Circumcision Does Cut HIV Risk in Africa

On July 21, 2014, The Daily Beast reported new research which suggests that the notion that increase circumcision in males could possibly encourage sexual risk practices is flawed. Though studies have shown reduction of contracting HIV by as much as 60 percent, there was a sense of fear by some that it could possibly give the wrong impression to people and encourage unsafe sexual practices due to men assuming that circumcision meant protection from HIV.  To learn moreclick here.

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Filed Under: AIDS AwarenessGlobal HealthMarginalized Populations in HealthcarePreventionPublic HealthScientific FocusSpecialty Corner

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  2. Mark Lyndon says:

    From a USAID report:
    “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.”

    It seems highly unrealistic to expect that there will be no risk compensation. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.

    It is unclear if circumcised men are more likely to infect women. The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:

    ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery seems likely to cost African lives rather than save them.

    Europeans don’t circumcise, South Americans don’t circumcise, Australians and New Zealanders used to circumcise but stopped, and less than half of North Americans circumcise. Why should Africans circumcise?

    Recent news from Botswana:
    “There is an upsurge of cases of people who got infected with HIV following circumcision.”

    and from Zimbabwe:
    “SOME circumcised men are contracting HIV and Aids after ditching the use of condoms, under a misguided belief that male circumcision (MC) would prevent them from getting infected”

    and from Kenya:
    “Push for male circumcision in Nyanza fails to reduce infections”

  3. PJ says:

    “What does the frequently cited “60% relative reduction” in HIV infections actually mean? Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive”, so the absolute decrease in HIV infection was only 1.31%…” (Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011; 19:316-34.)

    “At least 40 million Nigerians could have traces of the hepatitis virus–which causes inflammation in the liver, according to the Society for Gastroenterology and Hepatology in Nigeria.”

    “The survey found people who had undergone local circumcision were 43% more likely to contract hepatitis
    B–mostly from using unsafe implements.”

    “Global figures indicate hepatitis is a more serious disease than HIV: some 400 million infection of hepatitis occur every year compared with 34 million for HIV.”

    See: http://allafrica.com/stories/201312240022.html

  4. The latest from the ARC:

    Attorneys for the Rights of the Child’s Legal Advisor Peter Adler and Executive Director Steven Svoboda have co-authored a letter sent by the National Coalition for Men (NCFM; http://www.ncfm.org) to the Gates Foundation. The text reproduced below omits the references. The letter with all references and the cover letter with which it was submitted to the Gates Foundation can be found here: http://arclaw.org/our-work/letters/arcs-adler-and-svoboda-write-letter-about-hiv-and-circumcision-ncfm-sends-gates

    To support the work of Attorneys for the Rights of the Child, please visit http://arclaw.org/donate.

    Steven Svoboda
    Attorneys for the Rights of the Child
    http://www.arclaw.org

    July 16, 2014
    Open Letter to The Bill and Melinda Gates Foundation

    Everyone should applaud how your Foundation is funding proven methods to slow the spread of HIV and AIDS in sub-Saharan Africa, including testing, teaching the so-called ABC’s (Abstinence, Be Faithful, and Condoms), retroviral therapy, treating schistosomiasis (which causes vaginal bleeding) and STDs, and helping to lead the search for an HIV vaccine. It is time, however, for your Foundation to stop funding the scientifically, morally, ethically, and legally unjustified program to circumcise 38 million African men as an HIV preventive strategy. After seven years and 6 million circumcisions, your program
    has failed.

    1
    Biased, Deeply Unethical Trials and Buried Results. The mass male circumcision program is being justified based on four random controlled trials (RCTs) conducted in sub-Saharan Africa. The RCTs suffered from numerous ethical, scientific and methodological flaws that render the results meaningless.
    Worse, one of the RCTs produced evidence that was quickly buried suggesting that circumcision may increase male to female transmission of HIV by 61%. Moreover, the African circumcision program may be completely unnecessary, as a Ugandan RCT showed that intact men who wait at least ten minutes to clean their penis after sexual intercourse are 41% less likely to contract HIV than circumcised men.

