Male Circumcision - Hiv Prevention

[mommysboy]

Here ya go for doubts about this topic. Tear it apart if you must, but this feeling is out there, and by doctors. I also read a comprehensive African study recently and the researchers ended up in much doubt about how much circumcision affects HIV infection. They seemed to find that condom use was much more important and it was more like poor personal hygiene with regards to uncircumcised men. If they followed hygiene and condom use it was basically equal infection rates compared to circumcised men. So yes, it increases risk, but only if you're unsanitary. I wish I could find that story again. Basically, the danger with blaming HIV infections on not being circumcised has the risk of educating the ignorant that they can just have all the sex they want with on protection if they just get circumcised.

For more, see here and here and here and here.

It's not really quite an open and shut case as the OP thinks.

Good Posting.

'Not statistically signficant'.

No scientific evidence whatsoever save some notion that some types of skin cells might be more susceptible than others against a virus that can't be observed in action anyway.

And no data to suggest a connection.

[dotcom]

The OP with his massive 36 posts maybe came here to promote his theory.

[khundon]

Anyway, its a proven fact now that with the removal of the foreskin and therefore the HIV receptors which form part of it, the risk of catching HIV is massively reduced........so why in Thailand is there minimal awareness of this ? and no action plan to get it introduced ?

You say the risk is "massively reduced". I would rather say "somewhat reduced".

If it were truly "massively reduced" we would see clearly lower HIV rates amongst for instance religious or other groups where all men are circumcised. Not the case.

You also state that 'prostitutes should be made aware of the fact uncircumcised men have a higher HIV rate". This you made up yourself. Indeed there is a theoretical "harder" transmission path to circumcised men, but stating the HIV rates are higher amongst uncicumcised men is just your personal guess.

The small reduction in "transmission speed" between circumcised and uncircumcised men is not at all the answer or solution to the HIV epidemic. IMO condoms and safe sex education and campaigns are the way to go, together with compulsory testing of the population.

On top of it your kind of messages might have opposite effect: circumcised men could take more risks (thinking they are at 'low risk') and thereby compensating the so called extra safety factor you describe, and thus even being at higher risk.

Besides, there are disadvantages to circumcision as well. Limited medical risks during and after the procedure, limited sensitivity and related sexual problems. Note the lawsuits in the US of people circumcised at young age -as a standard procedure in the hospital, who argue they never wanted this. Also note the reverse circumcision operations for people who 'want their skin back'. You call this "misinformation".

The condom campaign that was running in Thailand (and stopped by the Taksin administration because it was bad for Thailand's image) was highly effective and praised around the world. They should restart that campaign.

Once tested what happens to the people who have tested Positive??? in countries that do not have free drugs etc.

I seem to remember Castro put all HIV positive people in jail, something I think none of us would agree with.

Compulsory testing sounds a bit draconian, it should be a personal choice.

Much better to promote the safe sex methods which are well known, cheap and easy to follow.

[dotcom]

I would like to bet you a lot of money that a foreigner found to be HIV pos in Thailand will be deported A.S.A.P.

[mommysboy]

Anyway, its a proven fact now that with the removal of the foreskin and therefore the HIV receptors which form part of it, the risk of catching HIV is massively reduced........so why in Thailand is there minimal awareness of this ? and no action plan to get it introduced ?

You say the risk is "massively reduced". I would rather say "somewhat reduced".

If it were truly "massively reduced" we would see clearly lower HIV rates amongst for instance religious or other groups where all men are circumcised. Not the case.

You also state that 'prostitutes should be made aware of the fact uncircumcised men have a higher HIV rate". This you made up yourself. Indeed there is a theoretical "harder" transmission path to circumcised men, but stating the HIV rates are higher amongst uncicumcised men is just your personal guess.

The small reduction in "transmission speed" between circumcised and uncircumcised men is not at all the answer or solution to the HIV epidemic. IMO condoms and safe sex education and campaigns are the way to go, together with compulsory testing of the population.

On top of it your kind of messages might have opposite effect: circumcised men could take more risks (thinking they are at 'low risk') and thereby compensating the so called extra safety factor you describe, and thus even being at higher risk.

