOICE aren’t we? What about the choice of men?

  • invalid-0

    “We could dramatically reduce breast cancer in the U.S. if we gave all teen girls prophylactic mastectomies, but no health expert would recommend doing so.”

    That’s because, unlike male circumcision, the negative effects of prophylactic mastectomies, female circumcision and penectomies (castration removes the testes, not the penis) vastly outweigh their benefits.

  • invalid-0

    This is about the most ridiculous article I’ve ever read. Promoting circumcision as a reasonable method of HIV prevention is asking for trouble, will result in more problems than it solves, and is simply unethical. You’ll notice that any time they put fourth this strategy there is always the caveat in the fine print at the bottom of the page which states something like: “Circumcision is not entirely effective and circumcised men must still practice safe sex and use condoms correctly and consistently.” That is because condoms are the actual method of prevention not circumcision.

    The Australian Federation of AIDS Organizations in a September 2007 presentation laid things out pretty clearly, and responsibly, in their far more rational stance by pointing out that:

    “How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection).”

    That’s good advice.
    Lets be clear. Circumcision in and of itself does not protect men from HIV acquisition; correct and consistent use of condoms does. In a previous study, De Vincenzi, I. A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners, New England Journal of Medicine 331 (1994): 341-6, the effectiveness of condoms was examined in preventing HIV acquisition in heterosexual couples that included an HIV-infected partner. It was found that after a total of about 15,000 instances of intercourse, none of the uninfected partners became infected.
    Two recently published works that put the notion of circumcision as an HIV prophylactic into the proper perspective include Green et al. Male Circumcision is not the HIV vaccine we have been waiting for, in the May issue of Future Medicine and Garenne’s Long-term population effect of male circumcision in generalized HIV epidemics in sub-Saharan Africa, African Journal of AIDS Research 2008, 7(1):1-8. That perspective is that circumcision is of little relevance. By promoting circumcision, as it has been promoted, we run a very real danger of confusing fact vs. fiction and it is already happening. A recent article in The Times – Rwanda by David Gusongoirye, Nothing can fight HIV/AIDS better than discipline, speaking of the new campaign a man was quoted as saying:

    “Mister, these Aids people have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one. Don’t have sex, don’t do this, don’t do that. Eh, man, how can a young man such as I forfeit sex, eh? And the condoms – where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!”

    Perhaps this explains their eagerness to get circumcisions because now they believes they have a “natural condom”.
    In your article, you point out that

    Current supplies of male and female condoms do not satisfy the global demand.

    With this being the case it would be irresponsible to spend money on circumcision while there is a deficit in condom availability. At three cents a piece, in the bulk loads aid agencies would be buying condoms, the money spent on circumcision could be used to by at least 2500 condoms, which the newly circumcised would need anyway.
    The author also suggests we should investigate more options for women. Well I have a suggestion. Perhaps we should examine more closely the results of the the Stallings study, Female circumcision and HIV infection in Tanzania: for better or for worse? where it was concluded that:

    “In the final logistic model, circumcision remained highly significant [OR=0.60; 95% CI 0.41,0.88] while adjusted for region, household wealth, age, lifetime partners, union status, and recent ulcer.”

    Now of course I am not think like one of those ritual circumcisions, I am thinking more along the line of what Dr Jon Myers suggested in his article in the May 2007 issue of the South African Medical Journal, news story here. As Dr. Myers explains:

    A Tanzanian study had found that female circumcision reduced HIV transmission. Biologically, the explanation for this was probably the same as for male circumcision. … If female circumcision was medicalised in a similar way to male circumcision, it could be made safer and less damaging.

