Where Circumcision Doesn't Prevent HIV

[–]kanuk876[🍰] 7 points8 points9 points 15 years ago (1 child) | Copy Link

[–]argv_minus_one 2 points3 points4 points 15 years ago (0 children) | Copy Link

[–]turinturambar 5 points6 points7 points 15 years ago* (12 children) | Copy Link

As someone against circumcision, I've had a lot of trouble arguing the health benefits of staying intact vs circumcision.

My main problem is the WHO endorsement -- I can't really present a proper critique of those 3 papers because I'm not in the medical profession. And while analysis like yours is nice, it simply can't hold water against published papers in established research journals...

And when I look in Google Scholar for papers against circumcision, it's simply true that papers for circumcision are better cited... don't get me wrong, it does seem like even in medical circles, there's plenty of debate. But there's too much support for circumcision in these circles to make a strong point against it.

I feel like there's a cultural bias influencing researchers in this field, as the most famous papers supporting this technique come from western countries.

I can only hope this critique is reasonable enough to convince fair Redditors who believe in circumcision's benefits (you can have a look at my commenting history to see one thread in which I was arguing about this -- I failed to present a convincing argument against it in my own eyes, although I at least showed there aren't necessarily clear benefits).

For example, even in the analysis presented in this link -- it would be nice to see a comparison to other medical research, and the arguments against/for some kind of medical technique. Critically, how much medical research does it take for a technique to be considered "sound" and "beneficial"? And how much would it take for it to be considered "not worth the risk"?

I had trouble understanding this as someone outside this field. This is why, from now on, I've chosen to purely argue against circumcision on the basis of medical ethics rather than health benefit vs cost.

[–]Joseph4GI 5 points6 points7 points 15 years ago (0 children) | Copy Link

I think arguing about the "health benefits" is the wrong angle from which to look at it.

Circumcision is an action, and not circumcising is inaction. One is a forced phenomenon, the other is not. It is circumcision that requires a rational explanation, not having normal, healthy body parts. It is circumcision advocates who have an axe to grind; they need to explain their actions. They need to make a strong case for cutting off part of a normal, healthy body part, esp. when it comes to doing this to a child. They will present any and every argument as to why circumcision is acceptable, recommendable, and even indespensable.

Intactivists are put in the position of apologizing for the presence of the foreskin, and I think this is just plain wrong. Most other body parts are innocent until proven guilty; it is the foreskin that seems to be the only body part that is the other way around.

Back to the WHO endorsement, I think anybody that sees inconsistencies, can and SHOULD point them out. This "layman vs. scientist" problem has been around since the beginning of time. And time and time again, the lowly layman has shown up the high and lofty "scientist." It is the story of science's life. Just look at Sammelweiss, Pare, Galileo etc.

There has GOT to be something wrong with results of "studies" that do not correlate with real world data. The idea that "circumcision prevents (insert your favorite disease here)" has been around since at least a century, when, much to circumcision advocates' dismay, it was discovered that no, circumcision DOESN'T prevent masturbation. It should be of no surprise that circumcision advocates are STILL at it, trying to justify circumcision over other, better forms of disease prevention.

Medical circles and bigwig scientists can proclaim the "benefits of circumcision," and wave around their studies all they want, but the MUST explain why it is that real world data does not substatiate these claims. If circumcision ISN'T preventing HIV, then they have to be responsible for the spread of HIV caused by the complacency in the promotion of circumcision. Maybe pride keeps them from questioning?

"I feel like there's a cultural bias influencing researchers in this field, as the most famous papers supporting this technique come from western countries."

Your feelings would not be unfounded. Research who writes these "studies." You'll see your answer right there. These studies are all written by people who are circumcised, and who come from cultures where circumcision is, or was a norm, if not an outright requirement. The most vocal of the researchers are from America, where circumcision was once a norm, and is now a dying trend, such as Robert Bailey, Ronald Gray, Maria Wawer etc. A lot of these "researchers" also happen to be Jewish, where circumcision is a religious requirement, and historically, circumcision has been controversial religious practice, and ethically problematic. Jewish "researchers" include Edgar Schoen, Daniel Halperin, Stephen Moses, etc. etc. There are people from other cultures involved too, where circumcision is important, but I'm not too familiar with them. Circumcision is also important in African tribes, and in Islam.

I think that for people who believe in "circumcision's benefits," you've really got to ask, do they really actually believe in them? Or do they cling to them because they need a pseudo-scientific alibi for a practice that is culturally important to them?

Circumcision advocates really like to cling to their "health benefits" and their "studies." But it doesn't really sound like they're interested in finding alternatives.

The nature of science is such that it is always seeking to outdate itself; to make itself obsolete. There is a reason why we don't perform trephination on people anymore. There is a reason why electro-shock therapy has fallen out of fashion. So how interested would these same people be in alternatives to circumcision?

All of the "health benefits" of circumcision can already be obtained elsewhere. STDs are already better prevented through the use of condoms. UTIs are already rare, and easily preventable. Phimosis is already rare, and science has found ways to treat most cases without surgrey.

So how interested would these same people be if a doctor came into their birthing room and said "Good news! This vaccine has the same benefits of circumcision, so now we don't need to circumcise your son anymore!" How many parents would jump for joy, how many would panic? That would be the litmus test right there.

But another question I'd like people to address; how interested would we be in the "benefits" of female circumcision? Doctors in the west already perform a cosmetic procedure called "labiaplasty." Another one called "unroofing." (exposure of the clitoris) These doctors tell us that the women are satisfied and feel even better in bed, as do their doctors. Well, what if we found "medical benefits" in labiaplasty? Would circumcision advocates wish to find out more?

