S Afr Med J. 2008 Oct;98(10):789-94.
Visualizzazione post con etichetta Hiv. Mostra tutti i post
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martedì 11 novembre 2014
Male circumcision and hiv
lunedì 2 giugno 2014
MASS CIRCUMCISION CAMPAIGNS
MASS CIRCUMCISION CAMPAIGNS: The Emasculation and Harassment of Africa
And now, it seems, circumcision promoters are asking themselves, "What could be the problem? What has gone wrong? Why aren't men breaking down the doors to have part of their penis cut off?"
"Circumcise or bust!" seems to be the motto.
"We need to do whatever it takes to get as many men and boys circumcised."
And this, I believe, is what's wrong with HIV programs in Africa today. There is something wrong when progress on the HIV front is measured, not by how much HIV infection has decreased in time, but by how prolific the practice of circumcision has become. It is simply mistaken to assume that a mostly circumcised population automatically translates to a lowered HIV transmission rate, as real-world data indicates.
Latest Ploy: Sex Appeal
Circumcision advocates have been trying to use the influence of women to try and see if they could coerce men to go get circumcised. For a while now, programs like PEPFAR have been trying to sell circumcision as "beneficial to women," rather farfetched, as, even if the so-called "research" is correct, circumcision would only reduce HIV transmission from women to men. Actually, research shows that women are 50% more likely to acquire HIV from a circumcised partner, but this fact is ignored. In sub-Saharan Africa, women constitute 60% of people living with HIV, according to none other than the WHO itself. Circumcision promoters, however, still insist that male circumcision eventually benefits women "because less men being infected with HIV means less women will be infected."
To be quite sure that women will be interested in making sure their partner is circumcised, other dubious claims are sprinkled into the mix, such as a claimed reduction in HPV, which exclusively affects women, and other STDs. (Actually, studies are conflicting regarding the HPV claim. The claim falls apart in light of recent data, but circumcision proponents continue to adorn HIV propaganda with it none the less.)
But now, it seems, circumcision promoters are through with trying to use pseudo-scientific alibis to get women to influence the men, and are now turning to flat-out emasculation and harassment.
The following posters are apparently being used as part of the circumcision propaganda going on in Africa:
Is this what it has come to?
The photo at the head of this article shows a man in a T-shirt. The T-shirt reads "EARN RESPECT: TEST AND CIRCUMCISE."
Is this what it has come down to?
A man can't be respected unless he is circumcised?
What if he tests, is STD-free, and consistently wears condoms?
This is not enough to earn "respect?"
As an intact man who is STD-free and faithful to his wife, I am insulted. Is what I do not enough? Do I not deserve respect until I have part of my penis cut off? Is this what they call "voluntary?" How is this not outright coercion?
Circumcision/HIV propaganda has gotten out of hand. I think it's about time human rights organizations stepped in and stopped this madness. This isn't HIV prevention, this is outright harassment and humiliation masquerading as medicine and foreign aid.
A Disservice in the Fight Against HIV/AIDS
We intactivists keep saying time and time again; the promotion of circumcision is going to make the HIV/AIDS problem WORSE, because it gives men and women a false sense of security, and an excuse to forgo condoms, which, even given the so-called "evidence," would still supersede circumcision. News outlets and organizations report that men are already saying they don't have to wear condoms, and that it is hard for women to convince emboldened circumcised men to wear condoms. In a Botswana sex scandal, a woman claims that the health minister she slept with couldn't have infected her with HIV because he's circumcised. (The research says SHE can't infect HIM IF she were HIV+.)
In response to questions about risk compensation, circumcision promoters like PLoS and Richard Wamai assert flatly that the evidence for it "doesn't exist," that the evidence that does exist (theirs, of course) says that risk compensation isn't a problem. However, absence of evidence is not equivalent to evidence of absence.
The following articles certainly show that a false sense of security in circumcised males is a problem:
UGANDA: Myths about circumcision help spread HIV
ZIMBABWE: Circumcised men abandoning condoms
Here is evidence of risk compensation that “simply does not exist” – according to some:
Botswana – There is an upsurge of cases of people who got infected with HIV following circumcision.
Zimbabwe – Circumcised men indulge in risky sexual behaviour
Nyanza – Push for male circumcision in Nyanza fails to reduce infections
Providing a dubious form of "protection," which can, and is being perceived in Africa by men and women, as an alternative to the most conclusively effective mode of prevention, condoms, is a disservice in the fight against HIV/AIDS.
If indeed men are walking away with the message that they don't have to wear condoms because they're circumcised, then intactivist predictions were right all along; the promotion of circumcision is spreading HIV/AIDS, and millions, if not billions in precious funds are being squandered on a dubious mode of prevention that is not only not helping, but making things worse, where the money could be better spent on promoting more effective ways of HIV prevention, if not on other, much needed medicine.
A Crime Against Humanity
It is simply despicable that the very idea that circumcision could do anything to prevent HIV transmission was even considered at all. It horrifies me that some people actually took it a step further and decided to test this hunch, with absolutely no demonstrable causal link, by circumcising thousands of men to see which ones would get HIV and which ones would not. One would think that scientists and researchers learned their lesson after Tuskegee. I don't even know what to think, now that entire "mass circumcision campaigns" are being carried out based on dubious "studies" which continue to have no scientific foundation, whose results were ill-conceived and exaggerated, where the claim that circumcision has anything to do with HIV transmission is pure correlation hypothesis.
I ask, what if it could be proven with "research" that the removal of the labia and clitoral hood "reduced the likelihood of HIV transmission" from female to men? The disproven hypothesis that the Langerhans cells facilitate HIV transmission in males, as they are found in the mucosal lining of the foreskin, would also apply to female genitalia, whose mucosal lining is lined with the same cells. In at least one study, it would appear that HIV was less prevalent in circumcised women. And yet, there was no rush to test and see if this worked. No "trials" to circumcise thousands of women to see what "effects" this might have on HIV transmission.
Why?
Because no one is interested in justifying female genital cutting; it is clear to everyone that female circumcision is unethical, and no amount of "research" could be used to justify it. The converse is true with circumcision, where "researchers" are trying to "prove" that male circumcision, particularly the forced circumcision of males, is "ethical" by showing it is "not harmful," even "beneficial" to males. We have this double-standard where the vindication of female genital cutting through "science" and "research" is unacceptable and flatly rejected, but the vindication of male genital cutting is not. No organization would ever approve of similar "trials" in African women as they were in African men. Dissenters would argue that if positive findings were published, advocates of FGM would pounce upon them as vindication, and rightly so.
And yet, this wasn't a concern with male circumcision.
It wasn't a concern that advocates of circumcision would use the "research" to justify forced genital mutilation in boys and men.
I will go as far as to wager that the justification of forced genital mutilation in boys and men is precisely what the "researchers" had in mind.
No, actually, I KNOW for a fact that is what they had in mind; the idea that circumcision could "prevent HIV/AIDS" was actually heavily promoted by Jewish circumcision advocate Aaron J. Fink, out of disdain for policy statements of medical organizations at the time, which were already saying that infant circumcision was harmful. Others jumped on the idea, and they've been trying to "prove" that male circumcision "prevents HIV" ever since.
Much media attention is given to the fact that girls and women suffer FGM by amateurs in the African bush. Attention is brought to the fact that FGM is performed using crude instruments such as glass shards and rusty blades. Attention is brought to the fact that girls are abducted to be circumcised. Attention is brought to the fact that FGM results in death. But little attention is given to the fact that boys and men being circumcised in Africa suffer the exact same predicaments.
In criticizing Sara Johnsdotter and Lucrezia Catania, Hussein Ghanem said that their research, which showed that FGM isn't as detrimental as often portrayed, "played right into the hands of people who defend female genital cutting." But for whatever reason, this wasn't a concern when the WHO endorsed male circumcision as HIV prevention.
Yes, they try very hard to sell the slogan "Voluntary Male Medical Circumcision," as if adding the words "voluntary" and "medical" are supposed to make the fact that male genitals are being cut any more rosy. Somehow, I don't think the words "Voluntary Female Medical Circumcision" could ever be successfully juxtaposed.
But are people aware that boys and men are being forcibly circumcised in Africa? Are they aware that the pretext of "HIV prevention" is being used by some tribes to abduct and forcibly circumcise men in rival tribes? Are they aware that men are going around stopping men, asking them to take down their pants to see if they're circumcised? No doubt some may see this as "poetic justice" for the harassment Jews experienced in the Holocaust. Was this not a concern? Or was this actually an intended consequence to "create demand" for so-called "Voluntary Male Medical Circumcision?"
Here is a list of reports of boys and men being forcibly circumcised:
Here is a list of reports of boys and men suffering complications, or dying as a result of annual initiation rites:
The WHO endorsement of circumcision as HIV prevention has served to embolden forced circumcision wars among rival tribes, and to endorse traditional initiation practices which put the lives of boys and men in danger.
Would the WHO ever endorse female circumcision, even if this were "research-based?"
No. For the reason that they know that it would result in the de facto endorsement of human rights violations. They would not do anything that would "play into the hands of FGM advocates."
So why the different set of rules for male circumcision?
Why the blind eye and deaf ear to the forced MGM inflicted on boys and men?
Out of Touch
Eight years following the WHO endorsement of circumcision as HIV prevention, and millions of dollars later, African men aren't too keen on the idea of cutting off part of their genitals, and organizations intent circumcising the whole of the African male population seem to be puzzled and frustrated that their programs simply aren't taking off as they would have liked. Here and there one can read articles about circumcision promoters and organizations thinking out loud, asking themselves "What went wrong?"
I've read articles on the PEPFAR website. I've seen videos and articles published by the Bill and Melinda Gates Foundation. I've seen articles published in peer reviewed journals. "Studies" and "research" on the "feasibility" of circumcision scale-up projects, the "acceptability" of circumcision, attitudes in men and women, their views of circumcision.
Instead of seeking to better educate Africans about the sexual transmission of STDs, it seems, promoters are intent in looking for the best way to brainwash them into both, believing circumcising their men and boys is desirable, and that they need to continue using conventional methods of STD prevention, such as fidelity and condoms.
