Tuesday, December 18, 2007

The Rabbi had it right: circumcision helps prevent HIV

I love Discover Magazine's Top 100 Science Stories of the Year. Unfortunately, that's the geek in me looking for clips on dark matter and soil problems causing the fall of ancient civilizations. But every so often you find news you can use.

Top story number 15 is Male Circumcision: A New Defense Against HIV, which documents the fact having your newborn baby boy visited by a mohel can actually reduce his risk of transmitted HIV by a whopping 60%!!!

"Circumcision is thought to prevent infection because the underside of the foreskin is rich in immune cells that are particularly vulnerable to HIV. Small tears in the foreskin during intercourse can also allow the virus to slip into the body."

What's really interesting (and dismaying) about this story is that apparently this 2006 study only reinforces a 1999 study done in Great Britain that has been studiously and intentionally ignored by the World Health Organization. The study estimates that implementing a policy of recommending universal male circumcision in Africa could "6 million HIV infections and 3 million deaths over 20 years."

****[Correction]****As an alert reader pointed out, I got the part about a Brit study wrong. It has been an ongoing debate, not a study.****[Correction]****

Hey, just another reason why we should turn our medical decisions over to a bureaucracy!


Um, No said...

In a decade or two (if not much sooner) this absurd notion that circumcision helps prevent AIDS will be widely understood as another idiotic chapter in the history of false claims about circumcision.

Moreover, infants don't need protection from sexually acquired diseases anyway! They won't be having sex until they're old enough to consent or decline their own circumcision.

No, "The Rabbi" didn't "have it right" regarding health. No medical association today says that there are benefits that exceed the risks, which include death. They did have one thing right, though. Circumcision is intended to reduce sexual pleasure and sensitivity (you know, keeps the mind off the "material world"): We've finally started quantifying that obvious truth!

Libertarianism is about Liberty. Circumcising an infant removes the fundamental liberty of maintaining bodily integrity. Depriving a child of part of his penis... Depriving him of the right to make that choice, when there's no medical need... Well, that doesn't sound very Libertarian to me!

The British Medical Journal is debating whether medically unnecessary circumcision constitutes child abuse. Libertarians cannot, in good conscience, deny children the liberty they can't yet fight for themselves.

Hugh said...

And 60% is hardly "whopping". I can still walk through a door that is 60% closed. In those famous trials, they circumcised about 5,400 men (not babies) and left a similar number intact. Over 21 months, 64 of the circumcised men got HIV and 137 of the intact control group (and 340 circumcised men dropped out, their HIV status unknown - quite enough to swallow up the difference). That's an average of 39 circumcisions to prevent one HIV transmission (from woman to man only) in countries where HIV is rampant. Where HIV is relatively rare, it would be hundreds or thousands of circumcisions per prevention.

Steve Newton said...

I corrected the part about the Lancet debate.

I disagree that a 60% reduction in transmission rates is insignificant. That kind of thinking in the early 1980s caused CDCP to turn down the notion of using hepatitis testing as a substitute for the HIV test (which then didn't exist) because it was only about 85% reliable.

I'll deak with the issue um.no raises in a post later today--got to run now

um, no said...

Thought you might find this interesting:

Libertarian Party of Iowa
Annual State Convention Address
Iowa State University
Ames, Iowa
October 12, 1997

Hugh said...

The "unreliability"* of a test is a very different thing from the ineffectiveness of a treatment.

* There are two measures of "reliability", selectivity and sensitivity. Low selectivity, many false positives, leads to unnecessary worry and wasted treatment; low senstivity, many false negatives, to untreated disease, so the latter is much more unacceptable than the former. 85% sensitivity, ie 15% of negatives being false, would be horrendous.

In the developed world, where the rate of HIV infection per capita is very low, cutting part of the genitals off every baby in order to partially prevent HIV some 15 years later would be a very inefficient way to proceed.

Focussing on 60% when the incidence is tiny is a con-job. What is the Number Needed to Treat? The figure for Canada is about 5000 and that for the US would not be much less.

There have been many studies that fail to show any correlation between circumcision and HIV.

Most recently, a study of 58,600 US men (Mor et al.) found no significant difference in circumcision rates between men with and without HIV (though you'd never guess that from the way it was written up).

(Your reference to rabbis and your illustration puts the focus on one high-profile kind of circumcision. 97% of circumcision in the US is surgical; in the world 2/3 is Muslim.)

Anonymous said...

Are babies really at risk of catching AIDS through unprotected sex? Last I checked, infants weren't going around having sex. ha ha! (Maybe I just haven't asked the right babies)
And my common-sense side tells me that if circumcision really reduced HIV, the US gay population wouldn't have such an AIDS crisis within it's mostly circumcised community. I'm pretty sure abstinence and/or condom use without fail are the only methods that will protect agains HIV.
I just have a real problem giving consent for surgery on my child unless I know there is a dire health need, like cardiac surgery or something.
I can not speak to the religious aspect of circumcision as it's not something my religion practices (thankfully! - ouch!).

Anonymous said...

I'm tired of people trying to justify cutting parts off children's genitals. The push to circumcise comes from people who are interested in promoting circumcision rather than fighting AIDS.

HIV doesn't strike people at random, and circumcision can't make any difference unless you're having unsafe sex with an HIV+ partner. So... don't have unsafe sex with HIV+ partners.

ABC (Abstinence, Being faithful and Condoms) works against AIDS. Circumcision does not. Has no-one read the studies showing that circumcised virgins are twice as likely to be HIV+, that circumcised HIV+ men are more than twice as likely to pass on HIV to their wives, or that female circumcision appears to protect against HIV? We're trying to stamp that out, so how will encouraging male circumcision help that?

What about the 1993 study that found that "partner circumcision" was "strongly associated with HIV-1 infection [in women] even when simultaneously controlling for other covariates." See also the 2007 Stallings study, which showed that female circumcision seems to protect against AIDS. We wouldn't dream of promoting female circumcision whatever level of protection it offered, so why we we want to promote male circumcision (which does more damage than some of the minor forms of female circumcision).

Why does the USA have a higher rate of HIV than any European country, whilst also having a higher circumcision rate?

12 months ago, a Jewish baby died after suffering a heart attack 15 minutes after being circumcised. In NYC, another baby died and two suffered brain damage after contracting the cold sore virus from the mohel during circumcision. These are just some of the ones we know about. Google "David Reimer" for someone who survived circumcision, but lost his penis.

Does anyone really think that circumcised men are not going to use that fact as an excuse not to use condoms? First, the most sensitive part of their penis is cut off, then they're told they have some protection against AIDS. The Auvert study and Brian Morris even compared it to a vaccine!

This is a *huge* step backwards, and will not only cost yet more African lives to AIDS, but make it harder to stop female circumcision.

TLC Tugger said...

Amputating healthy normal body parts from people who have not consented has nothing to do with Libertarianism.

Boiling Pot said...

Circumcisers, and defenders of chopping off healthy pieces of babies, have disturbed feelings about sexuality and the sex organs. And they have spent their entire lives manoeuvering themselves into a position where they can do this ugly thing - and get away with it, and even get paid for it!

I don't care if the practice is religious or secular or health-based or anything else. For people who want to do circs, or cannot stand the sight of normal male genitals, the justifications are endless. The mental condition precedes the act, and as long as there is mental illness regarding sexuality, there will be circumcision of unconsenting children.

www.teruel-3d.com said...

Quite helpful material, thank you for this post.