What would we say to "studies" that tried to measure the "medical benefit" of female circumcision in Africa? Would we support the NIH, Johns Hopkins etc. going over there and testing to see how female circumcision "affects" the transmission of HIV?

If there was a clear benefit, how many of us would actually take our daughters to be circumcised?

What is the number of benefits that might convince you?

I think that answer would be zero.

My point? People have been trying to find the "benefits" of circumcision for at least a century now. This reasoning is logically flawed; shouldn't we be looking for BETTER WAYS to prevent disease?

Progress is replacing the old with the new and better. Circumcision is at least 2 millennia old.

There are now newer, and better ways to prevent disease. Instead of those, WHY are circumcision advocates hell-bent on preserving an archaic blood ritual?

I don't know about the rest, but as for me, the less surgical procedures I have to put my child through, the better.

Condoms already outperform circumcision, even in the event that the so-called "studies" were proven to be 100%.

But here's the clincher; even if the "studies" were proven to be 100% accurate, there is still all that real world data that scientists need to explain.

If circumcision "reduces the risk of HIV by 60%," then why isn't this reflective in real situations where there is already a prevalence of circumcision?

Why are HIV rates HIGHER in America, for example, where 80% of the men are already circumcised, than in Europe, where the majority of the men aren't?

Why, despite the fact that HIV was found to be more prevalent among the circumcised, are we dumping millions of dollars in Swaziland?

The Soka Uncobe campaign is already proving to be disastrous, at it is sending the wrong message that you can have all the sex you want once you're circumcised and not have to wear condoms.

Even if the "studies" were correct, there is STILL a problem with promoting a surgery that detracts from the most effective mode of prevention known to us.

The question remains; even if the "studies" are "fool proof," what's with all these other countries?

WHY isn't circumcision preventing HIV there?

[–]LiamW -1 points0 points1 point 15 years ago (10 children) | Copy Link

It's pretty much unnecessary, there is no real benefit to circumcision (as far as I can tell, only negative impacts to one's life).

Except where HIV prevalence is high or significantly impairing the affected, and cost/benefits of other methods don't come anywhere near the reduction rate of male circumcision.

I've have a colleague (he worked for Gates Foundation, basically researching why their aid projects did NOT work) who worked in Africa and were asked by locals to show how to put on a condom (since the locals knew it prevented HIV), as they did not understand what that little wrapped tube of latex did, or how it worked.

When you're fighting ignorance (lack of being informed), and limited health services, a 1 time operation that has a 60% reduction in risk of HIV infection that costs pennies... it's just huge.

I've lived in Africa, condoms are not free for everyone (sometimes, yes), or always readily available. People live on far less income, and the relative cost of Condoms can be a huge deal breaker.

There was an interesting NYT article on Economist perspective on aid that showed one of the most cost effective HIV prevention schemes was informing youth groups about the dangers of sugar daddies... This was intended to simply reduce sex between generations (where older men are more likely to have HIV), and showed the best results of anything in reducing HIV prevalence amongst young women.

One major problem the the circumcision issue, is that women are no less likely to contract HIV from a circumcised HIV positive male, than an uncircumcised one. Women basically get the short end of the stick with STI's in general, and this isn't considered a solution, but additional risk reduction at best.

[–]Joseph4GI 3 points4 points5 points 15 years ago (9 children) | Copy Link

"Except where HIV prevalence is high or significantly impairing the affected, and cost/benefits of other methods don't come anywhere near the reduction rate of male circumcision."

Not even there. As the evidence I provide shows.

"I've have a colleague (he worked for Gates Foundation, basically researching why their aid projects did NOT work) who worked in Africa and were asked by locals to show how to put on a condom (since the locals knew it prevented HIV), as they did not understand what that little wrapped tube of latex did, or how it worked."

So instead of actually taking the time to show them how to use a cheaper, less invasive mode of prevention, the clear solution is cut them, and hope that this way, they'll start using condoms?

Is that the logic?

"When you're fighting ignorance (lack of being informed), and limited health services, a 1 time operation that has a 60% reduction in risk of HIV infection that costs pennies... it's just huge."

Correction; a one time operation that, if "studies" were correct, only protects "60%", for a year and a half (the length of the study). No, circumcision does not cost pennies. It actually costs time and money; of which is being spent on a worthless procedure over something that is actually cheaper, and works much better.

"I've lived in Africa, condoms are not free for everyone (sometimes, yes), or always readily available. People live on far less income, and the relative cost of Condoms can be a huge deal breaker."

I'll take your word for it, ;-). So instead of making the cheaper, least invasive method and MAKING it readily available, cut them, and let them roam free?

Oh wait, you were going to take that time to "educate" them right? You need to circumcise them for this, WHY?

And you seem to be agreeing at the end there with me;

Even if the "studies" are correct, and I show reason why they are suspect, circumcision would only "reduce" the risk in men; no protection for women.

I seriously can't see the logic in promoting an HIV prevention method that would be LESS EFFECTIVE THAN CONDOMS, and would only protect the MALE; the Wawer study showed that women were 50x more likely to get HIV from circumcised men (which is why they were ended early).

Circumcision would only protect MALES "60% (of 1.5 years)," condoms protect BOTH male and female over 90% of the time.

ARE YOU F'in KIDDING ME.

[–]LiamW -2 points-1 points0 points 15 years ago (8 children) | Copy Link

[–]Joseph4GI 2 points3 points4 points 15 years ago (7 children) | Copy Link

The claim presented is:

"Circumcision reduces the risk of transmission by 60% in males."

The evidence in Africa show that there is a prevalence in HIV transmission among circumcised men.

In Malaysia and the Philippines, this 60% figure is also not observable.