The buzz words going around in circumcision/HIV circles is "demand creation." These words ought to strike audiences as odd, because one would think that the magic words "reduces HIV by 60%" would be a good enough incentive for men to go out and get circumcised, would they not?
"If you build it, they will come" didn't work. And millions have been squandered in ad campaigns all over Africa. In some areas, promoters are turning to bribery.
What could be the problem?
Africans Aren't Stupid
It doesn't take a rocket scientist to figure out why circumcision promoters are having trouble achieving their quotas. You don't need "studies" and "surveys" to figure out why.
Men simply don't see the value of getting circumcised, to undergo a painful, life-altering, permanent surgical alteration, which will permanently change the appearance and mechanics of their penises, if it means they only get "partial protection." Being told that "circumcision reduces HIV transmission by 60%" isn't all that impressive if it means that they still have to wear condoms.
Married men simply don't see the value of getting circumcised if they are faithful to their wives, and therefore not at risk for sexually transmitted HIV.
Women certainly don't want to be made to feel like their man is going out on them with other women. They want to be able to trust their partners with fidelity. So why would they encourage their men to go get circumcised? What can having their husbands go get circumcised mean, other than that they are expecting them to be unfaithful?
That the people up at HIV organizations think that they can actually get away with promoting circumcision the way they do can mean only one of to things; either HIV organizations are dense and stupid, or they believe the African public is.
From an outside, non-African perspective, I simply can't believe the bullshit that western HIV organizations are attempting to feed the people of Africa. Looking at what's going on in Africa, I'm simply insulted as an intact male.
As an intact man, I am expected to believe that, a) circumcision "reduces the likelihood of HIV transmission by 60% (from female to male)," and b) that I still have to wear condoms.
I ask, why in the world would any man in the right mind choose to have part of his penis removed, if it meant that one still had to wear condoms?
I ask, if I'm not convinced by this argument, why would I expect any other man to be? Let alone the men in Africa?
No intact man in the right mind could ever go for this. Men who are fully informed, men who have been made aware of all the facts simply cannot see any value in undergoing circumcision, and can clearly see that it is complete madness that organizations are spending millions in funds trying to convince other men to part with their foreskins for only "partial protection." If you went around pushing this nonsense in Europe, people would laugh in your face. They're pushing this shit in Africa because they think Africans are gullible idiots.
The only people who see the value in circumcision campaigns are those men and women who already have religious or cultural convictions for the practice of circumcision. They would like circumcision to be a free service, performed at hospitals by trained professionals, as opposed to the African bush, performed by amateurs using crude utensils, where men are more likely to suffer complications, including infection, loss of their organ, and even death. People with religious or cultural convictions for circumcision cannot verily declare this to be the case, so they are more than likely to disguise these convictions and desire to have circumcision as a free service by parroting the circumcision/HIV propaganda. "I am glad I am protected," they will say, when they truly mean to say "I cashed in on a free circumcision, thanks to these HIV programs!" "Everybody should be circumcised in order to prevent HIV infection," they will say, when they mean to say "We want all men to be circumcised and must submit to our tribal or religious tradition."
THE SOLUTION: More Money, More Propaganda
So eight years and several million dollars later, the great scheme to circumcise Africa in the name of HIV transmission hasn't taken off. Africans simply aren't buying it. Worse than that, the risk compensation nightmare intactivists have warned about from the very beginning is coming true.
Men are walking away with the message that condoms aren't necessary once they're circumcised. This false sense of security makes it difficult for female partners to convince them to wear condoms.
The endorsement of circumcision as HIV prevention is seen as a green light for traditional, rite-of-passage circumcision practices, as well as the forced circumcision of men by men in rival circumcising tribes, resulting in infections, loss of genital organs and death, not to mention an increased risk of HIV transmission due to the usage of dirty, crude equipment.
These "mass circumcision campaigns" are a massive failure. But how are circumcision promotion agencies responding? What is their solution?
More money, more propaganda.
"Demand creation," say the circumcision "experts," is the key.
HIV promoting organizations are observing what's happening, and their solution is to up the ante, use more coercive tactics to get the men to circumcise themselves "voluntarily."
The problem, the reason they aren't seeing men flocking to get circumcised, according to them, is that men simply don't understand what's good for them. The women don't either. The solution is to "understand" "why" people aren't buying it, in order to hit the right buttons, come up with the necessary "studies" that quell people's fears, and people will start banging down the doors.
In Swaziland, the US wants to spend another 24.5 million to attempt to circumcise the male Swazi population again. This time, they're through with the "voluntary" part of the slogan, and they have their eyes set on newborns. (There is zero evidence that newborn circumcision does anything to reduce HIV transmission, not to mention the reality that is the United States of America, where 80% of US males are circumcised from birth, and yet the United States has a higher HIV prevalence rate than 53 countries where circumcision is rare [under 20%] or not practiced, according to he CIA Factbook.)
Because, apparently, enough money hasn't been squandered in circumcision campaigns as it is.
"Demand Creation": What does it mean?
Currently "demand creation" are the buzz words among circumcision promoters. But what do these words mean? To me this can only mean brainwashing and counterproductive propaganda.
When the goal of HIV organizations is no longer to prevent HIV, when the goal is, instead, to circumcise as many men, boys and children as possible, when the goal is to gain the "acceptance" of circumcision, when the goal is to achieve a quota within a certain time frame, then the only outcome of this is can be lies and deception.
In order to achieve "demand creation," one can expect more attacks on African masculinity. More coercion through sex appeal. More "studies" exaggerating the "benefits" of circumcision. More diseases that circumcision is supposed to cure. With the promotion of male infant circumcision, there will be more "studies" minimizing the risks and harms of circumcision. (Is it any wonder that the CDC has already published a "study" saying when the best time to circumcise male is?)
Men and women who fully understand the facts, that circumcision is a painful, permanent alteration which, even if the current "research" were correct, could only provide "partial" protection, that circumcision fails and therefore condoms must still be used, do not, cannot possibly see any value in circumcision. Men fully aware of the facts do not, cannot be convinced to accept this for themselves. Parents fully aware of the facts, do not, cannot be convinced to accept this for their children. Therefore the only possible outcome is that, in order to realize quotas and meet deadlines, the facts must be denied, lies must be told, and the truth must be hidden at all costs.
Therefore the only outcome of "demand creation" is that the public will believe that circumcision prevents HIV transmission, that being circumcised means condoms are disposable, that unsafe sex with a man is acceptable as long as he is circumcised.
Therefore the only outcome of "demand creation" is, necessarily, that the HIV epidemic in African countries will be exasperated.
At the expense of the American taxpayer.
At the expense of the truth.
At the expense of scientific credibility.
At the expense of the human dignity of Africans.
At the expense of African lives.
At the expense of basic human rights of minors.
The problem isn't that African men and women "don't understand" and that they need to be "educated," no. The men and women and Africa understand what circumcision and HIV are. They understand that circumcision, even if the "research" were accurate, could only provide "partial protection," that men would still have to wear condoms, and simply aren't interested.
The problem is that the people at HIV organizations, the people at the American CDC, the people at PEPFAR, the people at Bill and Melinda Gates, the people at the WHO have all lost their senses completely.
It is absolute madness that they've all made it the end goal of the HIV movement to circumcise Africa, if not the world. While precious funds could be put to better use, millions are being squandered on promoting a dubious form of HIV prevention which is already superseded by the cheaper, less invasive, more effective modes of prevention which are condoms and education.
Beyond Circumcision
Circumcision does not, cannot stop HIV transmission. Even if the research is accurate, circumcision fails to prevent HIV transmission, which is why circumcised males must still be urged to wear condoms. There is no doctor, researcher or HIV organization that can deny this fact. Circumcision is a stop-gap at best, and scientists and researchers need to be looking for other, better ways to prevent HIV. Or, at least they're supposed to be.
Are circumcision scientists and researchers thinking of a time where HIV can be stopped in less invasive ways, without surgery? Is there a time in their minds when there will be a method of HIV prevention so effective circumcision can be discontinued? What non-cutting way are "researchers" looking into? Or is circumcision all they got?
Has anyone up at the WHO, up at PEPFAR, etc. stopped to consider that maybe perhaps the men aren't stupid and don't WANT to be circumcised?
Here's a question I've got to ask; do these "mass circumcision campaigns" offer men alternatives?
Have "researchers" considered the possibility men may not want to get circumcised despite the much touted "benefits," that "60%" may not be all that convincing, and that they're just going to have to accept that some men may not want to get circumcised?
Do HIV information packages that are given the men and women include the option NOT to circumcise?
Something that reads along these lines:
These are the facts.
I somehow doubt that men and women in Africa will be give them, seeing as knowing these facts will defer them from opting in favor of circumcision, and HIV organizations are given quotas for funds from PEPFAR, Bill and Melinda Gates, etc.
HIV organizations, what's plan B?
Or is circumcision all you have?
Is it just that HIV organizations are spending millions in precious funds on a dubious, invasive, expensive form of HIV prevention that nobody wants?
When condoms are already cheaper, less invasive, and more worlds more effective?
Circumcision Promotion vs HIV Prevention: What Is the Objective of HIV Organizations?
It is clear that the HIV movement has been hijacked by mad individuals with the twisted world view that all boys and men in the world ought to be circumcised. Instead of the prevention of HIV transmission, their goal has become to circumcise boys and men in and outside of Africa at all costs.
The actions of circumcision advocates at HIV organizations, their resolve to keep spending millions on promoting circumcision, even after having previously spent millions more, indicate that they believe Africans are incapable of deductive reasoning. A separate experiment is being carried out in Africa, with African men, women and children as guinea pigs. This is not about how much HIV can be prevented, but about how people can be more effectively brainwashed, about just how gullible and stupid people can be, and what they could be manipulated into doing.
Look at the latest in circumcision "research." It focuses on "acceptability" and "feasibility." It has nothing to do with HIV prevention mechanisms; the research is in how people can be more efficaciously brainwashed. It's almost as if they've given up on researching for an actual HIV solution. All their eggs are in the circumcision basket. Circumcision promoters are taking advantage of the impoverished state of African nations in order to conduct social experiments on them.