    Dr. Myers goes on to point out the obvious notion that it is only the fact that male circumcision is still tolerated in the west that allows us to lower our ethical barriers to the point where this can be considered acceptable.
    But if we just forget about the previous commentary and get down to the proverbial brass tacks, your whole article, and indeed this whole issue, boils down to the following question: If you are circumcised can you have unprotected sex with a partner whose HIV status is positive or unknown and NOT worry about getting infected? Clearly the answer is no. You want the “Straight” Talk about Male Circumcision and HIV? Well here it is. The “Straight” Talk point is you have only two options:
    A. You don’t need a circumcision, but you need to always wear a condom and be choosy about your sex partners.
    B. You can get a circumcision but you need to always wear a condom and be choosy about your sex partners.
    If you are having sex with a partner whose HIV status is positive or unknown you will eventually get infected. Perhaps not the first time perhaps not the second but it will happen. And especially for those who live in the AIDS belt pandemic zone it is suicide to have unprotected sex; you’re still playing Russian Roulette but perhaps you now have two bullets instead of three. Sure it would be great to find a way that aloud people to check their common sense at the door but half baked policies like this stand a very real chance of unwinding much of the hard earned progress in those countries. It is a virtual certainty that the message won’t be communicated properly namely: “Yes even after this you STILL need to always wear a condom.” So then what’s the point? This will be an example of a slow motion train wreck. The only question that remains is how long till the bureaucrats wake up to it.

  • http://myspace.com/saynathespiffy invalid-0

    That’s because, unlike male circumcision, the negative effects of prophylactic mastectomies, female circumcision and penectomies (castration removes the testes, not the penis) vastly outweigh their benefits.

    Says who? You’re still cutting off a useful part of the human body that aids in the sensation of pleasure!

    And why is female circumcision so different? As long as we’re only talking about the removal of the clitoral hood and some of the labia and not the clitoris and entire vulva, they’re pretty comparable procedures. You’re still cutting off a prepuce that protects a glans and removing some lubricating pieces of skin! Why is it acceptable to remove parts of a male’s genitals without his conset but not a female’s?

  • http://myspace.com/saynathespiffy invalid-0

    It’s sooooooooooooooo incredibly disappointing to see such sexism from feminists. MEN are the real victims of this HIV circumcision B.S. Of course women will suffer too, but wow, who’s the one being coaxed into loosing sexual tissue? Who’s the real victim? http://www.NORM.org

    
We’re all supposed to be PRO CHOICE aren’t we? What about the choice of men?

    I almost can’t believe it when I see intelligent feminist women advocate what is, in principle, not all that different from female genital mutilation. Our gender gets ridiculous pressure to drastically alter our bodies because their natural state is considered “gross”, and I think we should know better than to pressure men that way, or insult their bodies’ natural state. Especially when the body part in question is a sensitive, sexual part. And progressive, safe-sex advocating feminists should also keep in mind that the burden of preventing HIV (as with pregnancy and other STDs) should be divided equally and that one gender shouldn’t be given the larger part of the burden. Asking men to permanently alter their genitals and sacrifice their bodily integrity and pleasure because it might reduce the risk is asking too much.

    You also bring up the issue of choice, and I think it’s relevant. The circumcision of child and infant males is a violation of bodily domain. It’s not the parents’ body, it’s the child’s. Why should they be able to decide to permanently remove one of their son’s most private parts before he is able to give consent? I’ll never understand the mind of someone who thinks this is acceptable and yet calls themself “pro-choice”.

  • janine

    The circumcision of child and infant males is a violation of bodily
    domain. It’s not the parents’ body, it’s the child’s. Why should they
    be able to decide to permanently remove one of their son’s most private
    parts before he is able to give consent? I’ll never understand the mind
    of someone who thinks this is acceptable and yet calls themself
    "pro-choice".

     

    Great
    points about choice. When I had my son I was asked if I wanted to circumcise
    and just couldn’t see how any personal preference or other
    justification could give me any right to inflict this to my son. Its
    his body and his choice alone, not mine. Instead, its my responsbility as a parent to educate him appropriately about condom use and HIV prevention.

  • invalid-0

    Excellent article.
    We are all starting to get tired and and fed up with these zealots who live in a state of denial and recursively write comments against all the body of solid scientific evidence that proves all the benefits of circumcision.

  • invalid-0

    The last paragraph of the article says it all:
    “Male circumcision is not a vaccine, and it is not a cure-all. It is simply one of the best ways to prevent HIV infections in men, right now. But we cannot overlook the fact that circumcised men, and their partners, are still vulnerable to HIV.”

  • invalid-0

    Sure, the removal of analogous tissue from men and women is comparable from an anatomical standpoint. However, we can’t ignore the social implications of these practices. Female circumcision is typically done to control the sexual behavior of its victims. This is no longer the case with male circumcision.