Neither is it in the US and Europe.

I need to know why.

I'll admit, there are many things I don't understand, and I do have a bias against circumcision. But that aside, I have a bias against using shoddy studies to make extraordinary claims.

Our bias for or against circumcision aside, if this 60% claim is not true, then endorsing it is dangerous.

"Circumcision reduces the risk of transmission by 60% in males."

If this is true, why isn't it reflected in the countries presented?

That's what I'd like to understand.

When somebody makes a claim, it should be evident elsewhere, not just in the unique, controlled situation of a "study" conducted by "researchers" eager to vindicate a known ethically problematic non-medical surgical procedure that is usually conducted in non-consenting minors.

[–]LiamW -5 points-4 points-3 points 15 years ago (6 children) | Copy Link

[–]Joseph4GI 2 points3 points4 points 15 years ago (5 children) | Copy Link

Are you sure we're talking about the same study? If I remember correctly, the study only lasted a little more than a year. And yes, I'm afraid the study is questionable for many reasons. One could say they ended it early because they liked the evidence they had, and the trend was going in an unfavorable direction; they circumcised the remaining men and called it "unethical" not to so as to avoid having to follow up on their study.

But again, let's assume for the sake of argument that these "studies" were 100% accurate.

The claim "Circumcision reduces the risk of transmission by 60% in males" does not conform to the situations in countries that I present.

HIV was more prevalent among the circumcised in 6 countries, 3 other studies showed the same prevalence, and the claim does not manifest itself in the US where 80% of the men are already circumcised. I'm not sure what more information you need.

THe infection rates are lower in countries with higher circumcision rates; in the countries that "researchers" choose to present.

This is not true in the countries I present.

If "circumcision reduces the risk of transmission by 60% in males," why does this ratio not manifest itself in other countries? And why doesn't this manifest itself in countries where there is already a prevalence of the practice of circumcision, IE, Malaysia, Indonesia, the Philippines, America?

[–]LiamW -4 points-3 points-2 points 15 years ago (4 children) | Copy Link

[–]Joseph4GI 1 point2 points3 points 15 years ago (0 children) | Copy Link

[–]thedarkerside 0 points1 point2 points 15 years ago (2 children) | Copy Link

The problem I see with this study, if it is the same we're talking about here, is that they never seemed to have captured other data, e.g. how often did the subjects have sex for example which sort of puts the risk analysis at best a bit askew.

My point being: It's quite possible that circumcision reduces the spread of HIV infection by putting the circumcised person off of having sex in the first place.

Now, is that a "desired" outcome? Or wouldn't it be better to promote the use of safer sex (e.g. condoms) instead?

Also: Let's presume for a moment that circumcision reduces the amount of sex a man has and female circumcision has the same effect should we then also promote female circumcision?

I have a serious problem with the idea that we should lob off body parts for some potential benefit, because if we apply that logic why dont we remove other troublesome body parts right at birth?

[–]LiamW -1 points0 points1 point 15 years ago (1 child) | Copy Link

[–]pakmanishere 4 points5 points6 points 15 years ago (0 children) | Copy Link

[–]rantgrrl 4 points5 points6 points 15 years ago (0 children) | Copy Link

[–]kloo2yoo[M] 3 points4 points5 points 15 years ago (0 children) | Copy Link

[–]GoatBased 4 points5 points6 points 15 years ago (0 children) | Copy Link

[–][deleted] 0 points1 point2 points 15 years ago* (2 children) | Copy Link

[–]IOnlyLurk 1 point2 points3 points 15 years ago (1 child) | Copy Link

[–][deleted] 0 points1 point2 points 15 years ago (0 children) | Copy Link

[–]Joseph4GI 0 points1 point2 points 15 years ago (7 children) | Copy Link

[–]LiamW -5 points-4 points-3 points 15 years ago (6 children) | Copy Link

[–]Joseph4GI 2 points3 points4 points 15 years ago (5 children) | Copy Link

No, you are countering arguments I never made. It's called "talking to yourself."

You are ignoring the main argument; that being that "studies" that do not correlate with real live data are suspect.

I'm not sure what you think my "hypothesis" is. I am questioning the claim "circumcision prevents HIV transmission 60%" of the time." If this is true, then why isn't this evident in the reald world?

What is dangerous is providing a dubious alternative "prevention method" to what we know is already conclusively effective.

If what I say is true, then we are basically paying millions for a procedure that not only does not help, but causes a false sense of security, SPREADING the disease. This is already self-evident in reports coming in from Africa, such as the PANOS report, and reports from the Soka Uncobe disaster.

Regarding my experience, I think that is irrelevant to the question I ask. (read above) I make ask a pretty relevant question, regardless of my "experience." I expect a relevant answer.

"Your crusade against circumcision could be as dangerous as recent crusades against infant vaccines."

Except that now you've added an extra burden to yourself; you must now tell us how exactly a circumcision is ANYTHING like a vaccine.

A vaccine functions by strengthening the immune system against microbes that cause disease. When HIV invades the body, what part of your penis is missing is really irrelevant.

A vaccine is proven to be conclusively effective, and the mechanism by which it works is known.

The best any "study" can give us is statistics hand-picked by "researchers" with an axe to grind, assertion of a claim, and no proven hypothesis.

Consider this; if those "studies" are wrong, then promoting circumcision in Africa is a huge mistake.

Obviously you're more concerned with defending circumcision than you actually are about public health.

[+]LiamW -8 points-7 points-6 points 15 years ago (4 children) | Copy Link

Circumcision reduces the risk of transmission by 60% in males.

That is all the study said. Circumcision, in addition to education programs, condom availability, and reducing poverty will have more of an effect on reducing HIV prevalence than education programs, condom availability, and reducing poverty on their own.

