This is Eric; I'm not a doctor. The straight answer is that "using a condom correctly every time for every sexual act greatly reduces, but does not completely eliminate, the risk of contracting or transmitting HIV." See our vid "The Importance of Condom Compliance" for more info.
1. Do you believe that circumcision as a HIV reduction strategy should be performed only on adult men with their informed consent, or should nations implement a neonatal circumcision program so that there is no risk of men potentially saying "no" to the procedure later in life?
2. What do you think about research pointing to female circumcision as a potential method of HIV risk reduction?
This is Eric. Dr. Kuhn doesn't monitor or respond to these comments. We are not advocating infant circumcision, as repeatedly noted previously in the thread. There is NO evidence published in peer-reviewed scientific journals that female genital mutilation has any positive effects that even make up for, much less outweigh, its massive documented harmful affects such as infection, higher death rate in childbirth, higher rate of obstetric fistula, etc. FGM kills and must be abolished.
sltr1 - I don't know whether your statement about the rate of HIV in the U.S. vs. "Europe" is correct (first of all, you'd have to define what you meant by "Europe" for us to even evaluate your claim). However, I do know that research has clearly, unambiguously shown that higher circumcision rates in nations and regions correlate with lower HIV prevalence rates. So even if your cherry-picked comparison of the U.S. vs. Europe is correct, it would be trumped by the worldwide evidence.
You cannot compare differing cultures as there are many confounding factors present. If you are to perform circ it must have a big effect, to counteract the downsides. It clearly doesn't.
This page presents the faults of the African trials:
Your argument is NOT sound. You are showcasing your inability to perform valid deductive reasoning. In one breath you cite the inability to compare "differing cultures" because of "confounding factors," then in the next breath you arbitrarily assert that France, Germany, and Netherlands have "equivalent GDP and culture." That's the essence of cherry picking. I'm sure the French and Germans would love to learn that their cultures are "equivalent" to that of the U.S.
Methodologically sound BROAD studies show there's a correlation between LOW rates of circumcision and HIGH rates of HIV. "Four ecological studies show the clear geographical correlation of high HIV prevalence and areas where male circumcision is rare." [Wilson & de Beyer, "Male Circumcision: Evidence and Implications," HIV/AIDS M&E - Getting Results, World Bank Global AIDS Program, citing Auvert et all 2001, UNAIDS 2004, USAID/AIDSMark 2003. See related Mehendale 1996, Gray 2000, Cameron 1989.]
They may not be exactly alike, but they are certainly closer to each other than Africa and the USA. Yet as you can see from the links I posted 5 days ago, these trials are being used to promote routine infant circ in the USA. So who here has invalid inductive reasoning?
So saying all this, using circumcision as another tool to prevent HIV should be abandoned. It is a waste of resources and sends out the wrong message. It is more likely to increase HIV contraction.
You can draw any incorrect conclusion you like when you ignore the results of controlled, replicated, peer-reviewed published scientific research studies and focus instead on hypothetical risks for which there is no evidence in practice. You're demonstrating the classic thinking pattern of radical anti-circumcision activists: "never let the facts get in the way of an opinion." You can believe 3 controlled studies, or you can believe YT user sitr1 "because he says so." Your choice, your life.
Who are you speaking to ? I doubt many Africans have internet access. If you are speaking to people in developed countries , it has already been acknowledged that there is no epidemic outside of Africa. It is localized to men who have sex with men communities and in Russia there is slight concern over infection due to drug injection.
The real problem is education,. Many Africans now see circumcision as full-protection.
This video is intended to educate a global audience about additional ways of preventing the spread of HIV beyond the original "ABC" approach. I agree that male circumcision is of greater importance for preventing the spread of HIV in places like Africa that have (a) a generalized heterosexual epidemic, and (b) limited access to condoms, than in developed countries. I'm all in favor of educating people to understand that circumcision doesn't GUARANTEE you won't contract HIV.