Besides, there are disadvantages to circumcision as well. Limited medical risks during and after the procedure, limited sensitivity and related sexual problems. Note the lawsuits in the US of people circumcised at young age -as a standard procedure in the hospital, who argue they never wanted this. Also note the reverse circumcision operations for people who 'want their skin back'. You call this "misinformation".

The condom campaign that was running in Thailand (and stopped by the Taksin administration because it was bad for Thailand's image) was highly effective and praised around the world. They should restart that campaign.

Once tested what happens to the people who have tested Positive??? in countries that do not have free drugs etc.

I seem to remember Castro put all HIV positive people in jail, something I think none of us would agree with.

Compulsory testing sounds a bit draconian, it should be a personal choice.

Much better to promote the safe sex methods which are well known, cheap and easy to follow.

Agreed.

The following is just my own opinions:

Most people accept HIV theory as a given, they really shouldn't IMHO. I mean when I go to the doctor and the doctor presents me with ample evidence as to why I should give up smoking, and I see my elderly dad and friends develop problems and start developing problems myself, then of course they are right, a perfect match across the board. And the same goes for most common knowledge that goes on these boards too,given by health professionals or otherwise across a wide area of topics- in fact I've benefited greatly already.

So the experts must be right about AIDS theories !!. Well I don't know, how can I know?, but I personally think it is a bodge. There is some phenomenon of course that can not be denied and to be sure what an awful thing it is too, and answers are needed. I just think the whole area needs to be reviewed, and by that I mean back to scientific basics.

I think it was Stephen Hawking who said wrong predictions affirm bad theories, correct predictions make them powerful. Based on this tenet, how does AIDS theory stand in all honesty? It's hardly conventional science and many of the predictions have proved wrong sufficient enough for UNAIDS figures to be revised downward and a statement issued that the primary concern had returned to the original risk groups. last year I believe a central tenet regarding how HIV replicates was finally binned too. The inventor of the PCR theory and machine has even rounded on the impossibility of it's use for heaven's sake, and it goes on and on.

Look at this thread, we've had all sort of distractions and diversions to the main point (remember the whole thread originated from a health report that the incidence of HIV infection had increased 2 fold for young women and the subsequent attempts of a crank to hijack the thread to promote circumsicicion for who knows what reason.)

No hard figures you notice, so maybe 10 young women were infected as opposed to five. I mean I don't know and it wasn't stated in the brief, we just took it as read it was a reliable figure, didn't we???

How many of us want to face the unpalatable truth that many of these girls might be subject to anal sex, or are in relationships with IV drug users (often a polite way of expressing that they themselves are drug users).?

Or that the science is plain wrong, or that there are cofactoral issues, or that HIV is a harmless passenger virus, or that there is viral AIDS but there is also toxic AIDS, or that there isn't a cure because there isn't a unique illness as such. Or ........... well I think you get my drift! and after all I really don't know.

My over riding point is that we should all be a little bit more aware of this subject area whilst also accepting the need for safety until the truth is established. I'm wholly esconsed in a boring conventional life incidentally and don't have any medical training or any academic qualifications to boast of either.

Any safety policy at the moment must surely focus on education on safe sex, ie, condom use. What good is it to tell a girl that she shouldn't sleep with a guy who hasn't been circumcised?

When pragma goes out the door look what happens?

[LevelHead]

Here ya go for doubts about this topic. Tear it apart if you must, but this feeling is out there, and by doctors. I also read a comprehensive African study recently and the researchers ended up in much doubt about how much circumcision affects HIV infection. They seemed to find that condom use was much more important and it was more like poor personal hygiene with regards to uncircumcised men. If they followed hygiene and condom use it was basically equal infection rates compared to circumcised men. So yes, it increases risk, but only if you're unsanitary. I wish I could find that story again. Basically, the danger with blaming HIV infections on not being circumcised has the risk of educating the ignorant that they can just have all the sex they want with on protection if they just get circumcised.

For more, see here and here and here and here.

It's not really quite an open and shut case as the OP thinks.

Excuse me, one of your links is about "gay sex, men to men".

I mean really, when all the discussion is about circumcision reducing "male infection from female" through vaginal sex, you post an article on "man to man sex" is misleading as it is not the matter of discussion.