My reference to vaccines was about the vaccines cause autism scare that was not medically backed, but had exceptionally similar "research" to your own, and has resulted in the unnecessary deaths of thousands of children.

You have no experience in Africa, you are not a Scientist, you are not asking intelligent questions regarding the nature of the data, you have shown your ignorance.

Stop spreading ignorance, a right to free speech comes with the responsibility of understanding the dangerous effects of incorrect speech and its influence.

[–]Joseph4GI 4 points5 points6 points 15 years ago (3 children) | Copy Link

"Circumcision reduces the risk of transmission by 60% in males."

If this is true, then I need to know why this does not correlate in the countries I've presented, and with the data in other studies.

" Circumcision, in addition to education programs, condom availability, and reducing poverty will have more of an effect on reducing HIV prevalence than education programs, condom availability, and reducing poverty on their own."

Why hasn't it had this effect in the countries I present?

"My reference to vaccines was about the vaccines cause autism scare that was not medically backed, but had exceptionally similar "research" to your own, and has resulted in the unnecessary deaths of thousands of children."

Your reference to vaccines was made under the assumption that I too am one of those "anti-vaxers." I'm afraid you're mistaken. And, made under the assumption that the claim that circumcision "reduces the risk by 60%" is correct.

Nice attempt at guilt by association, and at securing acquiescence to the claim I question.

"You have no experience in Africa, you are not a Scientist, you are not asking intelligent questions regarding the nature of the data, you have shown your ignorance."

You are, again, appealing to authority.

I ask quite relevant questions that. Now answer them or forever hold your peace.

"Stop spreading ignorance, a right to free speech comes with the responsibility of understanding the dangerous effects of incorrect speech and its influence."

Ignoratio elenchi.

Point duly noted.

I am ignorant, I will admit. There are many things I do not know.

Which is why ask questions.

No question is too stupid to ask.

And I expect an answer.

If circumcision "reduces the risk of HIV by 60%," the claim would be true everywhere, not just in select studies done on select populations, performed by select people.

Circumcision has not "reduced" the risk of HIV in the countries I present.

Why?

If circumcision does not prevent HIV as the claim says, then we are only funding genital mutilation, and, since these men are gaining a false sense of security, we are funding the spread of HIV.

THAT.

Is dangerous.

Real scientists (and by real scientists I mean objective, impartial scientists that don't have a particular interest in vindicating a controversial religious procedure) need to analyze the data further.

If circumcision is worthless, then governments need to told to stop promoting it, NOW. It's mutilating millions of African men, it doesn't prevent HIV, and it's putting their partners in danger.

We can go back and forth all night;

The data will simply never correlate, and we won't move closer as to why.

If they don't correlate, then something is seriously wrong.

[+]LiamW -6 points-5 points-4 points 15 years ago (2 children) | Copy Link

Ok, I'm going to go through this:

Cameroon is largely considered (blood exposure to SIV from bush hunting being the most legitimate theory) where HIV started, so infection rates will be the highest there. We pretty much have to eliminate that as one of your countries off the bat.

Ghana has the lowest HIV infection rate of any Sub Saharan African country, with the highest (second highest?) circumcision rate.

Lesotho, which has one of the HIGHEST HIV infection rates has one of the lowest circumcision rates.

Malawi, which has one of the lowest circumcision rates has one of the highest HIV infection rates in it's region (being far from the origination of the disease).

Rwanda (your data does not include %pop circumsized), has had tremendous HIV prevention work done (free IRVs through Gates foundation, as well as testing).

Swaziland had both many close ties to S. Africa/Cameroon transmission vectors and incredibly poverty, along with low circumcision rates, and has a very high HIV infection rate.

There are enough cultural, economic, and infrastructure differences between Malaysia, the Phillipines, and the US. Though from working as an expat, those countries do have quite a bit of sex tourism.

And again, circumcision does not STOP HIV infections, but may SLOW the rate of infection.

BTW, this is all from your sources and checking HIV infection rates by country in Africa.

[–]Joseph4GI 5 points6 points7 points 15 years ago (0 children) | Copy Link

I don't exactly see how being the origin of HIV eliminates Cameroon; the rate of circumcision is pretty high there, at about 91%. Shouldn't the "reduction" in HIV have been the most evident there?

Ghana: This may be true. But the prevalence of HIV WAS among the circumcised.

Lesotho: The circumcision rate is 23%, but the ratio circumcised men vs. intact men who contracted HIV was 22.8 vs 15.2.

The explanation given HERE, though, is different to yours:

"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)

From my blog: What [I find] 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.

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.

You may be right, but then could you explain the evident gap between circumcised and uncircumcised men with HIV here? And why the prevalence of HIV was amongst the circumcised men?

Rwanda: I commend Mr. Gates, and it's good that they're getting much HIV prevention, but the 60% claim is not reflected here either...

Swaziland does have low circumcision rates, and a high HIV infection rate, but the ratio of circumcised vs. intact men who contracted HIV was found to be 22 vs. 20. At any rate, given the claim that circumcision is supposed to "reduce" the risk of HIV, by 60% as it is claimed, shouldn't the ratio have been in the OPPOSITE direction? Even just a little?

This from the study: "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)

From my blog: 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.

Yes, there are a lot of cultural, economic and infrastructure differences between Malaysia, the Philippines an the US. But what ties these countries together is the fact that there are both a majority of circumcised males there, as well as a prevalence of HIV.

In another post, you talk about poverty etc., and here we have countries with different poverty levels.

In America, 80% or so of the male population is circumcised, and yet we have higher HIV rates than in Europe, where most men are not.

