Razib over at Gene Expression has an excellent post* about cultural issues affecting HIV and circumcision, elaborating on Lindsay's mention here of the limitations of trying to increase circumcision as a way to reduce viral spread:
There was a strong undercurrent of resistance to the approach throughout the session. It finally erupted during the question period. One man asked the panelists whether they considered circumcision a form of mutilation, and what kind of counseling or support services they would put in place to offset the traumatic effects of the surgery? When Auvert pointed out that all the studies are looking at voluntary, adult male circumcision, the man retorted, "It's not because you're an adult that you might not be traumatized by the loss of your foreskin." This is an extreme example, but several social scientists chastised the panelists for "decontextualizing" the debate about circumcision, and rallied against the label "biological technology," as some of the panelists had referred to it.
All prevention efforts must take culture into consideration, but because of the extreme and irreversible nature of circumcision, and the intermingling of the practice with significant cultural traditions in many areas, clearly it's a tougher sell than something like condom use. Whether it will play a significant role in future prevention efforts or not is difficult to tell.
(*Be sure to check out William Saletan's Slate commentary as well that Razib links--it discusses not only male circumcision but also female genital mutilation, and the parallels [and differences] between the two. Interesting stuff).
Comments
" The relationship between the presence of a foreskin and HIV infection is strong is some studies, but the exact opposite in other studies. The design of the study is paramount, as non-causal associations can easily arise in observational studies due to confounding and misclassification. The least reliable design study is the population-based random cluster sample survey. The difference in outcomes based on study design are shown in figure 3. Of the studies with most reliable study design, most found circumcised men to be at greater risk for HIV infection." http://tinyurl.com/gerga
Posted by: Gaia sighs... | August 19, 2006 11:49 PM
cite date: 1999.
Posted by: razib | August 20, 2006 1:31 AM
Are there any guesses on the mechanism? Is it simply an "area effect"?
Posted by: windy | August 20, 2006 6:29 PM
Are there any guesses on the mechanism? Is it simply an "area effect"?
i think it is area effect, if you mean include the fact that the foreskin has a lot of blood vessels. also, the epidermis glans of circumcized males is something like 10X thicker because it is always exposed to air over the lifetime.
Posted by: razib | August 20, 2006 7:40 PM
I think the circumcision thing is one of the best ideas that modern science has come up with in fighting HIV.
I am just not sure how it will be accomplished, but I do say benefits for it in various different areas.
It could create a lot of jobs in Africa or even for various people to join in a world effort to accomplish this feat of circumcising 500 million Africans. It IS going to take a lot of manpower to accomplish it.
As I said, I don't know how it will be actually done, but I can just imagine our scientists and medical teams going through the jungles with a circumcision blade reaching out for these black mens genitalia. Hopefully they will be tacit about it, and not scare too many back into the jungle.
Or perhaps it could be done on a larger scale in villages, where, say, all men would line up in a long line and hold out their appendages, and perhaps something like a self sterilising weed-whacker could be instituted. It could even be called a "wiener whacker".
This could benefit American companies and even create a lot of jobs over here, in the manufacture of these medical weiner wackers.
The only draw back, is that we all know, that all wieners are not created equal. And we don't want anyone to get their fingers lopped off in the process.
Therefore, I propose a deal with the Weiner Schnitzel hot dog take-out chain, to provide 500 million wiener buns in small, medium, large, and extra and perhaps extra extra large. The men and boys could simply hold the bun and whatever is protruding gets whacked.
Benefits all around. HIV minimalized, jobs created here and in Africa, business for American companies, AND whatever is left could even be fed to the poor starving dogs that are to be found through-out many of the poor ghettos in the cities of Africa!
This is American ingenuity of Science, Medicine, and Industry, at its finest!
Posted by: Michael | August 21, 2006 1:20 PM