Why not quote from the three biggest organisations, not some minor web sites of someone who has a theory or diskikes someone elses theory :

CDC :

http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm

WHO :

http://www.who.int/hiv/topics/malecircumcision/en/index.html

UN :

http://data.unaids.org/pub/Report/2007/mc_...ndations_en.pdf

[lectito]

A couple of factors which are worth keeping in mind before extrapolating from the (handful of) studies suggesting a possible between circumcision and HIV-transmission.

As the WHO points out, there were indications from "three randomized controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda and Orange Farm, South Africa that male circumcision reduces the risk of heterosexually acquired HIV infection in men" - they noted that there was a "geographical correlation long described between lower HIV prevalence and high rates of male circumcision in some countries in Africa". While there may evidence suggesting that circumcision may be of use a tool in Africa, there is limited evidence it would be of use elsewhere.

There are two key factors at play. The studies have been conducted in sub-Sahara Africa, where access to clean running water is not as prevelant as in other countries. In other countries with access to clean water - and by extension the ability to more easily undertake basic hygeine procedures under the foreskin - the link between circumcision and HIV has not been established.

The studies claiming a link between circumcision and HIV have been undertaken in areas where the practice of "dry sex" is common - a practice leading to abrasions of the vagina, which encourages the spread of STDs (including HIV).

[khundon]

I would like to bet you a lot of money that a foreigner found to be HIV pos in Thailand will be deported A.S.A.P.

I don't know what the official Thai reaction would be if a foreigner was found to be HIV positive, perhaps TV members have usefull info on that subject?

I do know that several years ago I applied for Life insurance in the Uk and one of the questions was "Have you ever been tested for HIV".

If you answered yes to that question, it was then almost impossible to get full insurance cover, ie: no cover against contracting HIV/AIDS.

I had not taken a test at that point, so was ok for insurance cover.

Maybe insurance companies have changed their systems, I don't know.

Sorry, I have wandered off topic, slap me someone.

Edited January 4, 2009 by khundon

[swifty5x5]

Male tissue in the foreskin of the penis is soft and more poris therefore the HIV virous can easily be transmited through there.

[Master Chief]

As being read here and also said by the medical professionals the whole matter is unethical, by bringing this subject to a forum like TV is not correct.

Only provoking the matter to its limits as a result.

Reading the articals gives facts to this, african hetro males, african-american hetro males, hispanic hetro males and hetro sexuals only.

The fact is that of 390+ hetro african males having sex with known hiv infected african females, and are being statisticly tested for this subject, is just as unethical as it can get.

Then the results show a 10% lesser infection rate and that should be a result affecting sexual behavior in the rest of the world. By mass male circumcision world wide.

What about the other 70% of this test group whom got HIV infected, 70 % ???.

MC

Edited January 5, 2009 by Master Chief

[FBN]

Perhaps this discussion has gone full circle and perhaps time to review the opening post.

The question asked was why there were no awareness and/or active campaigns in Thailand to promote circumcision as a preventative measure in the fight against Aids.

Despite compelling evidence that there is a protective effect of male circumcision, the WHO, CDC and other (quoted) international health organisations do not have a single campaign to promote male circumcision anywhere as far as I know. There are valid reasons for this. Thailand is not the exception.

There more reputable authors of these studies have also eluded to the bias in their studies (selected populations in hyperendemic areas, different population groups, variation in sexual practices etc etc) and most will advise that more research is needed before it would be accepted as an "Evidence based fact" and therefore be regarded as an important aspect in the approach to the management/prevention of HIV or as with any other medical condition.

Even this discussion may lead to complacency and a false sense of security of circumcised men; making them more prone to have unprotected sex. It is well known that complacency is one of the main factors facilitating the spread of this disease.

Moreover, circumcision may only be protective to some extent of the male participating partner, leaving the recipient totally exposed.

Established basic factors in the spread of this disease are the volume of bodily fluids exchanged (the female or recipient unprotected partner at obvious risk) as well as the actual viral load of the carrier or infected person at that point in time.

