martedì 30 agosto 2011

Germania: una legge contro la Circoncisione?

Il quotidiano tedesco Frankfurter Allgemeine Zeitung, giornale di ispirazione conservatrice e liberale, apre il dibattito sulla circoncisione rituale. Ci si chiede se questa pratica religiosa, attuata tradizionalmente tra gli ebrei all’ottavo giorno dalla nascita e tra gli islamici intorno ai 6 anni, non sia in contrasto con l’art. 223 del codice penale tedesco che condanna le mutilazioni corporali e i diritti umani.

Nella magistratura vi sono comunque giudici che sono per un’interpretazione più ampia dell’art. 223, tale da colpire anche la circoncisione, perché praticata su minorenni che non possono decidere autonomamente.
Magistrati autorevoli come Rolf Dietrich Herzberg insistono nell'interpretazione dura delle leggi: la circoncisione viola l'integrità del corpo, tanto più se praticata per rito su minorenni incapaci di difendersi e di decidere. I maschi ebrei vengono circoncisi 8 giorni dopo la nascita, i musulmani attorno al sesto anno d'età, per cui secondo i magistrati il loro trauma è ben più grave. La difesa dell'integrità fisica, secondo i giuristi anti-circoncisione religiosa, deve far premio sul rispetto delle religioni. È una svolta nella coscienza collettiva della Germania postbellica.

Stephan Kramer, segretario generale del consiglio centrale degli ebrei tedeschi, protesta pubblicamente.

GLI EBREI: "NON RINUNCEREMO MAI" - FURIOSI ANCHE I MUSULMANI

mercoledì 24 agosto 2011

Shane

Shane's circumcision nightmare

"I wish I'd never been born"

"Vorrei non essere mai nato"


SHANE Peterson's blue eyes are windows into a life of pain and mental anguish. Since his first teenage yearnings, he's longed for the thrill of a kiss, the caress of a woman and the fulfilment of love and sexual intimacy.
Instead, Shane has contemplated celibacy, sex change and even suicide. Shane was robbed at birth of the chance to be a normal, functioning male by a bungled circumcision that left life-long damage.

SHANE Peterson ha due occhi azzurri come una finestra spinta nell'anima di una vita di dolore e di angoscia mentale. Dal momento che le sue aspirazioni da adolescente, sono state l'aver atteso per l'emozione di un bacio, la carezza di una donna e la realizzazione di amore e di intimità sessuale e invece, Shane ha contemplato il celibato, cambiare sesso e persino il suicidio. Shane è stato rubato alla nascita della possibilità di essere "normale sessualmente" come ogni maschio da una circoncisione senza alcuna motivazione medica o terapeutica, che ha lasciato danni e traumi per tutta la sua giovane vita.

"I often wish I'd never been born. My life has been a living hell," says the shy 26-year-old, who has been paid $360,000 by a West Australian doctor.

"Spesso mi piacerebbe non essere mai nato. la mia vita è stata un inferno", dice il timido ragazzo di 26 anni, che è stata risarcito di 360.000 $ da un medico occidentale australiano.

"My right to the intact body I was born with has been violated. As far as I'm concerned, it's a breach of my human rights. I've been assaulted."

"Il mio diritto di aver un "corpo intatto" come tutti non appena sono nato è stato violato. Per quanto mi riguarda, è una violazione dei miei diritti umani. Sono stato aggredito, violentato".

"Someone held me down, then amputated part of my body while I screamed and went into shock."

"Qualcuno mi teneva giù, poi ha amputato una parte del mio corpo mentre io gridavo e sono andato in shock". (ho perso i sensi)

"My parents were not told that circumcision had no medical benefit, or of the risk of complications, which I believe amounts to fraud."

"Ai miei genitori non era stato detto che la circoncisione non aveva alcun beneficio medico, o del rischio di complicazioni, io credo gli importi solo di frodare le persone."

Eric and Kerry Peterson were unaware of the wrongdoing to their baby when they left the hospital and returned to their Perth home.

Shane's childhood years were carefree. At puberty, as his body grew into manhood, he became aware of a problem with his penis.

Durante la pubertà, in quanto il suo corpo è cresciuto verso l'età adulta, si accorse di un problema con il suo pene.

"Sex education classes gave little information on circumcision. I didn't even know I'd been circumcised," Shane says. "I assumed I'd been born deformed, which was totally devastating. I was too ashamed to tell anyone. Erections caused pain and my penis was misshapen and twisted."

"Educazione sessuale a scuola non danno tante informazioni sulla circoncisione. Io non sapevo nemmeno fossi stato circonciso", Shane dice. "Ho pensato fossi nato cosi, deforme, ed è stato totalmente devastante. Mi vergognavo troppo a dirlo a qualcuno. Erezioni causavano dolore e il mio pene era deforme e contorto".