One of the explanations I hear often is that the reason for this is that poverty levels are higher in America. Health and sex education is also poor.

If I'm to understand correctly, these are the exact same reasons why we SHOULD circumcise the majority of the men in Africa.

What didn't work in our own country is suddenly going to start working miracles in Africa.

"And again, circumcision does not STOP HIV infections, but may SLOW the rate of infection."

Again, there's that half-concealed qualification of "may."

And, again, the claim is that "Circumcision reduces the risk of transmission by 60% in males."

To which I continue to say, if this were true, then it would be evident in other real-world situations.

The claim fails to correlate. You can provide all the ad-hoc explanations you want, but it fails to correlate.

There is something wrong with results from "studies" that fail to correlate in real world situations.

There is something wrong with a claim that can only be applied to special unique circumstances that only a select few recognize or acknowledge.

There are other reasons that I won't get into why the "studies" being used to make this claim don't even have a leg to stand on, such as methodology, researcher bias, ethic, etc., but for now, I focus on conflicting real-world data.

The claim is "Circumcision reduces the risk of transmission by 60% in males."

The claim is not always true. There is something wrong with this claim.

And there is something wrong in promoting a dubious form of "prevention" that detracts from the most effective form of HIV prevention known to us.

If the claim is false, then we are not helping; we are promoting genital mutilation AND, effectively, hastening the spread of AIDS.

[–]Joseph4GI 3 points4 points5 points 15 years ago (0 children) | Copy Link

And you didn't address the other studies either:

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." http://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." http://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/techprogram/paper_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/article/PIIS0140-6736%2809%2960998-3/fulltext

But I'm sure you'll find reasons to dismiss these as well.

There is clear bias in wanting to only accept evidence that conforms to a claim or belief, while dismissing and/or finding flaws in evidence to the contrary.

But the bottom line is always the same:

Studies and claims that don't correlate with reality are suspect.

If I'm correct, then endorsing circumcision was a huge mistake, we are wasting millions of dollars, and we're doing African men a huge wrong.

I think promoting genital mutilation as a form of "HIV prevention" is wrong to begin with, knowing that circumcision didn't have the effect claimed would make it that much worse.

[–][deleted] -1 points0 points1 point 15 years ago (0 children) | Copy Link

[–]LiamW -3 points-2 points-1 points 15 years ago (39 children) | Copy Link

So a controlled study of circumsizing males from one ethnic/religious/economic group shows reduced infection rates... that much be wrong.

But comparing a bunch of studies that take existing conditions of circumcision, but not population centers, tribes, or religion proves it doesn't work?

Ghana has extremely low HIV infection rates, due to their culture, but 95% circumcision rates, uncircumcised Ghanaians tend to live in the far north where there is little contact outside of their village...

You are unlikely to contract HIV if you live in a remote village and don't have sex with anyone with HIV.

Circumised men having sex (with potentially infected women) have lower rates of HIV infection, period. That is the difference.

Everything this article said is retarded, conspiracy theorist crap of someone who didn't understand the circumcision study.

[–][deleted] 5 points6 points7 points 15 years ago (3 children) | Copy Link

[+]LiamW -7 points-6 points-5 points 15 years ago (2 children) | Copy Link

[–]LiamW -5 points-4 points-3 points 15 years ago (1 child) | Copy Link

[–][deleted] 2 points3 points4 points 15 years ago (0 children) | Copy Link

[–]Joseph4GI 0 points1 point2 points 15 years ago (7 children) | Copy Link

Yes. Real-world data is much more compelling than data obtained in so-called "controlled studies" where every aspect of the so-called "study" was controlled.

What happens in a controlled enviroment does not necessarily translate to the real world, as real world data shows.

When statistics don't match up with real world data, the problem isn't with real world data, there's got to be something wrong with these "statistics" and how they were acquired.

When you look at exactly who conducted these "studies," people who have been trying to establish a link between male circumcision and a reduction of HIV, and other disease actually, for a long time (ie, Bailey), and people for whom justifying circumcision has been a problem of centuries (IE, Moses, Halperin, Weiss etc.) the reason becomes clear.

The "studies" say one thing. Reality says another. That was the point of the article.

If circumcision doesn't actually prevent anything, then millions are being wasted on these "mass circumcision" campaigns that leave men with mutilated penises, and they still won't be any better protected than with what they were doing before; wearing condoms.

Now, it seems, "researchers" have a double-burden, of keeping those "studies" afloat, AND avoiding to look like self-interested idiots.

There are other problems with these so-called "studies," but the conflicting real-world evidence is just one area.

Another red flag with these "studies" is that they have no working hypothesis. You can insist and insist that "circumcision prevents HIV" based on hand-picked evidence, but if you don't have any kind of established mechanism, then all you have is ad-hoc/post-hoc reasoning.

Not to mention the studies were ended early...

Not to mention that in many of these studies, more men dropped out than they showed a difference...

Not to mention that that "60%" actually refers to smaller number of men...

The way this "study" was conducted, and the way the numbers are being manipulated can't really be called "scientific."

[–]LiamW -4 points-3 points-2 points 15 years ago (6 children) | Copy Link

[–]Joseph4GI 2 points3 points4 points 15 years ago (3 children) | Copy Link

[–]LiamW -4 points-3 points-2 points 15 years ago (2 children) | Copy Link

[–]Joseph4GI 6 points7 points8 points 15 years ago (1 child) | Copy Link

I think you're missing the question. I'll ask again.

The claim is that circumcision is supposed to reduce the risk of HIV transmission by 60%.

In the countries that I present evidence from, this isn't the case.

Why?

I'd like to know how scientists ascertained how much each of their subjects had sex, and how many partners they had. And how old each of their partners were etc.