These are the basic facts that need to be addressed in the prevention and control of this disease. Awareness of these facts and effective and cost effective as well as culturally and morally acceptable protective measures are the cornerstones of any successful campaign.

[Jimjim]

Excuse me, one of your links is about "gay sex, men to men".

I mean really, when all the discussion is about circumcision reducing "male infection from female" through vaginal sex, you post an article on "man to man sex" is misleading as it is not the matter of discussion.

You're excused.

So, you came here to show you hate gays? The article title was:"Circumcision Not Associated With Reduced Risk Of HIV For Men Who Have Sex With Men." Gay sex is still sex and it is obviously pertinent to the discussion as the article was about circumcision and HIV risk in sex. Pertinent to the discussion, isn't it? I guess your hatred of homosexuals blinds you to that, but thanks for playing. It's relevant. In case you didn't know, men and women do have anal sex as well, so it is absolutely relevant to the discussion. The main focus will be on vaginal sex but that doesn't mean anal sex can't be discussed, so it's not misleading at all unless thinking about gay sex makes you feel icky inside. In that case, grow up and get a life.

The point of my post is to show that there is disagreement out there, no matter what the official channels promote. It's not about disliking someone's theory, it's about there needs to be a lot more study done on this subject for it to be the truth that the OP thinks it is, and that seems quite clear.

[JimmyTheMook]

Male tissue in the foreskin of the penis is soft and more poris therefore the HIV virous can easily be transmited through there.

That is the basic fact that some here are in total denial about.

Plus most women prefer circumcised men

[Tolley]

There are so many red herrings being thrown in this discussion that the validity of the original post is being lost.

The research seems to indicate that male circumcision reduces the transimission of HIV in hetero sexual couples.

Is this the best way to prevent HIV infection? No obviously not. Abstinence is the number 1 preventative measure available although not practical in most cases. Use of condoms is probably the next best approach.

But circumcision shouldn't be ruled out as a measure especially where cultural and financial circumstances prevent condom usage eg Africa

[mommysboy]

There are so many red herrings being thrown in this discussion that the validity of the original post is being lost.

The research seems to indicate that male circumcision reduces the transimission of HIV in hetero sexual couples.

Is this the best way to prevent HIV infection? No obviously not. Abstinence is the number 1 preventative measure available although not practical in most cases. Use of condoms is probably the next best approach.

But circumcision shouldn't be ruled out as a measure especially where cultural and financial circumstances prevent condom usage eg Africa

The evidence is still tenuous even in Africa.

A lot of the operations could be botched, there is the suggestion that it could actually make matters worse.

It's a bad idea and serves to illustrate that in the absence of solid scientific evidence all number of cranks come up up with any number of findings.

[TJAN]

Some interesting, very emotional responses to a purely scientific issue. I guess some people's attachment to their "hoodies" is very intense.

I doubt most people are differing with the scientific evidence as such. Most will accept circumcision as a benefit, if of course you are stupid enough to wander about without using a condom. This being the case you are, circumcised or not, taking a big risk. Now if circumcision was enforced say in the USA, on males at birth, perhaps these scientific findings and the whole thought process around freedom of choice would sit a little more comfortably.

All of a sudden we are all doctors.

[whiterussian]

I wince every time somebody posts on this thread

chop it off if you want, but dont do it without adult consent.

Look at the map of Africa... lots of snipped willies. lots of AIDS. pointless thread.

Edited January 7, 2009 by whiterussian

[LevelHead]

I wince every time somebody posts on this thread

chop it off if you want, but dont do it without adult consent.

Look at the map of Africa... lots of snipped willies. lots of AIDS. pointless thread.

I do not see what the point of your summary is.

Could you perhaps explain the sub-division of AIDS in Africa, where are the hot spots ? and then from that map take off those countries that are heavily into anal sex ? and then from that take off those with lots of drug abuse ? and then put that into you map above and make some kind of comment ?

Or is it just another little snide comment, going back to post 2 for the reason for it ????? - ?

[mommysboy]

I wince every time somebody posts on this thread

chop it off if you want, but dont do it without adult consent.

Look at the map of Africa... lots of snipped willies. lots of AIDS. pointless thread.

I do not see what the point of your summary is.