"There were girls I felt attracted to, and who liked me, but I was so fearful of rejection because of my deformity, I avoided relationship. I hid from other guys in change rooms and toilets."

"Ci sono state tante ragazze da cui mi sentivo attratto, o che mi piacevano, ma ero così preoccupato, intimorito del rifiuto a causa della mia deformità, che cosi ho sempre evitato ogni tipo di relazione. Ho nascosto il tutto ad altri ragazzi negli spogliatoi e servizi igienici".

"At uni[versity] the problem escalated. As my interest in girls intensified, I felt frustrated because I couldn't do anything about it."

"All'università il "dramma il problema" ha avuto un'escalation. Con il mio interesse per le ragazze sempre più intensificato, mi sentivo frustrato perché non potevo farci niente."

At 18, Shane sought medical help. Referral to specialists revealed an 'aggressive' circumcision had been performed. In addition to the foreskin, the shaft skin had been removed and the scrotal skin pulled up to the head of the penis. Only shreds of sensitive fraenulum (sometimes known as the male G-Spot) remained.

A 18 anni, Shane ha cercato aiuto medico." Rinvio a specialisti ha rivelato che una circoncisione 'aggressiva' "totale" era stata eseguita". Oltre al prepuzio, la pelle ad albero del pene era stata rimossa e la cute scrotale tirata fino alla testa del pene. Solo brandelli di frenulo sensibile (noti anche come il punto G-Spot nei maschi) sono rimasti.

"Going from believing I was born deformed to realising I had been mutilated by a needless procedure made it worse," Shane recalls. "I hated my parents."

"Non ci potevo credere, non sono nato deforme e ho realizzato che il pene mi era stato mutilato da una procedura inutile, pericolosa, sbagliata. " Shane ricorda. "Ho odiato i miei genitori".

Angry and severely depressed, Shane, studying for a biotechnology, degree pored over medical journals for surgical options open to him.

Arrabbiato e gravemente depresso, Shane, studiando biotecnologie, studia e legge riviste mediche per le "opzioni chirurgiche" per le persone con le sue "problematiche".

"If the most functional result meant a sex change, I would have gone for it," he says, matter-of-factly.

"Se il risultato più funzionale ha significato un cambiamento di sesso, io sarei andato per questo", dice lui, molto realisticamente.

"The circumcision destroyed my sexuality. I didn't feel like a man and I didn't feel like a woman. Suicide seemed my only option if the damage couldn't be repaired."

"La circoncisione ha distrutto la mia sessualità. Non mi sentivo come un uomo e non mi sento una donna. Suicidio sembrava la mia unica opzione se il danno(al mio pene) non poteva essere riparato".

A Perth plastic surgeon grafted skin from Shane's left thigh to his penis. And a half thickness of skin harvested from his right thigh replaced the skin excised from the left.

Shane could now get a full erection and climax, but sensation was dramatically reduced due to removal of the remnant fraenulum. The pain from the graft sites was agonising, the cosmetic results disheartening.

Shane potrebbe ora avere con l'intervento plastico una piena erezione e orgasmo, ma la sensazione è stata drasticamente ridotta a causa della rimozione del frenulo e del resto . Il dolore del nuovo innesto è stato straziante, i risultati sconfortanti.

Counselling failed to bolster Shane's spirits. At 19, he crushed 100 painkillers into liquid, gulped it down, then prayed for death.

Consulenza (visita dallo psicologo) non è riuscito a sostenere, aiutare, confortare Shane nel suo profondo. A 19 anni, ha schiacciato 100 antidolorifici, resi liquidi, li ha tracannati, e poi pregato per la morte.

Shane survived. He directed his anger into a need for justice and began a seven-year ordeal to obtain evidence and sue the GP who circumcised him.

Shane è sopravvissuto. Ha diretto la sua rabbia in un bisogno di giustizia e ha iniziato un calvario di sette anni per raccogliere prove e citare in giudizio il medico che lo ha circonciso.

Using his own medical expertise to build a solid case and achieve legal recognition of his injury and suffering has given Shane's fragile confidence a much-needed boost.

Grazie alla sua conoscenza e esperienza medica Shane può costruire una solida difesa e ottenere il riconoscimento legale del suo "danno" e alla sofferenza patita, e il tutto ha dato fiducia e una spinta tanto necessaria al fragile Shane.

"The money is no redress for what I've been through. Aside from the pain and social stigma, so much of my freedom of choice has been removed. A part of my body and part of my life were taken away, and they can never be replaced."