It all comes down to the same question.

If circumcision is supposed to "reduce the risk of HIV by 60%," why isn't this evident in other countries where circumcision is already near universal?

And I didn't JUST present 6 African countries and 2 South East Asian Countries, not to mention the US.

I mentioned three other studies that showed contrasting results. What do you think of those?

What do you think of the latest study in Kenya?

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.' http://www.plosone.org/article/info%3Adoi/10.1371/journal.pone.0015552?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+plosone/PLoSONE+%28PLoS+ONE+Alerts:+New+Articles%29

I'm sorry, but circumcision advocates have some explaining to do. The "science" simply isn't adding up.

To continue promoting a dubious practice, spending millions where they could be better spent, is, I believe, a waste of money, not to mention dangerous.

The reports such as PANOS and reports from the Soca Uncobe situation don't help much either.

[–]LiamW -5 points-4 points-3 points 15 years ago (0 children) | Copy Link

[–]Joseph4GI 3 points4 points5 points 15 years ago (1 child) | Copy Link

[–]LiamW -3 points-2 points-1 points 15 years ago (0 children) | Copy Link

[+]LiamW -6 points-5 points-4 points 15 years ago (26 children) | Copy Link

[–]Joseph4GI 6 points7 points8 points 15 years ago (7 children) | Copy Link

It's all really plain and simple.

You can churn out all of the "studies" you want, and try to prove that circumcision "does" something. (They've been trying to prove it "does" something for at least a century now...)

If circumcision "reduced the risk of HIV by 60%" as these studies claim, then this would be reflected in real world environments, where there is already a prevalence of circumcised men.

They don't. Even if these "studies" were correct, their numbers simply don't line up with the real world situations given here.

You can pick apart the surveys I point out, but I also give other situations, and other studies.

What do you say about the situation in Malaysia? The Philippines? AMERICA???

Why should we make entire policies based on numbers that make sense only in a few carefully constructed studies written by people with an axe to grind?

Why on EARTH are they even relevant, given the fact that, even if they were accurate, circumcision would still be out performed by condoms? Even if the "studies" are correct, the very authors can't overstate enough that circumcised men would still have to use condoms. That's right, because circumcision FAILS. Even if that 60% number were accurate (and there is plenty of reason to believe it is not), circumcision would be like a condom that broke 40% the time.

Why on EARTH are we presenting an alternative to the most effective form of HIV prevention known to us?

According to PANOS, quite a few men believe that they are 100% protected via circumcision. This is causing complacency in condom use, making the situation WORSE.

Even if these "studies" were correct, the WHO should have NEVER endorsed this as a form of HIV prevention. Resources are being wasted, men are being mutilated, and HIV is STILL being spread.

Gee, thanks a lot.

One thing's for sure; the results of the latest "studies" DON'T correlate with real data. Circumcised men are STILL getting HIV, and in some cases, at higher rates than intact men. There's got to be something wrong. The WHO, UNAIDS, UNICEF, PEPFAR etc. have GOT to explain what the meaning of this is.

[–]LiamW -2 points-1 points0 points 15 years ago (0 children) | Copy Link

[–]LiamW -4 points-3 points-2 points 15 years ago (5 children) | Copy Link

[–]Joseph4GI 3 points4 points5 points 15 years ago (4 children) | Copy Link

How does this happen? Can you tell us?

Studies can show all they want, but why don't they correlate with real world data?

And uh, let's back up a little bit;

"Unprotected sex circumcised is 60% less likely to contract HIV than uncircumcised."

This is a claim based on the hand-picked statistics in those studies. Making this claim is a post-hoc argument which doesn't really establish a causal link.

Tell us, since you know all about it, what is that link?

How exactly does not having a foreskin "reduce the risk" of HIV?

As someone who knows better, you can tell us.

"You can still contract it if you expose yourself to that risk (albeit reduced risk) multiple times."

Rendering circumcision useless.

Again, WHY is this even being endorsed if you still need to use a condom?

Men are already using their circumcsions as an excuse to forgo condoms.

Isn't this a fear at all?

[–]LiamW -5 points-4 points-3 points 15 years ago (3 children) | Copy Link

No, you have hand picked data, that came to conclusions based on a personal belief against circumcision (which, I actually don't disagree with). But that belief, and spreading false interpretation (bad science) can foster distrust in something that can actually save lives.

The data you cite cannot reasonably describe a situation where circumcision does NOT reduce transmission rates to men by 60%.

Ghana is a great example though... under 3.1% HIV infection rate, 95% circumcision rate. That's pretty low when it's neighboring countries are in double digit infection rates.

60% is not 100%, and circumcision does not protect women from contracting HIV from men. Using a condom is still most effective (outside of not having sex of course), but condoms are not always available, they can break, and not everyone knows how to use them.

Circumcision can help slow the growth rates of HIV, and in conjunction with other effective HIV prevention campaigns, we may have a chance at negative growth rates in the next generation.

Your blog post is very dangerous, because to the casual observer (most blog readers) your points make sense. Most anyone with real experience in scientific data analysis or who knows what "T.I.A." stands for, will come to see your blog as patently false.

[–]Joseph4GI 2 points3 points4 points 15 years ago (2 children) | Copy Link

Actually, no. If you've even bothered to look at it, the authors themselves have a personal belief FOR circumcision. If I read correctly, they were EXPECTING a reduction, and didn't find any. Or am I reading that incorrectly?

I'm afraid that the "false interpretation" and the "bad science" is something that circumcision advocates are guilty of.

Tell us about that 60%. 60% of what? A lifetime? 1.5 years? (The length of the study?) And from what is that figure extrapolated from? Wasn't the ABSOLUTE reduction rate something like 1.6%?