There is a problem when the slogan to promote circumcision is no longer "reduce your chances of contracting HIV prevention," but has been replaced with "become popular with women" and "last longer in bed." There is a problem when HIV organizations are more concerned with "demand creation" for a dubious mode of HIV prevention with human rights implications, than they are in making sure Africans understand how they can be HIV/AIDS free.
There is a problem when millions of dollars are being pumped into a mode of prevention that men don't want, and for good reason. There is a problem when the goal of circumcision promotion replaces HIV prevention.
The goal of HIV organizations needs to be brought back into focus, which is to prevent HIV and find a cure. If the end goal is to make sure everyone is circumcised, regardless of whether or not HIV is being prevented, not to mention other medical problems where precious funds are needed, then HIV organizations seriously need to reevaluate their priorities.
Conclusion
The promotion of male circumcision as HIV prevention is not based in science, but on unproven, or even disproven theories and correlation hypothesis based on exaggerated numbers. There is no scientifically demonstrable causal link between the foreskin and increased HIV transmission, and conversely, between circumcision and decreased HIV transmission. Without it, the campaigns in Africa are belief-based, not science-based medicine.
Real world data does not support the claim circumcising 80% of the male population results in decreased HIV transmission.
It is simply irrefutable that circumcision does not, cannot prevent HIV transmission. Circumcision fails to prevent HIV, and no doctor, researcher or scientist can deny this fact; this is the reason why circumcised men must still be urged to wear condoms.
The promotion of male circumcision is doing more harm than good, as it is a dubious form of HIV prevention which is being seen as an alternative to more effective sex practices, such as abstinence, fidelity and condoms.
The promotion of male circumcision is resulting in the violation of basic human rights of boys and men in and out of Africa; rival tribes are forcibly circumcising each other, boys and men are being abducted and forcibly circumcised, and the forced circumcision of minors is being promoted.
The promotion of male circumcision is resulting in yearly massacre in Africa, where WHO endorsement is seen as a green light for traditional rites of passage.
The promotion of male circumcision is resulting in the humiliation and sexual harassment of men who are not circumcised and do not want to be circumcised.
The promotion of male circumcision is a gross waste of funds which could be being put to better, more productive use.
The promotion of male circumcision is a sexist, misandrist, mean-spirited attack on male sexuality, upon African males, upon children in other parts of the world, and the male sex in general, and the WHO should have NEVER endorsed it.
The "mass circumcision campaigns" have got to be stopped. The WHO needs to retract it's recommendation of male circumcision as HIV prevention, and the forced circumcision of healthy, non-consenting individuals needs to be recognized for the mutilation and violation of basic human rights it is.
I call on reputable scientists, researchers, doctors and medical organizations with a conscience, to speak out and demand that the WHO retract their endorsement of circumcision as HIV prevention, and to call out that these "mass circumcision campaigns" be brought to a halt.
Update (5/27/2014):
Latest ploy in Zimbabwe: "Circumcision makes you smarter."
If circumcision makes you smarter, what does this imply if you have a foreskin? Are African boys and men aware they're basically being slapped in the face?
Photo taken from ploscollections.com
It seems organizations intent on seeing the whole of Africa circumcised are growing ever desperate that their "mass circumcision campaigns" aren't working out as they had wished.
The pretext for promoting male circumcision for all is "HIV prevention," and sprinkled here and there, on various HIV organizations, one can read slogans along the lines of "an AIDS-free world." Or "an AIDS-free generation." "We can achieve it!," spokespeople say. "And the solution is circumcision!"
To begin with, "circumcision prevents HIV" is already a dubious, wishy-washy premise. Promoters of circumcision-as-HIV-prevention are careful in the way they present circumcision. They can't verily say "Circumcision prevents HIV," because it doesn't. They can't also say "Circumcision fails to prevent HIV, so circumcised men still have to wear condoms" either, because that would drive HIV charity donors, not to mention the men they're trying to convince, away.
No. They have to say "circumcision reduces HIV transmission by as much as 60%," that "circumcision is not foolproof" and that it has to be "part of a comprehensive package." They have to gloss over the fact that they've yet to establish a scientifically demonstrable causal link between the presence of the foreskin and increased HIV transmission, and/or between circumcision and decreased HIV transmission. They have to be careful to not bring any attention to the reality that a reduction in HIV transmission has not been observed in other populations where the majority of men are already circumcised, including other parts of Africa, South East Asia (e.g. Malaysia and The Philippines), and the United States.
The dubiousness of circumcision as an HIV prevention method goes further back. Promoters of circumcision would like to pretend as if circumcision were this "brand new innovative technology" that they've only "just found" yesterday, when history tells us that circumcision advocates have been trying to make circumcision relevant to medicine for at least 150 years. The idea that circumcision might do anything to prevent HIV is itself close to 30 years old.
Not to mention the fact that the practice itself has been under fire as far back as Greco-Roman rule; there are other, deep-running convictions to defend circumcision which have absolutely nothing to do with a genuine concern for disease prevention and public health. Circumcision may be an important rite of passage for members of certain tribes, for example. It is considered divine commandment by Jews, Muslims and certain Christian sects (although circumcision is not once mentioned in the Qur'an, and the New Testament says circumcision profits the Christian nothing.)
Jews have defended the practice of infant circumcision for centuries
With circumcision already being part of the culture in most, if not all, African countries, it's not too hard to find a captive audience that can be wooed by slogans to the effect that circumcision is medically advantageous, and that everyone ought to be circumcised.
Circumcision is already a rite of passage for many tribes and peoples in Africa
I personally suspect that that has been the plan all along; that circumcision promoters aren't the least bit interested in preventing disease, but in reinforcing pre-existing partiality to circumcision, and using it to their advantage in proliferating the practice of circumcision and ensure its continuance, both in Africa and elsewhere.
A Hard Sell
It seems despite their best efforts, circumcision promoters are failing to meet their quotas. "Those foreskins are flying," assures Robert Bailey in the New York Times, but, if reports from Africa are to be believed, not fast enough. Circumcision promoters have tried everything in the book, from celebrity endorsement, to songs on the radio, to art exhibitions, to patriarchal endorsement, to legislative proposition of compulsory circumcision for all (there goes the "voluntary" part of the program...), to bribery.
There was an initial surge of men lining up to get circumcised at medical facilities, but that has pretty much died down, and now circumcision promoters are at their wit's end trying to encourage more men to get circumcised.
In Swaziland, the "Soka Uncobe" (or "Circumcise and Conquer") campaign was launched with the intention of circumcising 80% of the male Swazi population (that's 200,000 men), but the program ended in failure, as after four years, the program was able to convince only 20% (roughly 34,000 men) of the population to undergo circumcision.
Programs in other countries are also facing the same failure to circumcise the number of men they want, such as in Zimbabwe, Botswana, Zambia and Kenya.
My suspicion is that the men who did go in to get circumcised, were men who belonged to tribes and cultures where circumcision is already a rite of passage, and who were going to be circumcised anyway. Perhaps there were a few gullible men here and there who actually bought into the circumcision/HIV propaganda, but on the whole, those who went in were probably only men who couldn't care less about the potential HIV reduction, who said whatever they had to in order to cash in on a free and "safe" circumcision. All of the men who were going to get circumcised have gotten circumcised, so there's no one left, until new tribe or Muslim initiates come of age.
There was an initial surge of men lining up to get circumcised at medical facilities, but that has pretty much died down, and now circumcision promoters are at their wit's end trying to encourage more men to get circumcised.
In Swaziland, the "Soka Uncobe" (or "Circumcise and Conquer") campaign was launched with the intention of circumcising 80% of the male Swazi population (that's 200,000 men), but the program ended in failure, as after four years, the program was able to convince only 20% (roughly 34,000 men) of the population to undergo circumcision.
Programs in other countries are also facing the same failure to circumcise the number of men they want, such as in Zimbabwe, Botswana, Zambia and Kenya.
My suspicion is that the men who did go in to get circumcised, were men who belonged to tribes and cultures where circumcision is already a rite of passage, and who were going to be circumcised anyway. Perhaps there were a few gullible men here and there who actually bought into the circumcision/HIV propaganda, but on the whole, those who went in were probably only men who couldn't care less about the potential HIV reduction, who said whatever they had to in order to cash in on a free and "safe" circumcision. All of the men who were going to get circumcised have gotten circumcised, so there's no one left, until new tribe or Muslim initiates come of age.
And now, it seems, circumcision promoters are asking themselves, "What could be the problem? What has gone wrong? Why aren't men breaking down the doors to have part of their penis cut off?"
"Circumcise or bust!" seems to be the motto.
"We need to do whatever it takes to get as many men and boys circumcised."
And this, I believe, is what's wrong with HIV programs in Africa today. There is something wrong when progress on the HIV front is measured, not by how much HIV infection has decreased in time, but by how prolific the practice of circumcision has become. It is simply mistaken to assume that a mostly circumcised population automatically translates to a lowered HIV transmission rate, as real-world data indicates.
Latest Ploy: Sex Appeal
Circumcision advocates have been trying to use the influence of women to try and see if they could coerce men to go get circumcised. For a while now, programs like PEPFAR have been trying to sell circumcision as "beneficial to women," rather farfetched, as, even if the so-called "research" is correct, circumcision would only reduce HIV transmission from women to men. Actually, research shows that women are 50% more likely to acquire HIV from a circumcised partner, but this fact is ignored. In sub-Saharan Africa, women constitute 60% of people living with HIV, according to none other than the WHO itself. Circumcision promoters, however, still insist that male circumcision eventually benefits women "because less men being infected with HIV means less women will be infected."
To be quite sure that women will be interested in making sure their partner is circumcised, other dubious claims are sprinkled into the mix, such as a claimed reduction in HPV, which exclusively affects women, and other STDs. (Actually, studies are conflicting regarding the HPV claim. The claim falls apart in light of recent data, but circumcision proponents continue to adorn HIV propaganda with it none the less.)
But now, it seems, circumcision promoters are through with trying to use pseudo-scientific alibis to get women to influence the men, and are now turning to flat-out emasculation and harassment.
The following posters are apparently being used as part of the circumcision propaganda going on in Africa:
Even when the Soka Uncobe campaign was underway in Swaziland, promoters tried to appeal to masculinity, implying that circumcision would make them more attractive in the eyes of women.
