Comments on: Promoting infant male circumcision to reduce transmission of HIV: A flawed policy for the US

By: P Hoath

P Hoath — Thu, 04 Feb 2010 18:40:41 +0000

This is second hand testimony with no corroborating evidence but it does agree with the facts:

http://www.youtube.com/watch?v=4AfPajxmfbE

By: Frank OHara

Frank OHara — Tue, 15 Sep 2009 15:07:01 +0000

“S,” you are making the mistake of taking the African studies at face value without critical review. The evidence clearly points to them not only being false but intentionally deceptive.

If male circumcision had the protective effect claimed, HIV would be conspiciously absent from The US and any country/locale where male circumcision is the dominant practice. Consider the polio epidemic of the first half of the 20th century. The vaccine was only 70% effective against a disease that is far, far more contagious yet managed to eliminate the infection in a single generation. If male circumcision had the protective effect claimed, we would see a similar situation. Instead, The US has the highest infection rate among the developed nations and among the demographic groups, the one with the highest circumcision rate also has by far the highest infection rate. African American males have both the highest circumcision rate and are estimated to represent 48% of infected males and African Amercan females represent 80% of all infected females. Why has circumcision so miserably failed African Americans? The answer is simply that circumcision provides no significant protection if any against HIV.

To understand the deception, you have to look into the history of the perpetrators. The two leaders in the promotion of male circumcision and the HIV studies, Bailey and Halperin have both been rabid promoters of male circumcision for more than 25 years, well before anything was known about HIV. It appears that these studies are simply a continuation of their agenda and an effort to raise their activities to a higher level.

By: Robert Samson

Robert Samson — Wed, 02 Sep 2009 17:48:23 +0000

“I don’t think it’s a reasonable option to wait until men are mature/already sexually active to perform the procedure, especially in light of new evidence published recently in the Lancet from the Uganda trials indicating that men did not wait the full time to heal before resuming sexual activity. Thus their female, previously HIV-negative, partners got HIV at a much higher rate than the partners in the control group. This is great evidence for performing the procedure at birth, and proof of the damage caused by waiting.:

Gee, yet ANOTHER flaw in the African studies? Started too early, ended too early–the known flaws keep piling up.

Talk about “GREAT” evidence–NOT!

By: Robert Samson

Robert Samson — Wed, 02 Sep 2009 17:44:34 +0000

“Samson – your second point is a fair one. I meant a longitudinal RCT where randomization occurs at birth (intact/cut) then follow up with lifetime number of sex partners would take a long time, instead of retrospective analysis of natural groups. To my knowledge, there hasn’t been any study anywhere (US or Africa) that has done that… so the potential for an increase in the number of sex partners (”promiscuity”) shouldn’t be used as fuel for people opposed to the recommendations.”

This HAS been done–in the real world and with ALL variables inherent in the study groups:

Reality studies:
Duration 30 yrs
subjects: >300M
Total conversions: millions
ratio 1/6 intact/cut

African studies:
Duration 2 yrs
subjects–10,000
total conversions <200
ratio: 2/1 intact/cut

Again I have to return to the efficacy of re-doing a study that has failed so miserably in the real world. I think logic CAN be used by people opposed to infant circumcision.

By: S

Wed, 02 Sep 2009 17:06:16 +0000

Hugh7 – I don’t think it’s a reasonable option to wait until men are mature/already sexually active to perform the procedure, especially in light of new evidence published recently in the Lancet from the Uganda trials indicating that men did not wait the full time to heal before resuming sexual activity. Thus their female, previously HIV-negative, partners got HIV at a much higher rate than the partners in the control group. This is great evidence for performing the procedure at birth, and proof of the damage caused by waiting.
Samson – your second point is a fair one. I meant a longitudinal RCT where randomization occurs at birth (intact/cut) then follow up with lifetime number of sex partners would take a long time, instead of retrospective analysis of natural groups. To my knowledge, there hasn’t been any study anywhere (US or Africa) that has done that… so the potential for an increase in the number of sex partners (”promiscuity”) shouldn’t be used as fuel for people opposed to the recommendations.

By: Robert Samson

Robert Samson — Wed, 02 Sep 2009 16:30:50 +0000

“no one has studied the between group differences in number of sex partners between circumcised at birth and un-circumcised men in the US since it would require maybe 30 years of follow-up?”

So, it would require 30 years HERE, but require only 2 years in Africa?

How exactly does this compute? Where is the logic?