    Thus, the program’s targets could be achieved without a single circumcision and at minimal cost versus a projected cost for the current program of $16 billion. African men and women should have been informed of these facts critical to their health and safety.

    2
    Circumcision Offers Men Little or No Protection From HIV. Some Africans are being told, and many will
    reasonably assume (why else are they being circumcised?) that circumcision will protect them from HIV, but that is false. Circumcision is no vaccine. Circumcised or not, men who have sex with HIV infected females risk becoming HIV positive.

    Africans should be informed as follows: “For highly exposed men, such as men living in southern Africa, the choice is either using condoms consistently, with extremely low risk of becoming infected, or being circumcised, with relatively high risk of becoming infected.” Even if circumcision did reduce the relative risk by 50%, Garenne concluded,“ a 50% reduction in risk [if true] is likely to have only a small
    demographic effect.

    “Observational studies of general populations have for the most part failed to show an association between circumcision status and HIV infection.”Thus, the true protection that circumcision provides to men from HIV infection is negligible or nil.

    3
    Ironically, Circumcision Will Likely Increase HIV Infections Among African Men and Women. Experts
    have concluded that “circumcision programs will likely increase the number of HIV infections.” First, only 30%-35% of HIV in African men is attributable to sexual transmission, not 90% as experts initially claimed. HIV in Africa is often blood borne, spread by contaminated needles. Circumcision surgery in Africa often causes HIV. The problem will much worse when millions of Africans are circumcised in multiple, often unsterile venues on a rush basis by poorly trained workers. Second, volunteers, reasonably believing that they are completely or substantially protected from HIV, are less likely to use
    condoms,and circumcised men are less likely to use condoms anyway. Third, mass circumcision diverts resources from the proven methods of HIV prevention listed in the introduction. Thus, your mass male circumcision program will not only fail but will backfire.

    4
    Circumcision Is Also Painful, Risky, and Harmful. Africans report surprised at how painful circumcision is.
    Even if local anesthetics are used and given time to work, they are largely ineffective, and pain continues during the healing period. Even the American Academy of Pediatrics ‘Task Force on Circumcision concedes that circumcision risks a long list of minor injuries, serious injuries (including hemorrhage, infection, deformed penis, and loss of all or part of the glans or of the entire penis) and death. In the United States, the risk of injury is estimated to be between 2% and 10%. In Africa, the risk of injury is much higher, estimated to be 17.7% clinically and 35.2% for traditional circumcisions.As the AAP conceded in its 2012 policy statement, the true extent of the risks associated with circumcision is unknown.

    5
    Circumcision Diminishes Every Man’s Sex Life. Circumcision removes one-half of the penile covering, the size of a postcard in an adult. The foreskin is replete with blood vessels and specialized nerves such as stretch receptors. The foreskin is, and circumcision removes, the most sensitive part of the penis. African men will be outraged to learn that circumcision not only has failed to protect them from HIV but has forever diminished their sex lives. Female partners of circumcised men also report reduced sexual satisfaction.

    6
    Africans Are Being Misinformed, Coerced, and Exploited. African men are not being informed of the truth, that circumcision is painful, risky, and harmful; that in itself it gives little to no protection from HIV, and the surgery itself may infect them with HIV. Serious ethical violations are occurring as usually poor Africans are being offered valuable incentives to volunteer such as free medical care.
    Boys as young as fifteen years old are being coerced, such as being offered team uniforms and equipment in exchange for being circumcised.

    7
    Call For Action. Your Foundation’s mass circumcision program violates science, medical ethics, and the law. Your Foundation should immediately terminate its misplaced support of the African mass circumcision program. Your Foundation should also immediately initiate a comprehensive investigation into the program led by unbiased experts, ethicists, and of course Africans. Otherwise, the legacy of the Gates Foundation, and inevitably your personal legacy, will be that you and your Foundation funded one of the most harmful medical programs in human history, and also that you and your Foundation failed to stop it after being informed that it had failed.

    Respectfully submitted,

    Harry Crouch, President
    National Coalition for Men