Circumcision Now a Matter of "Respect"
Recently, I came across PLoS' Facebook page, on which it was promoting the release of circumcision propaganda articles. Intactivists, such as myself, as well as other concerned people have posted questions on their Facebook page, but it seems the best they or anyone else can do is offer the same canned responses always given. It's always the same "Research shows circumcision to prevent HIV by 60%, but it must be used with condoms" soundbites. When asked for answers, all they can do is post links to other articles that repeat the same thing. "The programs are working. Circumcision reduces HIV transmission. Circumcision is as effective as a vaccine. Our studies show that." They can't seem to offer any real answers to the questions we ask directly though.
What is the demonstrable causal link between the foreskin and increased HIV transmission? Or between circumcision and decreased HIV transmission?
Even if one can be furnished, what does it matter that a man is circumcised if he still has to wear a condom for real protection?
Wouldn't said causal link also apply to female genitals, seeing as the same tissues and cells exist in the vulva as they do in males?
What if a man is faithful to his wife? Why would a faithful couple be encouraged to have the male partner circumcised?
Have HIV organizations considered that males may not want to get circumcised, even given the information?
Are there any information packages prepared for males who do not want to undergo circumcision?
Are women encouraged to support their male partner in being faithful and using condoms if the male doesn't want to get circumcised?
Or is circumcision the only option?
If circumcision is so effective at preventing HIV, why must men still wear condoms?
If circumcision is so effective at preventing HIV, why was HIV found to be more prevalent in circumcised men in 10 out of 18 African countries, according to USAID?
If circumcision is so effective at preventing HIV, why does the United States have a higher HIV prevalence rate than 53 countries where circumcision is rare (e.g. under 20%) or not practiced, according to the CIA Fact Book?
How is something that never worked in a first world country like the United States, going to suddenly start working miracles in Africa?
How is it "voluntary" if there's a quota of 80% of African men?
The photo at the head of this article shows a man in a T-shirt. The T-shirt reads "EARN RESPECT: TEST AND CIRCUMCISE."
Is this what it has come down to?
A man can't be respected unless he is circumcised?
What if he tests, is STD-free, and consistently wears condoms?
This is not enough to earn "respect?"
As an intact man who is STD-free and faithful to his wife, I am insulted. Is what I do not enough? Do I not deserve respect until I have part of my penis cut off? Is this what they call "voluntary?" How is this not outright coercion?
Circumcision/HIV propaganda has gotten out of hand. I think it's about time human rights organizations stepped in and stopped this madness. This isn't HIV prevention, this is outright harassment and humiliation masquerading as medicine and foreign aid.
A Disservice in the Fight Against HIV/AIDS
We intactivists keep saying time and time again; the promotion of circumcision is going to make the HIV/AIDS problem WORSE, because it gives men and women a false sense of security, and an excuse to forgo condoms, which, even given the so-called "evidence," would still supersede circumcision. News outlets and organizations report that men are already saying they don't have to wear condoms, and that it is hard for women to convince emboldened circumcised men to wear condoms. In a Botswana sex scandal, a woman claims that the health minister she slept with couldn't have infected her with HIV because he's circumcised. (The research says SHE can't infect HIM IF she were HIV+.)
In response to questions about risk compensation, circumcision promoters like PLoS and Richard Wamai assert flatly that the evidence for it "doesn't exist," that the evidence that does exist (theirs, of course) says that risk compensation isn't a problem. However, absence of evidence is not equivalent to evidence of absence.
The following articles certainly show that a false sense of security in circumcised males is a problem:
UGANDA: Myths about circumcision help spread HIV
ZIMBABWE: Circumcised men abandoning condoms
Here is evidence of risk compensation that “simply does not exist” – according to some:
Botswana – There is an upsurge of cases of people who got infected with HIV following circumcision.
Zimbabwe – Circumcised men indulge in risky sexual behaviour
Nyanza – Push for male circumcision in Nyanza fails to reduce infections
Providing a dubious form of "protection," which can, and is being perceived in Africa by men and women, as an alternative to the most conclusively effective mode of prevention, condoms, is a disservice in the fight against HIV/AIDS.
If indeed men are walking away with the message that they don't have to wear condoms because they're circumcised, then intactivist predictions were right all along; the promotion of circumcision is spreading HIV/AIDS, and millions, if not billions in precious funds are being squandered on a dubious mode of prevention that is not only not helping, but making things worse, where the money could be better spent on promoting more effective ways of HIV prevention, if not on other, much needed medicine.
A Crime Against Humanity
It is simply despicable that the very idea that circumcision could do anything to prevent HIV transmission was even considered at all. It horrifies me that some people actually took it a step further and decided to test this hunch, with absolutely no demonstrable causal link, by circumcising thousands of men to see which ones would get HIV and which ones would not. One would think that scientists and researchers learned their lesson after Tuskegee. I don't even know what to think, now that entire "mass circumcision campaigns" are being carried out based on dubious "studies" which continue to have no scientific foundation, whose results were ill-conceived and exaggerated, where the claim that circumcision has anything to do with HIV transmission is pure correlation hypothesis.
I ask, what if it could be proven with "research" that the removal of the labia and clitoral hood "reduced the likelihood of HIV transmission" from female to men? The disproven hypothesis that the Langerhans cells facilitate HIV transmission in males, as they are found in the mucosal lining of the foreskin, would also apply to female genitalia, whose mucosal lining is lined with the same cells. In at least one study, it would appear that HIV was less prevalent in circumcised women. And yet, there was no rush to test and see if this worked. No "trials" to circumcise thousands of women to see what "effects" this might have on HIV transmission.
Why?
Because no one is interested in justifying female genital cutting; it is clear to everyone that female circumcision is unethical, and no amount of "research" could be used to justify it. The converse is true with circumcision, where "researchers" are trying to "prove" that male circumcision, particularly the forced circumcision of males, is "ethical" by showing it is "not harmful," even "beneficial" to males. We have this double-standard where the vindication of female genital cutting through "science" and "research" is unacceptable and flatly rejected, but the vindication of male genital cutting is not. No organization would ever approve of similar "trials" in African women as they were in African men. Dissenters would argue that if positive findings were published, advocates of FGM would pounce upon them as vindication, and rightly so.
And yet, this wasn't a concern with male circumcision.
It wasn't a concern that advocates of circumcision would use the "research" to justify forced genital mutilation in boys and men.
I will go as far as to wager that the justification of forced genital mutilation in boys and men is precisely what the "researchers" had in mind.
No, actually, I KNOW for a fact that is what they had in mind; the idea that circumcision could "prevent HIV/AIDS" was actually heavily promoted by Jewish circumcision advocate Aaron J. Fink, out of disdain for policy statements of medical organizations at the time, which were already saying that infant circumcision was harmful. Others jumped on the idea, and they've been trying to "prove" that male circumcision "prevents HIV" ever since.
Much media attention is given to the fact that girls and women suffer FGM by amateurs in the African bush. Attention is brought to the fact that FGM is performed using crude instruments such as glass shards and rusty blades. Attention is brought to the fact that girls are abducted to be circumcised. Attention is brought to the fact that FGM results in death. But little attention is given to the fact that boys and men being circumcised in Africa suffer the exact same predicaments.
In criticizing Sara Johnsdotter and Lucrezia Catania, Hussein Ghanem said that their research, which showed that FGM isn't as detrimental as often portrayed, "played right into the hands of people who defend female genital cutting." But for whatever reason, this wasn't a concern when the WHO endorsed male circumcision as HIV prevention.
Yes, they try very hard to sell the slogan "Voluntary Male Medical Circumcision," as if adding the words "voluntary" and "medical" are supposed to make the fact that male genitals are being cut any more rosy. Somehow, I don't think the words "Voluntary Female Medical Circumcision" could ever be successfully juxtaposed.
But are people aware that boys and men are being forcibly circumcised in Africa? Are they aware that the pretext of "HIV prevention" is being used by some tribes to abduct and forcibly circumcise men in rival tribes? Are they aware that men are going around stopping men, asking them to take down their pants to see if they're circumcised? No doubt some may see this as "poetic justice" for the harassment Jews experienced in the Holocaust. Was this not a concern? Or was this actually an intended consequence to "create demand" for so-called "Voluntary Male Medical Circumcision?"
Here is a list of reports of boys and men being forcibly circumcised:
Are people aware that, as in FGM, boys and men also die as a result of their initiation? That boys and men are also being circumcised out in the African bush with crude utensils by amateurs? That many boys and men do in fact lose their penises to gangrene, forcing them to live their life in shame? Why are these facts only a problem when we talk about female circumcision?
Here is a list of reports of boys and men suffering complications, or dying as a result of annual initiation rites:
The WHO endorsement of circumcision as HIV prevention has served to embolden forced circumcision wars among rival tribes, and to endorse traditional initiation practices which put the lives of boys and men in danger.
Would the WHO ever endorse female circumcision, even if this were "research-based?"
No. For the reason that they know that it would result in the de facto endorsement of human rights violations. They would not do anything that would "play into the hands of FGM advocates."
So why the different set of rules for male circumcision?
Why the blind eye and deaf ear to the forced MGM inflicted on boys and men?
Out of Touch
Eight years following the WHO endorsement of circumcision as HIV prevention, and millions of dollars later, African men aren't too keen on the idea of cutting off part of their genitals, and organizations intent circumcising the whole of the African male population seem to be puzzled and frustrated that their programs simply aren't taking off as they would have liked. Here and there one can read articles about circumcision promoters and organizations thinking out loud, asking themselves "What went wrong?"
I've read articles on the PEPFAR website. I've seen videos and articles published by the Bill and Melinda Gates Foundation. I've seen articles published in peer reviewed journals. "Studies" and "research" on the "feasibility" of circumcision scale-up projects, the "acceptability" of circumcision, attitudes in men and women, their views of circumcision.
Instead of seeking to better educate Africans about the sexual transmission of STDs, it seems, promoters are intent in looking for the best way to brainwash them into both, believing circumcising their men and boys is desirable, and that they need to continue using conventional methods of STD prevention, such as fidelity and condoms.