"Il denaro non è un risarcimento sufficente per quello che ho passato. A parte il dolore, il trauma, il disagio sociale.. il mio diritto di scegliere, la mia libertà è stata violata. Una parte del mio corpo e una parte della mia vita sono stati portati via per sempre, e non potranno mai essermi restituiti. "

"The months since settlement have been the first for many years, that I haven't contemplated killing myself on a daily basis."

Now studying for a doctorate in medical science, Shane plans to form a support group for other men who suffer trauma from circumcision, and to establish an independent, non-profit research foundation to evaluate the impact of circumcision.

Ora studia per un dottorato in scienza medica, Shane ha intenzione di costituire un gruppo di sostegno per gli altri ragazzi(e uomini) che soffrono di traumi dovuti alla circoncisione, e per stabilire un indipendente, ricerca non-profit Fondazione per valutare l'impatto della circoncisione.

The Australian Medical Association (AMA) doesn't advise circumcision for many reasons. They claim the practice can lead to scarring, deformity, severe blood loss, as well as infection.

L'Australian Medical Association (AMA) non consiglia la circoncisione per molte ragioni. Essi sostengono la pratica può portare a cicatrici, deformità, grave perdita di sangue, così come a infezioni.

"Routine circumcision is imposed on 10 to 15 percent of healthy Australian boys. I want my case to bring to people's awareness how dangerous and potentially disastrous it is," Shane says.

"Parents should not have the right to surgically inflict their religious, sexual or cosmetic preferences on their children. It's for the child to decide, when old enough. Until then, they must be legally protected from this assault and mutilation."

"I genitori non dovrebbero avere il diritto di infliggere chirurgicamente le loro preferenze religiose, sessuali o estetiche sui loro figli. E 'per il bambino a decidere, quando è nell'età della ragione. Fino ad allora, devono essere legalmente protetti da queste violenze e mutilazioni".

Shane has reconciled with his family, but his father Eric cannot forget the trauma that affected everyone's lives.

Shane si è riconciliato con la sua famiglia, ma suo padre Eric non può dimenticare il trauma che la vita gli ha riservato.

"Not for a moment did I imagine the impact this so-called safe and routine procedure would have on my son Shane's life, or the heartbreak it would cause those who love him," Eric says.

"Non per un attimo ho immaginare l'impatto di questa procedura cosiddetta di sicurezza e di routine che avrebbe sulla mia vita il figlio Shane, o il crepacuore causerebbe coloro che lo amano", dice Eric.

"Are parents prepared for the guilt they'll feel if their son is harmed, and the very real possibility it will tear their family apart?"

For Shane's mother, Kerry, having her baby circumcised is her biggest regret.

.... pubblicato nel 2006 ....

Awarded $360,000 [~$US234,000] compensation, this deeply traumatised medical student now wants to help others trapped by the same horror

Shane gave a seminar sharing his experience at the Sixth International Symposium on Genital Integrity at the University of Sydney. Many of the participants were in tears at the photographs he presented. Some expressed outrage that the "reparative" surgery removed still more of his sensitive mucosa.

Shane ha tenuto un seminario in cui ha condiviso la sua esperienza al sesto International Symposium on Genital Integrity presso l'Università di Sydney. Molti dei partecipanti erano in lacrime alla vista delle fotografie che ha presentato. Alcuni si sono indignati e hanno espresso che la chirurgia riparativa ha rimosso qualcosa di più della sua mucosa sensibile.

(www.circumstitions.com/Shane.html)

2 month old baby dies after circumcision

Baby dies after circumcision

The day after going home with their child the parents performed a circimcision at home which they state was in concordence with their religious beliefs.
The following day the child is noticed having difficulties breathing whilst in its pram being pushed by the parents. They flag down a passing police car who rushes the child to hospital. It died the following day. Post mortem states that the child died as a direct consequence of shock of the cutting of its foreskin which caused  the childs system to over produce over production of andrenalin and other internal chemical reactions which led to its death. The parents have been charged with manslaughter and are currently applying for bail pending the trail. Truly sad but I worry that there are so many fucked up stories regarding the horror emenating from the living ,practising mythologist community that there is the risk of becoming immune. WHich is why I took the time to post this.Lest I get to the point of  just sighing and raising eyebrows.

Valencia, Spain. 2011

martedì 23 agosto 2011

La circoncisione non riduce il rischio di malattie sessualmente trasmissibili

stop-HIV

La circoncisione non riduce il rischio di malattie sessualmente trasmissibili

La circoncisione maschile non ha ridotto il rischio di contrarre infezioni trasmesse sessualmente (IST) - quelli che causano la gonorrea, clamidia e la tricomoniasi - tra gli uomini in uno studio in Kenya (Journal of Infectious Diseases , Ottobre 2010). L'analisi dei dati sulle malattie sessualmente trasmissibili negli studi di circoncisione maschile condotti in in Sud Africa, Kenya e Uganda (New England Journal of Medicine and Study of Aids -Maggio 2011) ha mostrato che la circoncisione inoltre non offre protezione neppure contro il papillomavirus umano, anche se potrebbe offrire una protezione parziale dall'herpes genitale.