Look, there are other problems with these studies, including methodology, the fact that they were ended early, and researcher bias (the headers of these studies have been trying to establish a link between male circumcision and HIV for some time now, some with other diseases), not to mention that the studies weren't double-blinded (that would be unethical).

But let's just say they were 100% accurate, and there were no question about them.

The question remains, WHY doesn't the data correlate with other real-world situations?

The 6 African countries were one thing, but what about Malaysia? The Philippines? THE USA???

What is "dangerous" is that we are promoting a mode of "prevention" that not only is outperformed by already existing methods that are cheaper and more effective, but it is actually helping to SPREAD disease.

Let other "researchers" with their agendas come.

I posit real questions, and I hope to get some answers.

You can explain away the "studies," you can't explain away real world data.

When data doesn't correlate, there is something wrong.

If the claim that "circumcision prevents HIV transmission 60% of the time" is false, then we are not only needlessly mutilating millions of Africans, but because they are already showing to have a false sense of security, we are effectively funding the spread of AIDS.

If it's something that I know about science is that it must always be questioned. Always. That's the whole point of science. This is why it doesn't stop at "god created it all." If a claim is true, then it must be through throughout, demonstrably provable every time, not just in unique special circumstances.

Again, that 60% may occur in the select studies, but why isn't this apparent everywhere else?

If there is a scientific explanation for this, I'm waiting.

Otherwise, I feel sorry for those Africans who are being coerced to forever alter their organs.

[–]LiamW -4 points-3 points-2 points 15 years ago (1 child) | Copy Link

Look up "co-factor."

The studies you have referenced only contain aggregate population data, they did not collect the data necessary to come to your conclusions.

The effects of reduce risk of infection would be SLOWER growth rates of HIV, not 60% less HIV overall.

Cameroon is largely established as the most likely place for the origination of HIV (through eating bush meat which can entail simian blood exposure).

Vectors for spreading the disease will of course be based on human interactions (trade, sexual activity, migrations, resistance).

Circumcised/non-Circumcised groups are typically segregated in Africa (different tribes), unprotected sex is your major transmission vector for HIV, introducing circumcision into a mixed populous showed reduced infection rates in men.

There is no conspiracy here. You're conclusions do not have the data necessary to support them.

If you wanted to come to your conclusions you will have to go into the raw data and look for HIV growth rate trends amongst population centers, normalizing datasets that do not exist.

[–]Joseph4GI 4 points5 points6 points 15 years ago (0 children) | Copy Link

[–][deleted] 2 points3 points4 points 15 years ago (17 children) | Copy Link

[–]LiamW -3 points-2 points-1 points 15 years ago (16 children) | Copy Link

[–]Joseph4GI 5 points6 points7 points 15 years ago (14 children) | Copy Link

[–]LiamW -4 points-3 points-2 points 15 years ago (13 children) | Copy Link

[–]Joseph4GI 6 points7 points8 points 15 years ago (12 children) | Copy Link

[–]LiamW -3 points-2 points-1 points 15 years ago (11 children) | Copy Link

[–]Joseph4GI 5 points6 points7 points 15 years ago (6 children) | Copy Link

Yes, appealing to authority IS a logical fallacy.

It's called argumentum ad verecundiam.

And, in this case, because you're trying to use "authority" to make me look bad, it's also ad hominem.

Poisoning the well.

Again, the claim is:

"Circumcision reduces the risk of transmission by 60% in males."

It's not reducing it in males in the countries I present.

If the data does not correlate, then there is something wrong in either the data in the so-called "studies," or there is a flaw in the real world.

Placing beliefs before fact, as opposed to fact before beliefs, is another logical fallacy called, a priorism.

If the claim that "Circumcision reduces the risk of transmission by 60% in males" isn't correlating with the rest of the world, then something is wrong with the claim, not the reality that is the rest of the world.

Real world data does not correlate with that claim.

There is something wrong with it, and, basing entire policies and campaigns on it is not only deceptive and dishonest, it is dangerous.

[–]LiamW -3 points-2 points-1 points 15 years ago (5 children) | Copy Link

My authority is from working in Africa (not as an AID worker), and studying African Development, having African family (and thus more personal knowledge of tribal taboo topics at least with Ghanian tribes), all of which back the claim of saying that those countries are harder to get accurate data from, and less reliable to work with. All of this is also very clear if you actually read about Africa in any major international publication.

You're clear lack of experience and not describing your background (which to anyone who has lived in Africa, is clear), is what I use, not my background in African development, to show that you are NOT an authority.

I use my background only to describe the difficulty of working Africa, which is largely an understood problem in the Western world. Not assumptions, but on the ground experience, for the last 5 years.

I consult with both academics and private sector companies and volunteer groups on dealing with cultural difference and difficulties in operations and logistics in Africa.

[–]Joseph4GI 5 points6 points7 points 15 years ago (3 children) | Copy Link

"Saying that circumcision does not reduce risk of infection by 60% vs uncircumcised males because there are populations of circumcised men in Africa with HIV IS a logical fallacy."

That WOULD be a logical fallacy, except I never made that claim.

The claim that I made was this:

Real world data does not conform to the claim that "Circumcision reduces the risk of transmission by 60% in males."

In the countries presented, the prevalence of HIV was HIGHER among the circumcised, vs. the intact.

That's quite different than merely saying "circumcision does not reduce risk of infection by 60% vs uncircumcised males because there are populations of circumcised men in Africa with HIV."

The claim is that if most men were circumcised, then the rate of HIV transmission would also be reduced.

I also mention other countries where circumcision has failed to prevent HIV, despite the prevalence in the practice, such as Malaysia, the Philippines and the United States.