The buzz words going around in circumcision/HIV circles is "demand creation." These words ought to strike audiences as odd, because one would think that the magic words "reduces HIV by 60%" would be a good enough incentive for men to go out and get circumcised, would they not?
"If you build it, they will come" didn't work. And millions have been squandered in ad campaigns all over Africa. In some areas, promoters are turning to bribery.
What could be the problem?
Africans Aren't Stupid
It doesn't take a rocket scientist to figure out why circumcision promoters are having trouble achieving their quotas. You don't need "studies" and "surveys" to figure out why.
Men simply don't see the value of getting circumcised, to undergo a painful, life-altering, permanent surgical alteration, which will permanently change the appearance and mechanics of their penises, if it means they only get "partial protection." Being told that "circumcision reduces HIV transmission by 60%" isn't all that impressive if it means that they still have to wear condoms.
Married men simply don't see the value of getting circumcised if they are faithful to their wives, and therefore not at risk for sexually transmitted HIV.
Women certainly don't want to be made to feel like their man is going out on them with other women. They want to be able to trust their partners with fidelity. So why would they encourage their men to go get circumcised? What can having their husbands go get circumcised mean, other than that they are expecting them to be unfaithful?
That the people up at HIV organizations think that they can actually get away with promoting circumcision the way they do can mean only one of to things; either HIV organizations are dense and stupid, or they believe the African public is.
From an outside, non-African perspective, I simply can't believe the bullshit that western HIV organizations are attempting to feed the people of Africa. Looking at what's going on in Africa, I'm simply insulted as an intact male.
As an intact man, I am expected to believe that, a) circumcision "reduces the likelihood of HIV transmission by 60% (from female to male)," and b) that I still have to wear condoms.
I ask, why in the world would any man in the right mind choose to have part of his penis removed, if it meant that one still had to wear condoms?
I ask, if I'm not convinced by this argument, why would I expect any other man to be? Let alone the men in Africa?
No intact man in the right mind could ever go for this. Men who are fully informed, men who have been made aware of all the facts simply cannot see any value in undergoing circumcision, and can clearly see that it is complete madness that organizations are spending millions in funds trying to convince other men to part with their foreskins for only "partial protection." If you went around pushing this nonsense in Europe, people would laugh in your face. They're pushing this shit in Africa because they think Africans are gullible idiots.
The only people who see the value in circumcision campaigns are those men and women who already have religious or cultural convictions for the practice of circumcision. They would like circumcision to be a free service, performed at hospitals by trained professionals, as opposed to the African bush, performed by amateurs using crude utensils, where men are more likely to suffer complications, including infection, loss of their organ, and even death. People with religious or cultural convictions for circumcision cannot verily declare this to be the case, so they are more than likely to disguise these convictions and desire to have circumcision as a free service by parroting the circumcision/HIV propaganda. "I am glad I am protected," they will say, when they truly mean to say "I cashed in on a free circumcision, thanks to these HIV programs!" "Everybody should be circumcised in order to prevent HIV infection," they will say, when they mean to say "We want all men to be circumcised and must submit to our tribal or religious tradition."
THE SOLUTION: More Money, More Propaganda
So eight years and several million dollars later, the great scheme to circumcise Africa in the name of HIV transmission hasn't taken off. Africans simply aren't buying it. Worse than that, the risk compensation nightmare intactivists have warned about from the very beginning is coming true.
Men are walking away with the message that condoms aren't necessary once they're circumcised. This false sense of security makes it difficult for female partners to convince them to wear condoms.
The endorsement of circumcision as HIV prevention is seen as a green light for traditional, rite-of-passage circumcision practices, as well as the forced circumcision of men by men in rival circumcising tribes, resulting in infections, loss of genital organs and death, not to mention an increased risk of HIV transmission due to the usage of dirty, crude equipment.
These "mass circumcision campaigns" are a massive failure. But how are circumcision promotion agencies responding? What is their solution?
More money, more propaganda.
"Insanity is doing the same thing over and over again and expecting different results."
"Demand creation," say the circumcision "experts," is the key.
HIV promoting organizations are observing what's happening, and their solution is to up the ante, use more coercive tactics to get the men to circumcise themselves "voluntarily."
The problem, the reason they aren't seeing men flocking to get circumcised, according to them, is that men simply don't understand what's good for them. The women don't either. The solution is to "understand" "why" people aren't buying it, in order to hit the right buttons, come up with the necessary "studies" that quell people's fears, and people will start banging down the doors.
In Swaziland, the US wants to spend another 24.5 million to attempt to circumcise the male Swazi population again. This time, they're through with the "voluntary" part of the slogan, and they have their eyes set on newborns. (There is zero evidence that newborn circumcision does anything to reduce HIV transmission, not to mention the reality that is the United States of America, where 80% of US males are circumcised from birth, and yet the United States has a higher HIV prevalence rate than 53 countries where circumcision is rare [under 20%] or not practiced, according to he CIA Factbook.)
Because, apparently, enough money hasn't been squandered in circumcision campaigns as it is.
"Demand Creation": What does it mean?
Currently "demand creation" are the buzz words among circumcision promoters. But what do these words mean? To me this can only mean brainwashing and counterproductive propaganda.
When the goal of HIV organizations is no longer to prevent HIV, when the goal is, instead, to circumcise as many men, boys and children as possible, when the goal is to gain the "acceptance" of circumcision, when the goal is to achieve a quota within a certain time frame, then the only outcome of this is can be lies and deception.
In order to achieve "demand creation," one can expect more attacks on African masculinity. More coercion through sex appeal. More "studies" exaggerating the "benefits" of circumcision. More diseases that circumcision is supposed to cure. With the promotion of male infant circumcision, there will be more "studies" minimizing the risks and harms of circumcision. (Is it any wonder that the CDC has already published a "study" saying when the best time to circumcise male is?)
Men and women who fully understand the facts, that circumcision is a painful, permanent alteration which, even if the current "research" were correct, could only provide "partial" protection, that circumcision fails and therefore condoms must still be used, do not, cannot possibly see any value in circumcision. Men fully aware of the facts do not, cannot be convinced to accept this for themselves. Parents fully aware of the facts, do not, cannot be convinced to accept this for their children. Therefore the only possible outcome is that, in order to realize quotas and meet deadlines, the facts must be denied, lies must be told, and the truth must be hidden at all costs.
Therefore the only outcome of "demand creation" is that the public will believe that circumcision prevents HIV transmission, that being circumcised means condoms are disposable, that unsafe sex with a man is acceptable as long as he is circumcised.
Therefore the only outcome of "demand creation" is, necessarily, that the HIV epidemic in African countries will be exasperated.
At the expense of the American taxpayer.
At the expense of the truth.
At the expense of scientific credibility.
At the expense of the human dignity of Africans.
At the expense of African lives.
At the expense of basic human rights of minors.
The problem isn't that African men and women "don't understand" and that they need to be "educated," no. The men and women and Africa understand what circumcision and HIV are. They understand that circumcision, even if the "research" were accurate, could only provide "partial protection," that men would still have to wear condoms, and simply aren't interested.
The problem is that the people at HIV organizations, the people at the American CDC, the people at PEPFAR, the people at Bill and Melinda Gates, the people at the WHO have all lost their senses completely.
It is absolute madness that they've all made it the end goal of the HIV movement to circumcise Africa, if not the world. While precious funds could be put to better use, millions are being squandered on promoting a dubious form of HIV prevention which is already superseded by the cheaper, less invasive, more effective modes of prevention which are condoms and education.
Beyond Circumcision
Circumcision does not, cannot stop HIV transmission. Even if the research is accurate, circumcision fails to prevent HIV transmission, which is why circumcised males must still be urged to wear condoms. There is no doctor, researcher or HIV organization that can deny this fact. Circumcision is a stop-gap at best, and scientists and researchers need to be looking for other, better ways to prevent HIV. Or, at least they're supposed to be.
Are circumcision scientists and researchers thinking of a time where HIV can be stopped in less invasive ways, without surgery? Is there a time in their minds when there will be a method of HIV prevention so effective circumcision can be discontinued? What non-cutting way are "researchers" looking into? Or is circumcision all they got?
Has anyone up at the WHO, up at PEPFAR, etc. stopped to consider that maybe perhaps the men aren't stupid and don't WANT to be circumcised?
Here's a question I've got to ask; do these "mass circumcision campaigns" offer men alternatives?
Have "researchers" considered the possibility men may not want to get circumcised despite the much touted "benefits," that "60%" may not be all that convincing, and that they're just going to have to accept that some men may not want to get circumcised?
Do HIV information packages that are given the men and women include the option NOT to circumcise?
Something that reads along these lines:
"Circumcision only provides partial protection against HIV in the event a couple decides to have unprotected sex, or if you are male and plan on having casual sexual encounters without condoms. If you are a faithful man, if your partner is a faithful man, circumcision may not be appropriate for you. For men who are faithful to their partners, and/or use condoms consistently, not circumcising is an option."
These are the facts.
I somehow doubt that men and women in Africa will be give them, seeing as knowing these facts will defer them from opting in favor of circumcision, and HIV organizations are given quotas for funds from PEPFAR, Bill and Melinda Gates, etc.
HIV organizations, what's plan B?
Or is circumcision all you have?
Is it just that HIV organizations are spending millions in precious funds on a dubious, invasive, expensive form of HIV prevention that nobody wants?
When condoms are already cheaper, less invasive, and more worlds more effective?
Circumcision Promotion vs HIV Prevention: What Is the Objective of HIV Organizations?
It is clear that the HIV movement has been hijacked by mad individuals with the twisted world view that all boys and men in the world ought to be circumcised. Instead of the prevention of HIV transmission, their goal has become to circumcise boys and men in and outside of Africa at all costs.
The actions of circumcision advocates at HIV organizations, their resolve to keep spending millions on promoting circumcision, even after having previously spent millions more, indicate that they believe Africans are incapable of deductive reasoning. A separate experiment is being carried out in Africa, with African men, women and children as guinea pigs. This is not about how much HIV can be prevented, but about how people can be more effectively brainwashed, about just how gullible and stupid people can be, and what they could be manipulated into doing.