Adult Male Circumcision Does Not Reduce the Risk of Incident Neisseria gonorrhoeae, Chlamydia trachomatis, or Trichomonas vaginalis Infection: Results from a Randomized, Controlled Trial in Kenya e Sud Africa.


 
Effect of circumcision status on incidence of nonulcerative STI

The incidences of nonulcerative STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or as a fixed variable based on assignment (table 1). Incidence rate ratios for circumcised versus uncircumcised men (time-dependent circumcision status) were 0.95 for N. gonorrhoeae infection (95% CI, 0.68–1.34; P p.781 ), 0.87 for C. trachomatis infection (95% CI, 0.65–1.16; P = .325), 0.89 for N. gonorrhoeae and/or C. trachomatis infection combined (95% CI, 0.70–1.12; P = .305), and 0.77 for T. vaginalis infection (95% CI, 0.44–1.36; P = .346).
Incidence of nonulcerative STI by sociodemographic and behavioral characteristics and baseline infection status
The incidences of N. gonorrhoeae and C. trachomatis infection were increased among men with lower educational attainment, baseline N. gonorrhoeae or C. trachomatis infection, multiple sex partners reported in the 30 days previous to the visit at which infection was detected, and a history of having sex with a woman during her menses in the 6 months before infection was detected (table 1). For both N. gonorrhoeae and C. trachomatis infection, the incidence rates were highest among men who reported having sex during a woman's menses (N. gonorrhoeae and C. trachomatis, 8.0 and 9.3 cases per 100 person-years, respectively) and among those who had baseline N. gonorrhoeae and/or C. trachomatis infection (N. gonorrhoeae and C. trachomatis, 9.8 and 9.3 cases per 100 person-years, respectively; data not shown). The incidence of T. vaginalis infection was low, and few baseline factors distinguished men with infection at follow-up from those who were not infected (table 1). Men who reported a preference for dry vaginal sex had an increased incidence of T. vaginalis infection but not of N. gonorrhoeae or C. trachomatis infection, compared with men who preferred wet vaginal sex. The incidence rate of each infection was lower by 35%–50% among men reporting condom use at their last sexual intercourse. Marital status and herpes simplex virus type 2 infection at baseline were not significantly associated with increased incidence of nonulcerative STI. Only 7 HIV seroconversions occurred among men who also had incident nonulcerative STI; HIV seroconversion was detected in the same follow-up interval as was STI for 6 of the men. Thus, HIV seroconversion was not examined as a predictor of STI.

Cox proportional hazards regression: risks for infection

In multivariate regression, risks for N. gonorrhoeae and C. trachomatis infection were similar (table 2) and included N. gonorrhoeae or C. trachomatis infection at baseline, multiple recent sex partners, and sexual intercourse with a woman during menses. Condom use at last intercourse remained significantly protective against N. gonorrhoeae infection (HR, 0.50) and T. vaginalis infection (HR, 0.52) in multivariate analysis but not against C. trachomatis infection. The only other significant risk factors for T. vaginalis infection were baseline infection with C. trachomatis or T. vaginalis. Men who reported that their penis had been abraded or felt sore during intercourse in the 6 months before infection was detected had an increased risk for N. gonorrhoeae infection (HR, 1.61). There was no statistically significant or meaningful 2-way interaction term in any model. Examination of Schoenfeld residuals identified no violation of the assumption of proportionality for each independent variable or for the global test of each model.


Background We examined the effect of male circumcision on the acquisition of 3 nonulcerative sexually transmitted infections (STIs).
Methods We evaluated the incidence of STI among men aged 18–24 years enrolled in a randomized trial of circumcision to prevent human immunodeficiency virus (HIV) infection in Kisumu, Kenya. The outcome was first incident nonulcerative STI during 2 years of follow-up. STIs examined were laboratory-detected Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infection.
Results There were 342 incident infections among 2655 men followed up. The incidences of infection due to N. gonorrhoeae, C. trachomatis, and T. vaginalis were 3.48, 4.55, and 1.32 cases per 100 person-years, respectively. The combined incidence of N. gonorrhoeae and C. trachomatis infection was 7.26 cases per 100 person-years (95% confidence interval, 6.49–8.13 cases per 100 person-years). The incidences of these STIs, individually or combined, did not differ by circumcision status as a time-dependent variable or a fixed variable based on assignment. Risks for incident STIs in multivariate analysis included an STI at enrollment, multiple sex partners within <30 days, and sexual intercourse during menses in the previous 6 months; condom use was protective.

