Gene Expression

Circumcision reduces spread of HIV

Male Circumcision Reduces HIV Risk: No Further Evidence Needed, According To Review:

The clinical trials included in the review took place in South Africa, Uganda, and Kenya between 2002 and 2006, and included a total of 11,054 men. The results show that circumcision in heterosexual men significantly reduces their risk of acquiring HIV by 54% over a two year period, compared with uncircumcised men. This reduced risk is the best estimate of the average effect and the researchers report that the true risk will be reduced by between 38 to 66%. Further research, however, is required to establish whether male circumcision offers any benefit to women partners of circumcised men and homosexual men.

Related: Circumcision & AIDS.

Comments

  1. #1 hans
    April 15, 2009

    Hmm, upon a careful reading I know what is going on:

    “…HIV infection rates are reduced in heterosexual men for at least the first two years after circumcision,”

    Yes, for the first two years it is still too painful to do anything ! ;)

  2. #2 James F
    April 15, 2009

    On topic, this paper provoked a great deal of negative response.

  3. #3 Ethan Siegel
    April 15, 2009

    …as opposed to using condoms, which are 98% effective at stopping the transmission of the virus.

    Why is anyone advocating anything besides condom use when we see overwhelming evidence that everything else is inferior?!

  4. #4 Ray Ingles
    April 15, 2009

    If our sons are persuaded by these studies, they can have it done when they’re old enough to make that decision. :->

  5. #5 zyxwvutsr
    April 15, 2009

    Shouldn’t that say, “Male Circumcision Reduces HIV Risk in Africa“?

    (e.g., is Ethan’s 98% stat from studies conducted solely in Africa?)

  6. #6 Lassi Hippeläinen
    April 16, 2009

    They don’t seem to have a good idea about the underlaying mechanism. Is it possible that circumcised men are better motivated to take care of personal hygiene? In that case I would recommend education is stead of mutilation.

  7. #7 razib
    April 16, 2009

    They don’t seem to have a good idea about the underlaying mechanism.

    i think their anatomical argument is good. circumcised men do not have a piece of tissue which is loaded with blood vessels and a relatively high surface area. also, since their glans is exposed its skin is much thicker and tougher. this serves in some ways as a “natural condom.” the same arguments that anti-circ activists make which suggest that the natural state heightens pleasure and sensation, just as not wearing a condom is preferable to wearing one, works against them when it comes blocking pathogens from slipping in.

    as noted by a commenter above, the main effect here is obviously in the african context. japanese and swedish men don’t seem to have raging HIV epidemics despite their uncut status (in fact, it is lower than the USA, and japan’s HIV rate is the same as south korea, where circumcision is the norm).

    …as opposed to using condoms, which are 98% effective at stopping the transmission of the virus.

    Why is anyone advocating anything besides condom use when we see overwhelming evidence that everything else is inferior?!

    abstinence is 100% effective, but the argument against it is that people won’t follow it all the time. if condom education exhibits diminishing returns i think one can make the case that circumcision has a value-add.

  8. #8 pushmedia1
    April 16, 2009

    You have to consider the behavioral response. Yes, circumcision (or condoms) reduce the chance of a particular sexual contact leading to a transmission of Aids, but it doesn’t mean there won’t be more sexual contacts. Circumcision (and condoms) reduce the cost of having more partners and if men like to have multiple sex partners, this means they’ll have more. On balance, these partial cures (and the behavioral response they induce) can actually exasperate the epidemic.

    Michael Kremer did the math and found that this perverse behavioral effect may be even more likely in high prevalence areas (like Africa).

  9. #9 Caroline
    April 16, 2009

    Since when do researchers decide “no further research is necessary”? Further research is ALWAYS necessary. This is how we find out if results are replicable or not. Interesting how when they got the results they wanted “no further research is necessary”, but regarding male to male and male to female transmission (by far the most prevalent form of transmission), “further research” IS required. Looks to me like the “researchers” don’t want anyone to try and replicate the results of the first study because they are afraid it won’t hold up.