Look at the latest in circumcision "research." It focuses on "acceptability" and "feasibility." It has nothing to do with HIV prevention mechanisms; the research is in how people can be more efficaciously brainwashed. It's almost as if they've given up on researching for an actual HIV solution. All their eggs are in the circumcision basket. Circumcision promoters are taking advantage of the impoverished state of African nations in order to conduct social experiments on them.
There is a problem when the slogan to promote circumcision is no longer "reduce your chances of contracting HIV prevention," but has been replaced with "become popular with women" and "last longer in bed." There is a problem when HIV organizations are more concerned with "demand creation" for a dubious mode of HIV prevention with human rights implications, than they are in making sure Africans understand how they can be HIV/AIDS free.
There is a problem when millions of dollars are being pumped into a mode of prevention that men don't want, and for good reason. There is a problem when the goal of circumcision promotion replaces HIV prevention.
The goal of HIV organizations needs to be brought back into focus, which is to prevent HIV and find a cure. If the end goal is to make sure everyone is circumcised, regardless of whether or not HIV is being prevented, not to mention other medical problems where precious funds are needed, then HIV organizations seriously need to reevaluate their priorities.
Conclusion
The promotion of male circumcision as HIV prevention is not based in science, but on unproven, or even disproven theories and correlation hypothesis based on exaggerated numbers. There is no scientifically demonstrable causal link between the foreskin and increased HIV transmission, and conversely, between circumcision and decreased HIV transmission. Without it, the campaigns in Africa are belief-based, not science-based medicine.
Real world data does not support the claim circumcising 80% of the male population results in decreased HIV transmission.
It is simply irrefutable that circumcision does not, cannot prevent HIV transmission. Circumcision fails to prevent HIV, and no doctor, researcher or scientist can deny this fact; this is the reason why circumcised men must still be urged to wear condoms.
The promotion of male circumcision is doing more harm than good, as it is a dubious form of HIV prevention which is being seen as an alternative to more effective sex practices, such as abstinence, fidelity and condoms.
The promotion of male circumcision is resulting in the violation of basic human rights of boys and men in and out of Africa; rival tribes are forcibly circumcising each other, boys and men are being abducted and forcibly circumcised, and the forced circumcision of minors is being promoted.
The promotion of male circumcision is resulting in yearly massacre in Africa, where WHO endorsement is seen as a green light for traditional rites of passage.
The promotion of male circumcision is resulting in the humiliation and sexual harassment of men who are not circumcised and do not want to be circumcised.
The promotion of male circumcision is a gross waste of funds which could be being put to better, more productive use.
The promotion of male circumcision is a sexist, misandrist, mean-spirited attack on male sexuality, upon African males, upon children in other parts of the world, and the male sex in general, and the WHO should have NEVER endorsed it.
The "mass circumcision campaigns" have got to be stopped. The WHO needs to retract it's recommendation of male circumcision as HIV prevention, and the forced circumcision of healthy, non-consenting individuals needs to be recognized for the mutilation and violation of basic human rights it is.
I call on reputable scientists, researchers, doctors and medical organizations with a conscience, to speak out and demand that the WHO retract their endorsement of circumcision as HIV prevention, and to call out that these "mass circumcision campaigns" be brought to a halt.
Update (5/27/2014):
Latest ploy in Zimbabwe: "Circumcision makes you smarter."
"We have campaigns that are specifically targeting adolescents, people in schools — so during school holidays we are doing massive mobilisations on mass media... "So get smart, get circumcised. Male circumcision is not only HIV prevention intervention, but it is improving hygiene, you are cleaner, you are smarter.'"
~Dr. Karin Hatzold, deputy head of Population Services International (PSI) Zimbabwe
If circumcision makes you smarter, what does this imply if you have a foreskin? Are African boys and men aware they're basically being slapped in the face?
lunedì 22 luglio 2013
Circumcision Status and HIV
JAIDS
December 15, 2007
Objective: To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection.
Methods: Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. A 45-minute computer-assisted interview and a rapid oral fluid HIV antibody test (OraSure Technologies, Bethlehem, PA) were administered to participants. Results: Circumcision prevalence was higher among black MSM than among Latino MSM (74% vs. 33%; P < 0.0001). Circumcised MSM in both racial/ethnic groups were more likely than uncircumcised MSM to be born in the United States or to have a US-born parent. Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex. Conclusions: In these cross-sectional data, there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM. JAIDS Journal of Acquired Immune Deficiency Syndromes. 46(5):643-650, December 15, 2007.
December 15, 2007
Circumcision Status and HIV Infection Among Black and Latino Men Who Have Sex With Men in 3 US Cities.
Millett, Gregorio A; Ding, Helen; Lauby, Jennifer; Flores, Stephen; Stueve, Ann; Bingham, Trista; Carballo-Dieguez, Alex; Murrill, Chris; Liu, Kai-Lih; Wheeler, Darrell; Liau, Adrian; Marks, Gary Abstract:Objective: To examine characteristics of circumcised and uncircumcised Latino and black men who have sex with men (MSM) in the United States and assess the association between circumcision and HIV infection.
Methods: Using respondent-driven sampling, 1154 black MSM and 1091 Latino MSM were recruited from New York City, Philadelphia, and Los Angeles. A 45-minute computer-assisted interview and a rapid oral fluid HIV antibody test (OraSure Technologies, Bethlehem, PA) were administered to participants. Results: Circumcision prevalence was higher among black MSM than among Latino MSM (74% vs. 33%; P < 0.0001). Circumcised MSM in both racial/ethnic groups were more likely than uncircumcised MSM to be born in the United States or to have a US-born parent. Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex. Conclusions: In these cross-sectional data, there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM. JAIDS Journal of Acquired Immune Deficiency Syndromes. 46(5):643-650, December 15, 2007.
domenica 2 giugno 2013
Circoncisione non protegge i gay da Hiv
Gay ou pas, la circoncision ne protège pas du VIH : utilisez un préservatif !
Le professeur Didier Raoult, directeur du laboratoire de microbiologie de Marseille, a récemment tenu des propos choquants et irresponsables. Dans un article du site tetu.com datant du 17 février, il est dit que monsieur Raoult souhaite que l'on pose publiquement la question d'une politique de circoncision visant les gays, en France et en Europe, et ce afin de lutter contre le VIH/SIDA. Voici justement une étude toute récente sur le sujet.
Extrait
Circoncision et infection au VIH parmi les homosexuels de sexe masculins en Grande Bretagne : le facteur du rôle actif.
Présenté par Rita Doerner (Royaume-Uni).
R. Doerner1, E. McKeown1, S. Nelson2, N. Low3, J. Anderson4, J. Elford1
1City University, London, United Kingdom, 2Terrence Higgins Trust, Bristol, United Kingdom, 3University of Bern, Bern, Switzerland, 4Homerton Hospital NHS Foundation Trust, London, United Kingdom
Méthode : Plus de 13000 homosexuels de sexe masculin, résidents en Grande Bretagne, ont rempli un questionnaire en ligne, confidentiel et anonyme, en 2007-2008.
Résultats : Cette analyse se concentre sur les 5425 hommes ayant déclaré avoir eu un rapport sexuel non protégé au cours des 3 derniers mois. Parmi ces 5425 hommes, 996 (18.4%) étaient circoncis. L’incidence du VIH était de 12.7% parmi les hommes circoncis et de 11.9% parmi les hommes non circoncis (quotient de possibilités ajusté/OR = 1.07, 95% ; intervalle de confiance/CI = 0.87, 1.32, p=0.51).
Parmi ces 5425 hommes, 1696 (31.3%) ont affirmé avoir principalement ou exclusivement un rôle actif lors des pénétration anales ; 317 de ces hommes (18.7%) étaient circoncis. Chez ces 1696 hommes, aucun lien n’a pu être identifié entre circoncision et prévalence du VIH dans l’analyse univariée (OR 1.06, 95% CI 0.62, 1.83, p=0.8). Après avoir procédé à des ajustements sur la base de l’âge, les rapports anaux non-protégés (donnée concordante ou discordante), de l’utilisation de drogues récréatives, du degré d’optimisme personnel face aux traitements VIH et du lieu de résidence, il n'y avait toujours pas de lien entre circoncision et prévalence du VIH dans ce sous-groupe d'hommes. (OR 0.81, 95% CI 0.44, 1.47, p=0.5).
Conclusion : Dans ce large échantillon d’homosexuels de sexe masculin en Grande Bretagne, il n’y avait aucun lien d’ensemble entre circoncision et prévalence du VIH. Parmi les hommes ayant principalement ou exclusivement un rôle actif lors des pénétrations anales, nous n’avons pas non plus trouvé de lien entre circoncision et prévalence du VIH lors d’analyses multivariées. Ces données suggèrent que même parmi les hommes homosexuels qui ont un rôle principalement actif lors des pénétrations anales, la circoncision ne réduirait pas le risque de contamination au VIH.
Extrait
Circoncision et infection au VIH parmi les homosexuels de sexe masculins en Grande Bretagne : le facteur du rôle actif.
Présenté par Rita Doerner (Royaume-Uni).
R. Doerner1, E. McKeown1, S. Nelson2, N. Low3, J. Anderson4, J. Elford1
1City University, London, United Kingdom, 2Terrence Higgins Trust, Bristol, United Kingdom, 3University of Bern, Bern, Switzerland, 4Homerton Hospital NHS Foundation Trust, London, United Kingdom
Contexte : Les preuves que la circoncision réduirait le risque d’être contaminé par le VIH chez les hommes ayant des rapports homosexuels demeurent faibles et inconsistantes. Certaines études suggèrent néanmoins que lors de rapport homosexuels avec pénétration anale, le partenaire ayant un rôle actif dans la pénétration pourrait encourir un risque plus bas d’être infecté. Cette étude examine le lien entre circoncision et prévalence du VIH parmi les homosexuels britanniques de sexe masculin qui assument exclusivement ou principalement un rôle actif lors des pénétrations anales.
Méthode : Plus de 13000 homosexuels de sexe masculin, résidents en Grande Bretagne, ont rempli un questionnaire en ligne, confidentiel et anonyme, en 2007-2008.