Conclusions: Circumcision of men in this population did not reduce their risk of acquiring these nonulcerative STIs. Improved STI control will require more-effective STI management, including partner treatment and behavioral risk reduction counseling.

Cox proportional hazards regression: risks for infection with N. gonorrhoeae and/or C. trachomatis

We combined N. gonorrhoeae and C. trachomatis infection at follow-up into a single outcome, owing to similarities in stratified models and to increase our power to detect significant associations (table 3). In a multivariate Cox regression analysis, N. gonorrhoeae or C. trachomatis infection at enrollment (HR, 2.31 [95% CI, 1.64–3.26]), multiple sex partners in the previous 30 days (HR, 2.15 [95% CI, 1.42–3.27]), and sexual intercourse during a woman's menstruation (HR, 1.67 [95% CI, 1.19–2.33]) remained significant predictors of N. gonorrhoeae and/or C. trachomatis infection (table 3). Conversely, higher education (HR, 0.67 [95% CI, 0.50–0.88]) and reported condom use at last intercourse (HR, 0.64 [95% CI, 0.50–0.82]) were protective against infection. There was no statistically significant or meaningful 2-way interaction term and no violation of the assumption of proportionality for each independent variable or for the global test of the model.
 
DiscussionWe did not find that adult male circumcision had a protective effect against any of the nonulcerative STIs examined (N. gonorrhoeae, C. trachomatis, or T. vaginalis infection) in these sexually active young men in Kisumu, Kenya. Multiple differences in organism pathogenesis and host immunogenicity may explain why circumcision may confer protection against HIV infection but not against these STIs. Specific HIV-1 target cells may be protected through increased keratinization resulting from circumcision; HIV-1 must attach to the CD4 receptor for cell entry. Bacterial STIs, such as N. gonorrhoeae, C. trachomatis, and T. vaginalis infection, however, may bind through multiple ligands and host receptors [18]. Unlike the chlamydia organism, gonococci are not obligate intracellular organisms, and T. vaginalis has complex and multiple methods of adhering to and entering host cells. The preferred host cell site is cuboidal or columnar epithelium (internal to the urethra) for both N. gonorrhoeae and C. trachomatis; thus, it is very unlikely that intact foreskin would provide protection against these infections. The suggestion of a protective effect stemmed from analysis of non-experimental study designs [19] rather than from a biological rationale. The findings of our randomized, controlled trial showing no association between circumcision status and these STIs confirm findings from several other studies with nonexperimental designs [11–14]. It is not likely that a longer observation period would have been necessary to demonstrate any potential protective effects; graphical inspection of the estimated cumulative hazard rate appears constant, and biological protective effects would be expected to appear shortly after circumcision. However, as demonstrated by statistical modeling, the effectiveness of circumcision in reducing the burden of HIV infection in the population varies by prevalence of circumcision, prevalence of HIV infection, and sexual behavior [20]; thus, adult male circumcision may have different effects on the risk of nonulcerative STIs at the population level, varying with population-level sexual practices and the prevalence of STIs and circumcision.
Despite the lack of protection against infection with N. gonorrhoeae, C. trachomatis, or T. vaginalis, adult male circumcision may have other beneficial effects on STIs, such as reduced transmission to sexual partners or decreased acuity or sequelae of infection. Among women enrolled as control subjects in a cervical cancer study in 5 countries, self-reported circumcision in male sex partners was strongly protective against C. trachomatis infection in the women [21]. Conversely, a cohort study examining hormonal contraception and the risk of HIV infection among women in 3 countries found that male sex partners' self-reported circumcision status was not associated with incident N. gonorrhoeae, C. trachomatis, or T. vaginalis infections in women [22]. However, few studies have examined this issue, and none were specifically designed to assess the association between male circumcision and the risk of STIs in female partners. Prospective studies comparing STI incidence among sexual partners and the course of infection among circumcised and uncircumcised men are necessary to determine a broader range of potential benefits of adult male circumcision.
Data on the incidence of nonulcerative STI among adolescent men in sub-Saharan Africa are limited, but the rates that we observed (combined incidence of N. gonorrhoeae and/or C. trachomatis infection, 7.26 cases per 100 person-years) seem to be relatively high. Among trucker drivers aged 16–62 years from Mombasa, Kenya, who were enrolled in a cohort study during 1993–1994, the incidence of N. gonorrhoeae infection was 12.6 cases per 100 person-years and the incidence of nongonococcal urethritis was 7.5 cases per 100 person-years [23]. As part of a 1997–1998 cross-sectional study in 4 sub-Saharan African cities, the prevalences of N. gonorrhoeae and C. trachomatis infection were 0% and 2.6%, respectively, among a representative sample of Kisumu men aged 15–49 years [24]. Beyond comparison with other populations, the incidence that we observed seems to be high contextually; the young men were enrolled in a study that provided ongoing testing and treatment for STIs, and men received risk-reduction counseling and unlimited numbers of free condoms. Men with baseline N. gonorrhoeae and C. trachomatis infection were at increased risk of reinfection. This suggests that men may become reinfected by infected partners. Infected men in the trial were given coupons for their sex partners to receive free treatment at a nearby clinic, but we do not know how many partners sought treatment. Our results suggest that more-aggressive partner tracing and treatment might be warranted.
Sexual intercourse with a woman during her menses was a risk factor for N. gonorrhoeae and C. trachomatis infection in stratified and combined analyses. In a previous analysis of our data, among men who were excluded from the trial because they were HIV infected at baseline, sexual intercourse with a woman during her menses was a risk factor for prevalent HIV infection in multivariate analysis [25]. Some studies have demonstrated increased HIV load during the menstrual phase of the menstrual cycle [26, 27]. In 1 study, sex partners of men with a diagnosis of gonorrhea were more likely to test positive for gonorrhea if they were tested during the menstrual phase rather than during other phases of the menstrual cycle [28], possibly because of increased organism shedding. There are limited published data quantifying STI organism load and transmission throughout the menstrual cycle. Individual studies suggest that mechanisms may include increased organism load or increased pathogenicity of organisms during menses as a result of altered genital flora [29]. Although further study is necessary to elucidate female-to-male transmission of STIs during the menstrual cycle, current counseling and prevention efforts could emphasize avoiding sexual intercourse during a woman's menses and using condoms.
Men who reported coital injuries (penis cut, scratched, or abraded during sexual intercourse in the 6 months before detected infection) had an increased risk of N. gonorrhoeae infection. The nature of these injuries and the mechanism by which they may increase the risk of infection are unknown. Use of condoms reduced the risk of infection by more than one-third, emphasizing the importance of promoting condom use.
The incidence (1.32 cases per 100 person-years) and baseline prevalence (2.1%) of T. vaginalis infection in our population was low, compared with prevalences detected in cross-sectional studies in other sub-Saharan countries. The prevalence of trichomoniasis was 11% among men aged 15–54 years in rural Tanzania [30] and 6.3% among male sex partners of a community-based sample of women in Moshi, Tanzania [31]. Because the epidemiological mechanism of T. vaginalis infection among African men is largely unknown, specific behaviors and sexual practices that increase risk may not have been measured in our study.
Limitations of the original trial have been reviewed elsewhere [3]; thus, our discussion of limitations is confined to the current analysis. If a large proportion of infected men sought treatment outside the study clinic, those infections would not be accounted for in this analysis, which would potentially lead to an underestimation of incidence and, thus, bias the results toward the null. Some participants did not attend all scheduled follow-up visits, but <5% of enrolled men did not have any follow-up testing for STIs. These men were significantly less likely than men with STI testing at follow-up to report coital injuries (results not shown). However, their baseline characteristics did not differ from those of men who received follow-up with regard to the number of sex partners in the previous 30 days; baseline infection with N. gonorrhoeae, C. trachomatis, or T. vaginalis; sexual intercourse during a woman's menses, condom use at last intercourse, age, educational attainment, or treatment assignment. Finally, behavioral risks were self-reported and were therefore subject to limitations of recall and socially desirable reporting.