I'd double-check what other people say before quoting them next time.

[–]LiamW -4 points-3 points-2 points 15 years ago (2 children) | Copy Link

[–][deleted] 1 point2 points3 points 15 years ago (0 children) | Copy Link

[–]LiamW -4 points-3 points-2 points 15 years ago (1 child) | Copy Link

I've played your game enough here.

http://www.doingbusiness.org/rankings

http://www.youtube.com/watch?v=PzQmdTt5dPQ

The growth rates of HIV outside of the epicenter of the disease have been lower in countries with high circumcision rates.

Even Rwanda, which has a somewhat lower infection rate than it's neighboring countries suffering from epidemics still has a high infection rate, but was the first country to step up with HIV prevention, and has massive amounts of funding going into free IRVs and testing nationwide.

Cameroon, the only country that has a high circumcision rate and high infection rate is where HIV likely originated, which explains that, clearly.

You ask me to provide studies that do not exist, while you yourself present an argument that would require the same data you ask me for.

Your entire argument is a logical fallacy, and a dangerous one at that.

Simply put, your conclusions do NOT match your own data, because you do not have the understanding of "co-factors", "time/rate", and "prevalence" and you completely ignore parts of those studies that do not agree with your bias against male circumcision.

You have no experience in dealing with Africa, and are simplifying the problems down to your own socio-political beliefs.

[–]Joseph4GI 1 point2 points3 points 15 years ago (0 children) | Copy Link

"I've played your game enough here."

I'm afraid the only person playing "games" here, is you.

Saying "HIV is higher where circumcision rates are lower" is misleading; all of the HIV cases in these countries could be circumcised men.

Alright, it's not quite as bad as this, but the HIV prevalence in these countries WAS in the circumcised men.

Insisting on interpreting the data the way you do demonstrates an intent to hide these numbers.

"Cameroon, the only country that has a high circumcision rate and high infection rate is where HIV likely originated, which explains that, clearly."

Being both the "origin of HIV," and a country of high circumcision prevalence, the difference, that "slow in growth" should be the MOST NOTABLE here.

"You ask me to provide studies that do not exist, while you yourself present an argument that would require the same data you ask me for."

Actually, no, I quite present the data, you seem to be intent on picking it apart for this or that reason. Your bias is obvious.

"Your entire argument is a logical fallacy, and a dangerous one at that."

What's dangerous is spending millions of precious funds on a dubious mode of "prevention" that is actually making matters WORSE.

"Simply put, your conclusions do NOT match your own data, because you do not have the understanding of "co-factors", "time/rate", and "prevalence" and you completely ignore parts of those studies that do not agree with your bias against male circumcision."

Simply put, you have failed to show how my conclusions do not match the data that I present.

Co-factors, time-rate, prevalence etc. are all attempts to blind me and others with science.

The bottom line is this: If circumcision "reduced the risk of HIV transmission 60%," then this would be evident anywhere at any given time, not just in the unique environment of "studies" written by known "scientists" with an axe to grind.

It is an interesting projection to tell me I "completely ignore the parts of those studies that I don't agree with based on my bias against male circumcision"; it seems you, and every other circumcision advocate out there ignore data from countries and studies that do not agree with your bias in circumcising the whole world.

Circumcision is an artificial, forced phenomenon; the foreskin is normal, healthy tissue. It is basic human anatomy and needs no apology. While there is no religious ceremony or importance in having a foreskin, there is much cultural and religious investment in cutting it off.

Science seeks to replace itself. Progress is replacing the old with the new and better. While the rest of the scientific world seeks to study the reason and functions of human body parts, circumcision advocates are busy finding the faults of the foreskin, condemning it and validating its deliberate distruction. And while medicine seeks to find better, less invasive methods to cure and present disease, circumcision advocates seem stuck on preserving an old archaic procedure that's over 2,000 years old.

I'm afraid it is circumcision advocates who have an inherent "bias," not those seeking better, less invasive methods of treatment.

The data in countries that I present do not conform to the claim. And the question is WHY?

If circumcision isn't preventing HIV transmission anywhere else, how on EARTH is it all of a sudden going to start working wonders in Africa?

"You have no experience in dealing with Africa, and are simplifying the problems down to your own socio-political beliefs."

Ad hoc, argumentum ad verecundiam, ad hominem, and projection.

I'm afraid the persons simplyfing problems down to "socio-political beliefs" are those who are trying to circumcise others, just as they are circumcised, and they circumcise their children in their culture.

History tells us that it's circumcision advocates who have been trying to square this circle for ages, but they can't.

Circumcision advocates actually believe that circumcision cures everything and everybody should be circumcised.

If that's not ramming your own "socio-political beliefs" down people's throats, in the name of "science" and "HIV prevention," then I don't know what is.

I feel sorry for those poor African men being coerced into having their organs mutilated. What must go through the minds of those who go to a clinic and find out they were infected with HIV anyway, despite having gone through radical genital surgery?

What's next for them? Expensive ARTs for the rest of their lives? And the lives of their partners?

Is this what "researchers" mean by "cost-effective?"

Good day to you sir.

Title	Where Circumcision Doesn't Prevent HIV
Author	[deleted]
Upvotes	27
Comments	65
Date	May 29, 2011 1:34 AM UTC (15 years ago)
Subreddit	Posted in /r/MensRights
Original Link	https://old.reddit.com/r/MensRights/comments/hmkbw/where_circumcision_doesnt_prevent_hiv/
Archive Link	https://theredarchive.com/r/MensRights/where-circumcision-doesnt-prevent-hiv.1039322 https://theredarchive.com/post/1039322

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