Résultats : Cette analyse se concentre sur les 5425 hommes ayant déclaré avoir eu un rapport sexuel non protégé au cours des 3 derniers mois. Parmi ces 5425 hommes, 996 (18.4%) étaient circoncis. L’incidence du VIH était de 12.7% parmi les hommes circoncis et de 11.9% parmi les hommes non circoncis (quotient de possibilités ajusté/OR = 1.07, 95% ; intervalle de confiance/CI = 0.87, 1.32, p=0.51).
Parmi ces 5425 hommes, 1696 (31.3%) ont affirmé avoir principalement ou exclusivement un rôle actif lors des pénétration anales ; 317 de ces hommes (18.7%) étaient circoncis. Chez ces 1696 hommes, aucun lien n’a pu être identifié entre circoncision et prévalence du VIH dans l’analyse univariée (OR 1.06, 95% CI 0.62, 1.83, p=0.8). Après avoir procédé à des ajustements sur la base de l’âge, les rapports anaux non-protégés (donnée concordante ou discordante), de l’utilisation de drogues récréatives, du degré d’optimisme personnel face aux traitements VIH et du lieu de résidence, il n'y avait toujours pas de lien entre circoncision et prévalence du VIH dans ce sous-groupe d'hommes. (OR 0.81, 95% CI 0.44, 1.47, p=0.5).
Conclusion : Dans ce large échantillon d’homosexuels de sexe masculin en Grande Bretagne, il n’y avait aucun lien d’ensemble entre circoncision et prévalence du VIH. Parmi les hommes ayant principalement ou exclusivement un rôle actif lors des pénétrations anales, nous n’avons pas non plus trouvé de lien entre circoncision et prévalence du VIH lors d’analyses multivariées. Ces données suggèrent que même parmi les hommes homosexuels qui ont un rôle principalement actif lors des pénétrations anales, la circoncision ne réduirait pas le risque de contamination au VIH.
Référence : Doerner R et al. Circumcision and HIV infection among men who have sex with men in Britain: the insertive sex role. Archives of Sexual Behavior, early online edition, DOI 10.1007/s10508-012-0061-1, 2013.
domenica 23 dicembre 2012
UN: circoncisione non previene hiv
UNITED NATIONS: Circumcision not important in preventing HIV
New H.I.V. Cases Falling in Some Poor Nations, but Treatment Still Lags
By Donald G. McNeil
New infections with H.I.V. have dropped by half in the past decade in 25 poor and middle-income countries, many of them in Africa, the continent hardest hit by AIDS, the United Nations said Tuesday.
The greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency U.N.AIDS.
“We are moving from despair to hope,” he said.
Despite the good news from those countries, the agency’s annual report showed that globally, progress is steady but slow. By the usual measure of whether the fight against AIDS is being won, it is still being lost: 2.5 million people became infected last year, while only 1.4 million received lifesaving treatment for the first time.
“There has been tremendous progress over the last decade, but we’re still not at the tipping point,” said Mitchell Warren, the executive director of AVAC, an advocacy group for AIDS prevention. “And the big issue, sadly, is money.”
Some regions, like Southern Africa and the Caribbean, are doing particularly well, while others, like Eastern Europe, Central Asia and the Middle East, are not. Globally, new infections are down 22 percent from 2001, when there were 3.2 million. Among newborns, they fell 40 percent, to 330,000 from 550,000.
The two most important financial forces in the fight, the multinational Global Fund for AIDS, Tuberculosis and Malaria and the domestic President’s Emergency Plan for AIDS Relief, were both created in the early 2000s and last year provided most of the $16.8 billion spent on the disease. But the need will soon be $24 billion a year, the groups said.
“Where is that money going to come from?” Mr. Warren asked.
The number of people living with H.I.V. rose to a new high of 34 million in 2011, while the number of deaths from AIDS was 1.7 million, down from a peak of 2.3 million in 2005. As more people get life-sustaining antiretroviral treatment, the number of people living with H.I.V. grows.
Globally, the number of people on antiretroviral drugs reached 8 million, up from 6.6 million in 2010. However, an additional 7 million are sick enough to need them. The situation is worse for children; 72 percent of those needing pediatric antiretrovirals do not get them.
New infections fell most drastically since 2001 in Southern Africa — by 71 percent in Botswana, 58 percent in Zambia and 41 percent in South Africa, which has the world’s biggest epidemic.
But countries with drops greater than 50 percent were as geographically diverse as Barbados, Cambodia, the Dominican Republic, Ethiopia, India and Papua New Guinea. [...where circumcision is not prevalent.]
The most important factor, Mr. Sidibé said, was not nationwide billboard campaigns to get people to use condoms or abstain from sex. Nor was it male circumcision, a practice becoming more common in Africa. There is no scientific evidence that male circumcision cuts Hiv infection risk .
Rather, it was focusing treatment on high-risk groups. While saving babies is always politically popular, saving gay men, drug addicts and prostitutes is not, so presidents and religious leaders often had to be persuaded to help them. Much of Mr. Sidibé’s nearly four years in his post has been spent doing just that.
Many leaders are now taking “a more targeted, pragmatic approach,” he said, and are “not blocking people from services because of their status.”
Fast-growing epidemics are often found in countries that criminalize behavior. For example, homosexuality is illegal in many Muslim countries in the Middle East and North Africa, so gay and bisexual men, who get many of the new infections, cannot admit being at risk. The epidemics in Eastern Europe and Central Asia are driven by heroin, and in those countries, methadone treatment is sometimes illegal.
Getting people on antiretroviral drugs makes them 96 percent less likely to infect others, studies have found, so treating growing numbers of people with AIDS has also helped prevent new infections.
Ethiopia’s recruitment of 35,000 community health workers, who teach young people how to protect themselves, has also aided in prevention.
...
By Donald G. McNeil
New infections with H.I.V. have dropped by half in the past decade in 25 poor and middle-income countries, many of them in Africa, the continent hardest hit by AIDS, the United Nations said Tuesday.
The greatest success has been in preventing mothers from infecting their babies, but focusing testing and treatment on high-risk groups like gay men, prostitutes and drug addicts has also paid dividends, said Michel Sidibé, the executive director of the agency U.N.AIDS.
“We are moving from despair to hope,” he said.
Despite the good news from those countries, the agency’s annual report showed that globally, progress is steady but slow. By the usual measure of whether the fight against AIDS is being won, it is still being lost: 2.5 million people became infected last year, while only 1.4 million received lifesaving treatment for the first time.
“There has been tremendous progress over the last decade, but we’re still not at the tipping point,” said Mitchell Warren, the executive director of AVAC, an advocacy group for AIDS prevention. “And the big issue, sadly, is money.”
Some regions, like Southern Africa and the Caribbean, are doing particularly well, while others, like Eastern Europe, Central Asia and the Middle East, are not. Globally, new infections are down 22 percent from 2001, when there were 3.2 million. Among newborns, they fell 40 percent, to 330,000 from 550,000.
The two most important financial forces in the fight, the multinational Global Fund for AIDS, Tuberculosis and Malaria and the domestic President’s Emergency Plan for AIDS Relief, were both created in the early 2000s and last year provided most of the $16.8 billion spent on the disease. But the need will soon be $24 billion a year, the groups said.
“Where is that money going to come from?” Mr. Warren asked.
The number of people living with H.I.V. rose to a new high of 34 million in 2011, while the number of deaths from AIDS was 1.7 million, down from a peak of 2.3 million in 2005. As more people get life-sustaining antiretroviral treatment, the number of people living with H.I.V. grows.
Globally, the number of people on antiretroviral drugs reached 8 million, up from 6.6 million in 2010. However, an additional 7 million are sick enough to need them. The situation is worse for children; 72 percent of those needing pediatric antiretrovirals do not get them.
New infections fell most drastically since 2001 in Southern Africa — by 71 percent in Botswana, 58 percent in Zambia and 41 percent in South Africa, which has the world’s biggest epidemic.
But countries with drops greater than 50 percent were as geographically diverse as Barbados, Cambodia, the Dominican Republic, Ethiopia, India and Papua New Guinea. [...where circumcision is not prevalent.]
The most important factor, Mr. Sidibé said, was not nationwide billboard campaigns to get people to use condoms or abstain from sex. Nor was it male circumcision, a practice becoming more common in Africa. There is no scientific evidence that male circumcision cuts Hiv infection risk .
Rather, it was focusing treatment on high-risk groups. While saving babies is always politically popular, saving gay men, drug addicts and prostitutes is not, so presidents and religious leaders often had to be persuaded to help them. Much of Mr. Sidibé’s nearly four years in his post has been spent doing just that.
Many leaders are now taking “a more targeted, pragmatic approach,” he said, and are “not blocking people from services because of their status.”
Fast-growing epidemics are often found in countries that criminalize behavior. For example, homosexuality is illegal in many Muslim countries in the Middle East and North Africa, so gay and bisexual men, who get many of the new infections, cannot admit being at risk. The epidemics in Eastern Europe and Central Asia are driven by heroin, and in those countries, methadone treatment is sometimes illegal.
Getting people on antiretroviral drugs makes them 96 percent less likely to infect others, studies have found, so treating growing numbers of people with AIDS has also helped prevent new infections.
Ethiopia’s recruitment of 35,000 community health workers, who teach young people how to protect themselves, has also aided in prevention.
...
giovedì 23 agosto 2012
Circoncisione: nessun beneficio per Hiv o Mst
PUERTO RICO: No benefit
from circumcision for HIV, STDS
Puero Rico: Circumcision not protective
Circumcision does not protect men against HIV or other sexually transmitted diseases, according to a study conducted in Puerto Rico.
The 660 men were randomly sampled from an STD clinic waiting room. Almost a third of them were circumcised.
The circumcised men reported significantly (but not greatly) more STDs in their lifetimes, were more likely to have been diagnosed with warts, and were more likely to have HIV.
J Sex Med. 2012 Aug 15. doi: 10.1111/j.1743-6109.2012.02871.x.
More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico.
Rodriguez-Diaz CE, Clatts MC, Jovet-Toledo GG, Vargas-Molina RL, Goldsamt LA, García H.