We did not find that adult male circumcision had a protective effect against any of the nonulcerative STIs examined (N. gonorrhoeae, C. trachomatis, or T. vaginalis infection) in these sexually active young men in Kisumu, Kenya e in Uganda.

Potential conflicts of interest: none reported.
Financial support: Family Health International, supported by the US Government and the Bill and Melinda Gates Foundation (to R.C.B.); Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health (AI50440); and Canadian Institutes of Health Research (HCT 44180; investigator award to S.M.).

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

(da Journal of Africa & Journal of Infectious Diseases)

martedì 16 agosto 2011

La circoncisione maschile non fornisce alcun beneficio diretto per le donne

Image and video hosting by TinyPic

La circoncisione maschile non fornisce alcun beneficio diretto per le donne

Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial

Circoncisione di uomini con infezione da HIV non ridurre la trasmissione dell'HIV ai loro partner sessuali femminili non infetti da oltre due anni in uno studio randomizzato di prova fra 450 coppie in Uganda. La prova è stata effettuata a causa di un precedente studio osservazionale aveva suggerito che i partner di uomini HIV-positivi avevano meno probabilità di acquisire l'HIV se gli uomini sono stati circoncisi. I risultati confermano inoltre che gli uomini con infezione da HIV che fanno sesso prima della cicatrizzazione completa della ferita in seguito a una circoncisione, possono essere ad aumentato rischio di trasmissione del virus. "La stretta osservanza di astinenza sessuale durante la guarigione della ferita e l'uso del preservativo deve essere coerente in seguito fortemente promosso", scrivono gli autori. Un commento sulle note di studio che le donne con partner circoncisi sono anche a maggior rischio di diverse infezioni trasmesse sessualmente.