    Furthermore, the WHO fact sheet on female genital mutilation states that it “has no health benefits for girls and women.” Male circumcision DOES have well documented health benefits.

  • http://myspace.com/saynathespiffy invalid-0

    While FGM is often done explicitly to reduce sexual pleasure for women and MGM is not usually done explicitly to reduce sexual pleasure, the result is still the same. It doesn’t make sense to accept one procedure and not the other when they have the same/similar results just because one is not done explicitly to acheive that result.

    And besides, many cultures that practice FGM do not do it solely to control female sexual behavior. They have other reasons like: tradition, aesthetics, cultural preferences, taboos about the offending body part being undesirable, disgusting or “unclean”. Sound familiar?

    While I agree that female circumcision has no health benefits, I’m not so sure about your claim that male circumcision does. Can you name any of these alleged benefits? Then, can you please explain if and how any of these benefits outweigh the cost of having a large natural, pleasure-giving piece of your genitals removed?

    • invalid-0

      it’s incredibly offensive that you keep trying to compare what is done to female genitalia to circumcision. (and i am NOT defending circumcision) most women who are mutilated can not experience pleasure or orgasm, live in pain, etc. if the effects of male circumcision were the same as female mutilation – believe me, male circumcision would’ve been outlawed forever ago.

  • http://myspace.com/saynethespiffy invalid-0

    Can you please explain these alleged benefits, and clarify your claim that circumcision has “very little risk” as well?

    Will you then explain how these benefits outweigh the cost of having a 3X5 piece of protective, sensitive genital tissue removed from your body?

  • invalid-0

    Actually, that isn’t even true. The best way to prevent HIV infection in men, right now, is by using condoms. As I mentioned in my previous comment, in a previous study, De Vincenzi, I. A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners, New England Journal of Medicine 331 (1994): 341-6, the effectiveness of condoms was examined in preventing HIV acquisition in heterosexual couples that included an HIV-infected partner. It was found that after a total of about 15,000 instances of intercourse, none of the uninfected partners became infected. If you are having sex with a partner whose HIV status is positive or unknown, you will eventually get infected. Circumcision gets you nothing; that is the take away message.

  • invalid-0

    Well there is 100% chance of losing the most sensitive part of your p enis.

    What are the benefits,

    a shorter or hairy or curved p enis?
    sexual dysfunction at an earlier age than if p enis left in natural state?
    Unnatural sex with less sensation for male and female partner?
    MRSA staph infection chance from baby being cut being higher than any minor (% chance) difference as to getting HIV? penile cancer…?
    A chance of serious harm to p enis or death to patient?

    There is no proof that any STD is lowered (see newest new Zealand study)

  • invalid-0

    The article initiating this blog isn’t promoting circumcision? Read your own rhetoric: “Adult male circumcision is being pushed as the latest magic bullet for the HIV pandemic. There is good reason for the enthusiasm about a new use for the world’s oldest surgical intervention.” “There is good reason for the enthusiasm,” you say; I rest my case. If that isn’t advocating circumcision, please explain what it is. (And by the way, the promoters of these “studies” are already saying they show the need for more infant circumcision in the US.) The only thing, you say, that is wrong with this circumcision program is that it may, just may, cause some men to believe they are immune to HIV and become wreckless. Come on. It’s not a may, it’s an absolute WILL. It’s already happening. News reports originating from Africa quote men saying they like their new circumcisions because they now can be safe from HIV/AIDS without using condoms and without worrying about NOT using condoms. They know they will not contract HIV since they are immune with their new immunization. The results of the trials say circumcison may reduce HIV infection by 60%, 50%, or 70% depending on how much hype is needed at any given time. In reality the best result was a difference of less than 2% in the infection rates of circumcised and non-circumcised men. The 50/60/70 hype is the percentage difference between the two infection rates. And all that is based on extremely biased manipulation of the circumcised group to discourage sexual activity while the non-circumcised group was sent forth to plunder sexually. The immunization idea was injected by the authors of the studies to bolster their claim they had used the “gold standard” in the RCTs. In fact the gold standard is double blind administration of a real vaccine. Their trial of their faux “surgical vaccine” wasn’t even single blind. Any uncritical acceptance of such pseudo-science is nothing less than advocacy of circumcision. As someone has pointed out, condom advocacy is the answer but it isn’t happening because the US government is in the service of religious extremists who oppose condom usage. Also, someone asked why this new advocay of circumcision hasn’t likewise been opposed. Precisely because the Victorian masturbation hyteria that got circumcision started in the US is still alive and well in many of those same religious minds that oppose condom usage. They still believe circumcision is a good thing because it prevents masturbation. It does not prevent masturbation, it just makes it less pleasurable. But old myths and superstitions die hard. Circumcision is a cure in search of a disease. The Africa RCTs are merely the latest effort to establish what that disease is. In a few years there will be another one after this proposal is debunked thoroughly.