Could you perhaps explain the sub-division of AIDS in Africa, where are the hot spots ? and then from that map take off those countries that are heavily into anal sex ? and then from that take off those with lots of drug abuse ? and then put that into you map above and make some kind of comment ?

Or is it just another little snide comment, going back to post 2 for the reason for it ????? - ?

Just let the tread go I think.

The thing is in the absence of proper scientific evidence- not studies, it's an unwinnable argument anyway.

AIDS figures in Africa may be greatly overstated anyway- the trend is towards downward revision of figures.

[LevelHead]

http://news.medill.northwestern.edu/chicag....aspx?id=112647

Male circumcision cuts risk of HIV and HPV

by Kimberly Weisensee

Jan 22, 2009

Circumcision reduces a heterosexual man's risk of contracting or spreading HIV. The procedure also lowers the risks of cervical cancer and STDs for women.

Male circumcision may help protect heterosexual men and women from contracting HIV.

The practice can reduce the risk of contracting sexually-transmitted diseases, including HIV and HPV (human papillomavirus), according to research published in the Journal of Infectious Diseases this month.

Dr. Bertran Auvert and a team of researchers from France...................................

[LevelHead]

http://news.bbc.co.uk/2/hi/health/7960798.stm

Thursday, 26 March 2009

Call for higher circumcision rate

Circumcision should be routinely considered as a way to reduce the risk of sexually transmitted infections, argue US experts.

They spoke out after research found circumcision significantly cut the risk of infection with herpes and the cancer-causing human papillomavirus.

Circumcision is known to sharply reduce the risk of HIV infection.

But the study, featured in the New England Journal of Medicine, failed to convince UK experts.

The research, carried out by scientists in Uganda, involved nearly 3,500 men and monitored their sexual activity over a period of up to two years.

The researchers, from Johns Hopkins University, found circumcision reduced the risk of herpes by 25%, and human papillomavirus (HPV) by a third.

HPV causes cervical cancer in women, and genital warts in both sexes.

Circumcision rates have been declining in the US and are lowest among black and Hispanic patients - the groups with the highest rates of HIV, herpes and cervical cancer.

Writing in the journal, Dr Matthew Golden and Dr Judith Wasserheit, from the University of Washington, said: "These new data should prompt a major reassessment of the role of male circumcision not only in HIV prevention but also in the prevention of other sexually transmitted infections."

Dr Wasserheit went on to say: "All providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured."

UK scepticism

The reason why a foreskin might increase the risk of infection with various viruses is unclear.

However, research has suggested that a man with a damp penis has a greater risk of being infected by HIV.

Various reasons for this have been put forward, including wetness allowing viruses to stick more easily to the penis, or creating tiny ulcers on the surface of the penis through which a virus might enter.

Dr Colm O'Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an "obsession" with circumcision being the answer to controlling sexually transmitted infections.

He said: "Sure, a dry skinned penis is a bit less likely to contract HIV, herpes and possibly genital warts but it will get infected eventually."

Dr O'Mahony also said pushing circumcision as a solution sent the wrong message.

"It suggests that it is women who infect innocent men - let's protect the innocent men.

"And it allows men who don't want to change their irresponsible behaviour to continue to sleep around and not even use a condom."

Keith Alcorn, from the HIV information service NAM, also warned against a knee jerk reaction.

He said: "We have to be careful not to take evidence from one part of the world and apply it uncritically to others.

"Male circumcision will have little impact on HIV risk for boys born in the UK, where the risk of acquiring HIV heterosexually is very low.

"Girls can be vaccinated against HPV and so protected from cervical cancer, and condoms protect against herpes."

[wanderer9020]

in philippines which is predominantly Catholic, all men should be circumsized, thats a fact.I dont think it has something to do with religion....May be a social or cultural thing..And no, nobody discuss about for health reasons, its just part of the culture....Uncircumsized is just for a child, but when you enter high school and you strt having crush, your supposed to be circumsized..

[Sheryl]

As often happens, people are confusing reduction of risk on a population level with prevention of disease on an individual level.