922 uncircumcised, HIV-infected, asymptomatic men aged 15—49 years with CD4-cell counts 350 cells per μL or more were enrolled in this unblinded, randomised controlled trial in Rakai District, Uganda. Men were randomly assigned by computer-generated randomisation sequence to receive immediate circumcision (intervention; n=474) or circumcision delayed for 24 months (control; n=448). HIV-uninfected female partners of the randomised men were concurrently enrolled (intervention, n=93; control, n=70) and followed up at 6, 12, and 24 months, to assess HIV acquisition by male treatment assignment (primary outcome). A modified intention-to-treat (ITT) analysis, which included all concurrently enrolled couples in which the female partner had at least one follow-up visit over 24 months, assessed female HIV acquisition by use of survival analysis and Cox proportional hazards modelling. This trial is registered with ClinicalTrials.gov, number NCT00124878.

The trial was stopped early because of futility. 92 couples in the intervention group and 67 couples in the control group were included in the modified ITT analysis. 17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0·36). Cumulative probabilities of female HIV infection at 24 months were 21·7% (95% CI 12·7—33·4) in the intervention group and 13·4% (6·7—25·8) in the control group (adjusted hazard ratio 1·49, 95% CI 0·62—3·57; p=0·368).

Circumcision of HIV-infected men did not reduce HIV transmission to female partners; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.

(da TheLancet-National Institutes of Health)

domenica 14 agosto 2011

Buon Ferragosto a Tutti

Image and video hosting by TinyPic

venerdì 12 agosto 2011

Two die at circumcision schools

Image and video hosting by TinyPic

Initial reports on the traditional circumcision schools in Limpopo this year indicate that the ritual is not 100% successful, as was the case last year.

Yesterday Chief Vusani Netshimbupfe, chairperson of the Limpopo Initiation School Task Team, told The New Age that 306 initiation schools were based in the province this winter although the final report was not yet available.

“Reports from districts such as Waterburg and Sekhukhune are still outstanding and we hope to get them this week. Two initiates died separately in Ga-Mashishi Village in Sekhukhune and one in Nwametoa in Mopani respectively. We have not received postmortem reports on the cause of deaths as yet. One initiation camp was closed down after we set police on it because operators were using fake documents. We transferred the affected initiates to another school,” said Netshimbupfe.

He said although most of the initiation schools were for males, there were a few for females. “We will be able to give you more details in terms of gender and the exact number of initiates once we have rubber stamped the official report on initiation schools for this year,” he said.

(da World News-Sud Africa)

domenica 7 agosto 2011

Esperti Aids scettici sui benefici della circoncisione maschile

Aids expert sceptical about benefits of male circumcision
HEALTH


Esperti su Aids scettici sui benefici della circoncisione maschile.

Recent studies have shown no evidence that male circumcision lessened the spread of HIV, a leading expert on the disease says.

"Recenti studi non hanno mostrato nessuna evidenza che la circoncisione maschile possa ridurre la trasmissione del virus HIV", uno dei maggiori esperti sulla malattia dice.

Director of the UNAIDS Regional Support Team for Asia and the Pacific, J.V.R. Prasada Rao expressed scepticism about the popular belief, which if confirmed, could help prevent the disease in men.

Direttore del Nucleo Regionale di supporto UNAIDS per l'Asia e il Pacifico, Prasada Rao JVR espresso scetticismo circa la credenza popolare che circoncisione potrebbe aiutare a prevenire la malattia negli uomini.

HIV is a virus that leads to Aids, which primarily attacks the body's immune system causing it to gradually fail. This leads to increased susceptibility to otherwise common infections such as influenza which can become life-threatening.

There is currently no cure for the virus, frequently transmitted through the transfer of bodily fluids such as blood, semen, vaginal fluid and breast milk.

L'HIV è un virus che porta all'AIDS, che attacca soprattutto il sistema immunitario. Questo porta ad un aumento della suscettibilità alle infezioni altrimenti comuni, come l'influenza che può diventare pericolosa per la vita.

Non esiste attualmente alcuna cura per il virus, spesso trasmesso attraverso il trasferimento di fluidi corporei come sangue, liquido seminale, liquido vaginale e latte materno.

Preventative methods only reached less than 20 per cent of these target populations especially in areas such as Thailand and Cambodia, Mr Rao added.

Different societal cultures also has to be taken into account when implementing such measures ? especially predominantly Islamic states such as Malaysia as the religion traditionally prohibits birth control.