  • invalid-0

    Just a little bit of logical and rational thinking will show that the influence of circumcision as an effective intervention against HIV/AIDS is virtually nil.

    The US has the both the highest circumcision rate and the highest HIV/AIDS rate in the industrialized world.

    Three separate studies in Australia, New Zealand and The US show absolutely no difference in the HIV/AIDS acquisition rate between circumcised and uncircumcised men.

    To evaluate the expected results of a 61% (as claimed) protective effect, we can look at another epidemic, the polio epidemic of the 1940′s and 1950′s and compare it with the HIV/AIDS epidemic.

    Polio is an easily transmissable disease. It is transmitted by casual contact. HIV/AIDS is relatively difficult to transmit requiring intimate contact and the exchange of bodily fluids. The polio vaccine developed in the 1940′s has a 70% effective rate compared to the claimed 61% effective rate of male circumcision. Comparing the difficulty of transmission, the two should be essentially the same in eliminating the respective infections.

    Polio was wiped out of the population in a single generation with the vaccine. The US has been “vaccinating” it’s males for more than 130 years with circumcision yet we have the highest infection rate in the developed world. With 80% – 85% of sexually active males “vaccinated” the vectors of transmission would be sufficiently broken that the disease would have no chance of spreading if the claims were accurate.

    Certainly there would be stark differences in areas where circumcision is practiced and where it is not. For instance, in Uganda where circumcision is common and virtually 100% of males are circumcised, in the mid 1990′s, there was a 38% infection rate. This rate would be virtually impossible if circumcision provided a 61% protective factor.

    There are obviously fatal flaws in the research. We can assume there is an agenda here for this level of flaws to exist and we only have to look at the history of two of the leading authors of the studies, Bailey and Halperin. Both are on the record as being avid proponents of male circumcision going back at least as far as 1984. Both have the training and experience to see the fatal flaws so it is obvious they have fabricated the results of the study to support their agenda to spread male circumcision worldwide. The development of the HIV/AIDS epidemic was convienient as it is just the last of a long line of most dreaded diseases the circumcision has been claimed to prevent or cure.

    The body of evidence is building that male circumcision has never and never will prevent or cure anything. After more than 130 years of searching, if it would prevent or cure anything, it would have been found by now.

    .

  • invalid-0

    “Male circumcision is not a vaccine, and it is not a cure-all. It is simply one of the best ways to prevent HIV infections in men, right now.”

    This is muddled thinking. Everybody knows what the risk factors are for acquiring HIV, and having a foreskin is not one of them. If you are having risky sex where HIV is epidemic, you can count on getting HIV. Another way of looking at these claims of 60% protection is this: instead of getting HIV in two years, you’ll get it a few years later. Wow. I’d chop off part of my penis for that benefit.

    Not only is circumcision to prevent HIV a cruel hoax, but it is being used as a proxy argument for promoting neonatal circumcision in the U.S. I’d like to answer the question “why are there so many anti-circumcision men in the U.S.?” It’s easy: the so-called complications of circumcision so blithely dismissed by circumcisers – urethral laceration, horrific skin bridges, extensive scar tissue, buried penis, partly missing glans, insufficient skin for erection – ensure that there will always be thousands of men in the U.S. who are furious that part of their sexual anatomy was chopped off without their consent. Before the internet, there was no way to express this rage, and the shame and secrecy of these injuries prevented public discussion. That is over now. All you clueless happy circumcised men who think it’s a laughing matter need to see some medically withered penises before you decide it’s your right to ampuate sexual tissue from non-consenting minors.

    We are creating the same social-sexual issues in Africa, and it won’t stop HIV.