On a population level -- in other words, taking a very large (hundreds of thoudans or m illions) of people as a group -- there is a definite reduction is risk (not absolute prevention, just reduction in risk) of acquiring HIV in circumcized men compared to uncircumsized. This has been very well established in a number of rigorously conducted studies.

How many cases of HIV would be prevented by how many percentage points increase in circumcision is, obviously, going to vary a lot depending on how high HIV prevalance is in a given population. This is the point that the UK authorities were making -- not that the studies are invalid or that it does not make solid sense to promote/encourage circumcision in parts of Africa with exteremely high HIV prevalance, but that it would not make as much sense in the UK.

There are countries in Sub-Saharan Africa where more than one quarter of the adult population is HIV infected. (There are also countries in that same region where it is only 2%). In places where the prevalance is so high, increasing the proportion of men who are circumcized will result in as measurable decrease in HIV. In places where it is already low, circumcision rates could double or triple and you would see littkle ior no a change in overall HIV prevalance.

The above discussion is entirely around public health measures i.e. whether or not parents should be encouraged (encouraged, not required) on health grounds to circumcize their sons.

The question of whether or not it would be of public health benefit to increase circumcision rates is a different one than the question of whether a specific individual should be circumsized.

[JimsKnight]

Maybe because circumcision has nothing whatever to do with HIV/AIDS transmission?

Sort of, but normally it's to do with STDs no affiliated with HIV/AIDs.

Having the 'cut' means sex can be more painful for the girl (due to the penis being more dry than a normal one).

This could mean that there is the possibility of small bleeding in some cases.

Although Christian my parents offered me the choice of having the 'cut' or not as a kid.

I chose not to and I'm glad as I've heard from others that sex isn't as sensitive on the male private parts if you've been 'cut'.

The other school of thought is that somehow the epidermis layer of skin on a 'cut' penis is an additional barrier against STDs. This might explain some of the ancients preference for circumcision. Given that back then only the wealthy could afford condoms (albeit rougher, linen ones).

Edited March 27, 2009 by JimsKnight

[krading]

"I chose not to and I'm glad as I've heard from others that sex isn't as sensitive on the male private parts if you've been 'cut'."

How can they tell ??

Anyway, I was done 50 years ago and I'm having it done again just to be sure.

[Orac]

Though there appears to be an arguement here for male circumcision I cannot understand why the 'benefits' would only apply to male-female virginal intercourse. Surely if the HIV/AIDs receptors referred to are in the foreskin, by removing it there should be a reduction in cases all round be it virginal, anal or male-male - why does where it is stuck make a difference ?

[krading]

I suppose they are talking about the male-female vaginal intercourse scenario where the female is already infected and the male is not. During this 'normal' sex act the circumcised male is statistically less likely to become infected than the uncircumcised male. The anal canal evolved as a one-way-street and is not really designed for intercourse so I suppose there is more chance of damage being done to the colon walls exposing the male to blood from the infected female (or male). I don't know if there is any difference in HIV transfer ability of bodily fluids in the female vagina compared to blood but one would think that contact with blood would present the higher risk. As the Pope says, Abstinence is the safest form of sex. or

[Jingthing]

The anal canal evolved as a one-way-street

I guess the ancient Greeks were really clever then. It is not a one way street (that's a classic code used by homophobes). You just have to check out that you have right of way.

Edited March 27, 2009 by Jingthing

[Jimjim]

Neither condoms nor circumcision helped me not get herpes...

[Orac]

I suppose they are talking about the male-female vaginal intercourse scenario where the female is already infected and the male is not. During this 'normal' sex act the circumcised male is statistically less likely to become infected than the uncircumcised male. The anal canal evolved as a one-way-street and is not really designed for intercourse so I suppose there is more chance of damage being done to the colon walls exposing the male to blood from the infected female (or male). I don't know if there is any difference in HIV transfer ability of bodily fluids in the female vagina compared to blood but one would think that contact with blood would present the higher risk. As the Pope says, Abstinence is the safest form of sex. or

I still don't get it. I can accept there can be an arguement that virginal sex is 'less risky' than anal sex - I am sure someone has statistics to prove this one way or the other. What I don't understand is the arguement being made that being circumcised ONLY is of benefit in virginal sex - surely it would beneficial in all cases.