In 2010 the WHO and UNAIDS have retracted that circumcision can prevent the spread of HIV among heterosexual.

(da cirp.org.)

venerdì 5 agosto 2011

La circoncisione non può proteggere gli omosessuali da HIV

(Reuters Health) - While circumcision has been shown to lower a man's risk of contracting HIV through heterosexual sex, a new study indicates that the value of circumcision for gay and bisexual men remains questionable.

In a study of more than 1,800 men from the U.S. and Peru, researchers found that overall, the risk of contracting HIV over 18 months did not significantly differ between circumcised and uncircumcised men.

Over the study period, 5 percent of the 1,365 uncircumcised men became HIV-positive, as did 4 percent of the 457 circumcised men, according to findings published in the journal AIDS.

All of the men in the study reported having sex with other men and were considered to be at increased risk of HIV infection because they were already infected with the genital herpes virus (herpes simplex type 2), which can make people more susceptible to HIV.

Male circumcision is far more common in the U.S. than in most other countries, and 82 percent of the 462 American men in the study were circumcised, compared with just 6 percent of the 1,360 Peruvian men.

The researchers did find some hints that circumcision could be protective among men who primarily had insertive sex with other men. Among men who said they'd had insertive sex with their last three male partners at least 60 percent of the time, circumcision was linked to a 69 percent lower HIV risk.

That difference, however, was not statistically significant, which means the finding could be due to chance.

Taken together, the results "indicate no overall protective benefit from male circumcision" when it comes to male-to-male HIV transmission, write the researchers, led by Dr. Jorge Sanchez of the research organization Impacta Peru, in Lima.

They add that studies should continue to look at whether circumcision affects HIV risk from insertive sex and do so in larger, more diverse study groups.

In general, the researchers write, public-health messages for gay and bisexual men should "reinforce the importance of condom use for HIV prevention."

The findings may help inform debate over whether circumcision could stand as a weapon against HIV transmission among men who have sex with men.

In 2005 and 2006, three clinical trials in Uganda, South Africa and Kenya showed that circumcision can reduce a man's risk of HIV infection through heterosexual sex by up to 60 percent.

The World Health Organization now recommends medically supervised circumcision as one way to lower men's risk of HIV in countries where heterosexual transmission is common.

But the public-health value of circumcision in other countries, including the U.S., is a contentious issue. Most HIV infections in the U.S. are related to homosexual sex or IV drug use and studies have yet to find strong evidence that circumcision lowers HIV transmission among men who have sex with men.

Circumcision is thought to lower the heterosexual transmission of HIV and other sexually transmitted diseases through several mechanisms. One is by reducing the amount of mucosal tissue exposed during sex, which limits the viruses' access to the body cells they target. Another theory is that the thickened skin that forms around the circumcision scar helps block the viruses' entry.

One reason circumcision might have little effect on homosexual HIV transmission is that it would have no impact on the risk from receptive anal sex. Experts have also pointed out that in wealthier countries, many HIV-positive people are on powerful anti-viral drugs that reduce the risk of transmission, and any added effect of circumcision might be small.

Currently, the American Academy of Pediatrics does not recommend routine circumcision for newborns, citing insufficient evidence of overall health benefits. The U.S. Centers for Disease Control and Prevention, meanwhile, is in the process of developing recommendations on adult and infant circumcision for lowering HIV risk.

(Fonte: Reuters.com/AIDS, 2010)

lunedì 1 agosto 2011

PEDIATRIA: MARTINI E FIMP SIGLANO INTESA CONTRO CIRCONCISIONE

Roma, Luglio 2011 (Adnkronos salute) - Rinnovato l'accordo di intesa già intrapreso e siglato a Roma nel Settembre del 2010 tra medici, pediatri e Ministero della Salute. Obiettivo: contrastare il fenomeno delle circoncisioni clandestine. Domani il sottosegretario alla Salute Francesca Martini e il presidente della Federazione italiana dei medici pediatri (Fimp), Giuseppe Mele, "dopo un percorso di riflessione comune sottoscriveranno un Protocollo di Intesa per la prevenzione della circoncisione rituale clandestina, aperto - si legge in una nota del ministero del Welfare - al contributo di tutti gli attori che operano nel campo della salute del bambino".

Il Protocollo sarà illustrato domani a Roma, in un incontro alle 10.30 nella sede del Ministero di Lungotevere Ripa, 1 (Sala Auditorium). All'incontro a parteciperanno anche i rappresentanti delle società scientifiche e delle associazioni professionali che operano nel campo della pediatria, della ginecologia, dell'ostetricia e della neonatologia.

(Fonte: IGN-PORTALE GRUPPO ADNKRONOS)