Medical Sciences Campus-School of Public Health, University of Puerto Rico, San Juan, Puerto Rico National Development and Research Institutes, New York, NY, USA Centro Latinoamericano de Enfermedades de Transmisión Sexual, Puerto Rico Department of Health, San Juan, Puerto Rico.
Abstract
Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence.
Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico.
Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room.
Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit.
Results. Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048), have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC = 12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027).
Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. [Actually, what the the data indicate is that intactness confers significant protection, compared to being circumcised.] Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.
Puero Rico: Circumcision not protective
Circumcision does not protect men against HIV or other sexually transmitted diseases, according to a study conducted in Puerto Rico.
The 660 men were randomly sampled from an STD clinic waiting room. Almost a third of them were circumcised.
The circumcised men reported significantly (but not greatly) more STDs in their lifetimes, were more likely to have been diagnosed with warts, and were more likely to have HIV.
J Sex Med. 2012 Aug 15. doi: 10.1111/j.1743-6109.2012.02871.x.
More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico.
Rodriguez-Diaz CE, Clatts MC, Jovet-Toledo GG, Vargas-Molina RL, Goldsamt LA, García H.
Medical Sciences Campus-School of Public Health, University of Puerto Rico, San Juan, Puerto Rico National Development and Research Institutes, New York, NY, USA Centro Latinoamericano de Enfermedades de Transmisión Sexual, Puerto Rico Department of Health, San Juan, Puerto Rico.
Abstract
Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence.
Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico.
Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room.
Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit.
Results. Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048), have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC = 12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027).
Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. [Actually, what the the data indicate is that intactness confers significant protection, compared to being circumcised.] Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.
sabato 4 agosto 2012
La circoncisione non protegge dall'Hiv/Aids
Where Circumcision Doesn't Prevent HIV
There's currently a lot of hype surrounding circumcision and the transmission of HIV. The word on people's lips is that "circumcision reduces HIV transmission by 60%." The claim is based on the result of three major "studies" that were carried out in Africa, but there are a few confounding factors that bring the validity of these so-called "studies" into question. One of the greatest confounding factors in these studies is empirical evidence to the contrary; real world data from countries where circumcision is already a widespread practice and studies with contrary results.
Countries in Africa
Let's begin with countries in Africa, where these "studies" would be relevant. According to demographic health surveys performed in other countries in Africa, HIV transmission was prevalent in circumcised men in at least 6 different countries. I go one by one, analyzing some of the commentary in these surveys, some of which seems to be revealing of the researchers' bias.
Cameroon
In Cameroon, where 91% of the male population is circumcised, the ratio of circumcised men vs. intact men who contracted HIV was 4.1 vs. 1.1. (See p. 17)
www.measuredhs.com/pubs/pdf/FR163/16chapitre16.pdf
Ghana
"...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the HIV prevalence by circumcision status..." (1.6 vs 1.4 See p. 13)
www.measuredhs.com/pubs/pdf/FR152/13Chapter13.pdf
Lesotho
In Lesotho, 23% of the men are circumcised, and the ratio circumcised men vs. intact men who contracted HIV was 22.8 vs 15.2.
"The relationship between male circumcision and HIV levels in Lesotho does not conform to the expected pattern of higher rates among uncircumcised men than circumcised men. The HIV rate is in fact substantially higher among circumcised men (23 percent) than among men who are not circumcised (15 percent). Moreover, the pattern of higher infection rates among circumcised men compared with uncircumcised men is virtually uniform across the various subgroups for which results are shown in thetable. This finding could be explained by the Lesotho custom to conduct male circumcision later in life, when the individuals have already been exposed to the risk of HIV infection. (Additional analysis is necessary to better understand the unexpected pattern in Table 12.9.)" (p. 13)
What is disturbing here is that it seems researchers grope for a reason to dismiss these results because they are not what they are looking for; a positive result for circumcision. The above is an interesting defense of male circumcision, given the fact that the latest "studies," if they can even be called that, observed HIV trasmission in men circumcised as adults. Then again, this demographic health survey was conducted in 2004, BEFORE the newer "studies" in 2006. None the less, the unproven assertion that "circumcision is only effective in reducing the risk of HIV when done in infancy" persists in some circles.
www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf
Malawi
In Malawi, 20% of the male population is circumcised. The ratio of circumcised vs. intact men who contracted HIV was 13.2 vs 9.5.
"The relationship between HIV prevalence and circumcision status is not in the expected direction. In Malawi, circumcised men have a slightly higher HIV infection rate than men who were not circumcised (13 percent compared with 10 percent). In Malawi, the majority of men are not circumcised (80 percent)(...where one would expect HIV to be the most rampant... note the "expected direction.") (p. 10)
www.measuredhs.com/pubs/pdf/FR175/12Chapter12.pdf
Rwanda
According to a demographic health survey taken in 2005, the ratio of circumcised vs. intact men who contracted HIV was 3.8 vs 2.1. (See p. 10)
www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf
Swaziland
In a recent demographic health survey (2006-2007), the ratio of circumcised vs. intact men who contracted HIV was found to be 22 vs. 20.
As Table 14.10 shows, the relationship between HIV prevalence and circumcision status is not in the expected direction. Circumcised men have a slightly higher HIV infection rate than men who are not circumcised (22 percent compared with 20 percent). (p. 256)
www.measuredhs.com/pubs/pdf/FR202/FR202.pdf
Here is that "expected direction" again. The majority of Swazi men are uncircumcised, and one would especially expect to see HIV prevalence here. HIV transmission was more prevalent in the circumcised men here, yet our (the US) government has decided to spend millions on a campaign to circumcise 80% of the men in Swaziland.
http://joseph4gi.blogspot.com/2011/05/soka...rs-at-work.html
Other Countries Where HIV/Circumcision Rates Don't Correlate
Malaysia
According to Malaysian AIDS Council vice-president Datuk Zaman Khan, more than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims. In Malaysia, most, if not all Muslim men are circumcised, whereas circumcision is uncommon in the non-Muslim community. 60% of the Malaysian population is Muslim, which means that HIV is spreading in the community where most men are circumcised at an even faster rate, than in the community where most men are intact.
http://www.mmail.com.my/content/39272-72-p...ms-says-council
The Philippines
In the Philippines, the majority of the male population is circumcised, as it is seen as an important rite of passage. In the 2010 Global AIDS report released by UNAIDS in late November, the Philippines was one of seven nations in the world which reported over 25 percent in new HIV infections between 2001 and 2009, whereas other countries have either stabilized or shown significant declines in the rate of new infections. Among all countries in Asia, only the Philippines and Bangladesh are reporting increases in HIV cases, with others either stable or decreasing.
http://globalnation.inquirer.net/news/brea...blem-worries-UN
Israel
Despite circumcision being near-universal, it hasn't stopped HIV transmission in Israel.
http://www.haaretz.com/print-edition/opini...s-test-1.249088
http://www.haaretz.com/print-edition/featu...n-aids-1.249372
http://www.haaretz.com/news/has-the-aids-c...israel-1.258520
http://www.haaretz.com/print-edition/news/...harply-1.248651
The most obvious smoking gun: The United States of America
Circumcision hasn't stopped HIV in our own country.
http://data.unaids.org/pub/Report/1998/199...c_report_en.pdf
And, it hasn't stopped other STDs either.
http://www.reuters.com/article/2009/01/13/...lBrandChannel=0
In America, the majority of the male population is circumcised, approximately 80%, while in most countries in Europe, circumcision is uncommon. Despite these facts, our country does poorly.
http://www.advocatesforyouth.org/index.php...=419&Itemid=177
In fact, AIDS rates in some US Cities rival hotspots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda.
www.nejm.org/doi/full/10.1056/NEJMp1000069
The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009:
"[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009
She once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe.http://www.washingtonpost.com/wp-dyn/content/article/2009/03/14/AR2009031402176.html
One would expect for there to be a lower transmission rates in the United States, and for HIV to be rampant in Europe; HIV transmission rates are in fact higher in the United States, where most men are circumcised, than in various countries in Europe, where most men are intact. It is telling that the HIV epidemic struck in our country in the 1980s, 90% of the male population was already circumcised. Somehow, we're supposed to believe that what didn't worked in our own country, or anywhere else, is going to start working miracles in Africa.
Studies With Contrary Conclusions
According to USAID, "there appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
"Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs."
www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431
Results: ...No consistent relationship between male circumcision and HIV risk was observed in most countries.
http://apha.confex.com/apha/134am/techprog...aper_136814.htm
One study which aimed at measuring male to female HIV transmission was ended early, because the results were not looking favorable. The Wawer study showed a 54% higher rate of male-to-female transmission in the group where the men had been circumcised. The figures were too small to show statistical significance, but there will be no larger scale study to find out if circumcising men increases the risk to women. Somehow that's considered unethical, yet it's considered ethical to promote male circumcision while not knowing if the risk to women is increased (by 54%?, 25%?, 80%? - who knows?)
http://www.thelancet.com/journals/lancet/a...0998-3/fulltext
The latest study in Kenya finds no association between male circumcision and lowered HIV rates:
'Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV.'
Conclusion
A few select studies show a prevalence of HIV transmission in uncircumcised men, but real world empirical data shows that circumcision hasn't stopped HIV in countries where there is already a prevalence of the practice of circumcision, nevermind the United States. Yet, for whatever reason, leaders at the WHO continue to endorse it as HIV prevention policy and millions are being spent on so-called "mass circumcision campaigns," even in countries where HIV transmission was shown to be prevalent among the circumcised.
As if the waste of money weren't bad enough, reports are showing that these "mass circumcision" campaigns are actually proving to be disastrous, as they are confusing African citizens, and many now believe to be fully protected by circumcision.
http://joseph4gi.blogspot.com/2011/05/male...-in-africa.html
Something must be done to alert our world leaders. Millions of precious funds are being used to promote a worthless surgical procedure that leaves men with permanently altered organs, and they are no better protected. The false security that the promotion of circumcision creates is actually helping to facilitate the spread of HIV. Funds are already scarce, and they could be better spent promoting cheaper, less invasive modes of prevention that have actually been proven to be conclusively effective, such as condoms and education. In light of the real-world evidence, promoting a worthless surgical procedure is an impertinent disservice in the fight against HIV/AIDS and governments need to be told to stop. Africans deserve better.
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