  10. #10 Tom Tobin
    April 16, 2009

    Here are a few dissenting opinions:
    The British medical community says circumcision merely postpones an inevitable infection without condom use:

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

    South Africans saying it increased their HIV infection rate, and is unethical:

    http://africasciencenews.org/asns/index.php?option=com_content&task=view&id=1124&Itemid=2

    An American woman who circumcised her son, saying why she wouldn’t do it again:

    http://www.examiner.com/x-3016-Detroit-Motherhood-Examiner~y2009m4d8-Why-todays-parents-are-saying-no-to-circumcision

    The danger of MRSA infection, even in the best of hospitals:

    http://www.boston.com/news/health/articles/2009/04/11/state_details_safety_lapses_at_beth_israel/?page=2

    recent lawsuits:
    http://cbs2chicago.com/local/northwestern.circumcision.lawsuit.2.985487.html

    http://www.foxnews.com/story/0,2933,511809,00.html

    Not to mention that removing healthy tissue from an unconsenting person is unethical. Whatever happened to “first, do no harm”?
    Circumcision typically removes half of the skin of a penis. It removes or damages the two most erotically sensitive parts of a man, the frenulum and inner foreskin. The head is a distant third in responsiveness. Studies have shown that circumcised women are less likely to be infected. Why is this not considered? Why the rush to cut men? Why would anyone in their right mind remove so much of their penis, when they could stay much safer with condom use?

  11. #11 Marco
    April 16, 2009

    Kaiser Daily HIV/AIDS Report

    Science & Medicine | Study Looks at Male Circumcision as HIV Prevention Among Black
    Men in Baltimore
    [Dec 19, 2008]

    HIV risk appears to be lower among U.S. black men who have been circumcised (up to 51%) and
    are considered at high risk of contracting the virus than among black men who have
    not been circumcised, according to a study published on Wednesday in the Journal of
    Infectious Diseases, Reuters reports. Two other studies in the journal also examine
    the benefits of male circumcision to prevent the spread of disease and infection.

    For one of the studies, CDC researcher Lee Warner and colleagues looked at black men
    living in Baltimore and found that 10% of those who were at high risk of HIV and were
    circumcised had the virus, compared with 22% of those who were not circumcised.
    According to the report, “Circumcision was associated with substantially reduced
    HIV risk in patients with known HIV exposure, suggesting that results of other
    studies demonstrating reduced HIV risk for circumcision among heterosexual men
    likely can be generalized to the U.S. context.”

  12. #12 D
    April 17, 2009

    i think their anatomical argument is good. circumcised men do not have a piece of tissue which is loaded with blood vessels and a relatively high surface area. also, since their glans is exposed its skin is much thicker and tougher. this serves in some ways as a “natural condom.”

    Does this mean that adult circumcision won’t be as effective as infant circumcision?

  13. #13 justme
    April 20, 2009

    Why not complete external genital excision, combined with gonadectomy. I’m pretty sure it’ll work, but we need to test it. The authors of this ‘study’ will be the first ‘compulsory volunteers’. If not, we can always carry out lower body amputation, that’ll be sure to work. And if it doesn’t, we can even euthanize a few of the ‘volunteers’ to make our data points come out right, because that is absolutely guaranteed to work.

    I know, not my normal commenting style. But I’m incensed at how cavalierly they can suggest circumcision, and that it is even being ‘suggested’ as a ‘compulsory’ public health measure.

  14. #14 Tony
    April 22, 2009

    Razib,

    The headline of the cited article is incomplete, but you bolded the necessary caveat that it ignored. Like Caroline said, further research is needed because drawing a definitive conclusion from “for the first two years after” is flawed. What about the first five years? Ten?

    the same arguments that anti-circ activists make which suggest that the natural state heightens pleasure and sensation, just as not wearing a condom is preferable to wearing one, works against them when it comes blocking pathogens from slipping in.

    This needs to be addressed, but I don’t think this works against anti-circ activists in a compelling manner. Anti-circ activists (like myself) acknowledge that condoms are required, regardless. If the foreskin provides sensation, and I think it’s logical to assume it does, then that extra sensation makes the lessened sensation from a condom more palatable. Education and personal responsibility still matter.

    The key point is that enough conflicting data exists to require a skeptical response. It doesn’t make sense to extend voluntary, adult circumcision in Africa to infants in Western nations, which is what public health organizations now promote.

  15. #15 Joe
    April 25, 2009

    I am curious why a simple study showing the benefits of circumcision would spawn such a negative reaction. I glad this article wasn’t written about how monogamy or abstinence reduces the spread of diseases. That might have an even stronger flavor of morality (God forbid) oops sorry about mentioning the G– word. I wouldn’t want to offend anyone.

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