By: Robert Samson

Robert Samson — Wed, 02 Sep 2009 16:27:09 +0000

” They are general recommendations based on available research. In this case, the evidence points overwhelmingly to the effectiveness of infant male circumcision for HIV prevention, even if all of that evidence comes from Africa.”

This assumption needs to have an explanation for the discrepancy I posted above–I have yet to have ANYONE provide solid evidence for this discrepancy.

Especially in light of this MUCH larger experiment:

Reality studies:
Duration 30 ys
subjects: >300M
Total conversions: millions
ratio 1/6 intact/cut

African studies:
Duration 2 yrs
subjects–10,000
total conversions <200
ratio: 2/1 intact/cut

Which is logically more credible?

By: Hugh7

Hugh7 — Wed, 02 Sep 2009 07:33:01 +0000

If “families are to be told what the benefits of circumcision are”, then they should also be told what it actually entails, and what the possible risks and certain damage are. They should see a video of an actual circumcision right through, such as as this, from Stanford University or this. And they should see what can happen (rarely, but unnecessarily, and always a real tragedy) These are not for the squeamish - the last picture shows something like what happened to David Reimer of Ontario, who was unsuccessfully brought up as a girl. But why should the decision be left to "families? As one circumcised man pointed out, his family has never had anything (else) to do with his genitalia - and rightly so. Through the Internet, more and more men are coming out as resentful that this choice was taken from them. In the wake of references to "mandatory" and "universal" circumcision, the CDC has issued a disclaimer, that circumcision should be "completely voluntary" and who can disagree with that? "Completely voluntary" can only mean at the option of the person most directly concerned, the man on the other end, when he is old enough to decide for himself. As Frank Inglis implies, the Royal Australasian [Australia and New Zealand] College of Physicians says, "ethical concerns have focused on recognition of the functional role of the foreskin, the non-therapeutic nature of the operation, and the psychological distress felt by some adult males circumcised as infants. The possibility that routine circumcision contravenes human rights has been raised because circumcision is performed on a minor for non-clinical reasons, and is potentially without net clinical benefit for the child. ... the RACP does not recommend that routine circumcision in infancy be performed, but accepts that parents should be able to make this decision with their doctors. One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice." This is a step forward, and it may be only legal caution that stops them from moving directly to total condemnation.

By: S

Wed, 02 Sep 2009 02:11:24 +0000

A few points:
1. CDC recommendations don’t mandate anything, and they most certainly aren’t policy. They are general recommendations based on available research. In this case, the evidence points overwhelmingly to the effectiveness of infant male circumcision for HIV prevention, even if all of that evidence comes from Africa.
2. I can see the confusion with the numbers, but obviously we’re not going to avert 50,000 infections. Speaking of the infant procedure alone, I don’t see a rights-based problem unless you’re worried about the right of the boy to make that decision when he’s older (I think that’s negligible- since parents make a lot of decisions in the first weeks, months, years of life that children may one day have the potential disagree with).
3. Having said that, if HIV is the number 1 killer among African American heterosexual women age 25-44 in the US, and presuming that 90% (I’m being generous) are not injection drug users, then they’re getting HIV from heterosexual men (all 5,250 of them). You haven’t taken herd immunity into account at all in the number of infections you suppose to prevent. What about the next women these men could infect?
But 4, and most infuriating, is the fear that this procedure is going to make people more promiscuous. It’s the same reason people say girls shouldn’t get the HPV vaccine – girls might “get slutty” now that we have a better tool for prevention. Presuming we’ll always have to do education, that’s a shoddy reason not to perform a potentially life-saving procedure. We will ALWAYS need more education about STIs, regardless of what other medical interventions come along, and on this point we agree. Furthermore, it is irresponsible to draw from the 2005 study from South Africa since the men in this study were old enough to be sexually active when the procedure was performed. To my knowledge, and I could be wrong here, no one has studied the between group differences in number of sex partners between circumcised at birth and un-circumcised men in the US since it would require maybe 30 years of follow-up? For the record, I think the adult and infant procedures are entirely different issues, and would require very different recommendations.

By: Robert Samson

Robert Samson — Tue, 01 Sep 2009 13:52:29 +0000

let’s take a critical look at reality:

The USA with circumcision rates as high as 90% has an HIV and STD epidemic many times greater than intact Europe and Japan..how is this possible?

The surest sign of stupidity is to keep repeating the same mistake hoping for a different outcome.