The claims of "reduction in HIV contraction in circumcised men" is being used as a reason to circumcise babies in the USA though. Do you think that is acceptable?
Are you proposing routine infant circumcision for African babies too?
I am not aware of any evidence that there is a medical need for circumcision of infants, and as noted previously, this video is not about infant circumcision and discussion of infant circumcision is off-topic. I see no reason that one can't wait until a male decides they wish to be sexually active and then let them decide whether or not to be circumcised at that point.
8) Circumcision has been shown to have no effect on other STI's. On the other hand presence of another STI, such as genital ulcers dramatically increases HIV transmission.
9) Post-circumcision the chances of contracting HIV dramatically increase.
10) Circumcised men have been shown to engage more in anal sex which is more risky.
(8) Not sure about what the data shows re: circumcision and transmission of *other* STDs, but the evidence on circumcision and HIV is clear as shown by 3 separate controlled clinical trials in Africa: circumcision reduces the rate at which men contract HIV through heterosexual sex by 50%. It's true that having other STDs will increase your risk contracting/transmitting HIV, but that's an argument for treating other STDs and has no bearing on whether circumcision reduces HIV transmission.
(9) It's true that IMMEDIATELY after circumcision (during the wound recovery period) risk of HIV transmission is increased if the person has sex, but the men are counseled NOT to have sex during that period and the studies clearly showed that there was a DECREASE in the HIV contraction rate by men, not an INCREASE, so there's no evidence that this hypothetical risk is causing problems in actual practice.
Oh and men are going to listen to counseling. These are people who think that sleeping with a virgin will rid them of HIV. Google the "Hawthorn effect".
sitr1 - I'm under no obligation to waste my time refuting every claim without evidence that you make. You have provided no scientific study reference for your claim that "Circumcised men have been shown to engage more in anal sex which is more risky" so I'm not going to waste time refuting your claim. Either start providing references from peer-reviewed studies published in scientific journals to support your claims, or stop spamming the comments with your claims.
Sltr1- Don't try to change the topic. The topic is "HIV" not other stds. It's more easier for anyone to contract an std (such as genital herpes or chlamydia)in comparison to hiv. I know people who've been to thailand and have contracted herpes and not hiv due to unsafe sex. The topic of HIV in this case is different because of not only how its transmitted and how fragile the virus is. Ur just continuously in denial like those other foreskin fundamentalists. Accept the fact, period!!!
5)Circumcisions reduces sensation. Which means more men will engage in sex without condom.
6)Circumcision hinders your ability to masturbate because the gliding action of the skin is lost. So, more likely to engage in penetrative sex (without condom).
7)The randomized trials have a number of methodological flaws. Circumcision has been shown to have no effect on HIV/STI rates in the USA compared to other non-circumcising countries.
(5) Regardless of what the effect of circumcision on sensitivity is or is not, you're speculating about hypothetical resulting behavior changes in the absence of any evidence. Studies showed no increase in the rate of risky behavior by circumcised subjects. (6) Again, speculation in the absence of evidence. (7) You claim that 3 separate controlled trials approved for publication in peer-reviewed journals had "flaws" yet you fail to state what those "flaws" were.
Why do you put so much faith in these studies ? Is it not possible that the authors have some other agenda? If the authors have been preaching this message for so long and their livelihood depended on it, do you really think they would allow a study that found that they were wrong all this time? What would happen then? there funding would dry up and they would have to find another job. I am asking you to use common sense rather than relying on a flawed study.
I am believing the studies because they are three independent, peer-reviewed controlled scientific trials. There's no better way of answering a scientific question than that. The studies have been reviewed by scientific experts and not shown to have any significant flaws. The burden of proof is now on YOU to demonstrate significant flaws in those studies. You haven't. You simply assert without evidence that they are flawed.
(1) Silly argument that you could make against all other proven effective techniques for HIV prevention such as condoms, education, etc. Most methods (except abstinence and faithfulness) cost money. Circumcision is no different but it's been proven safe and effective in clinical studies. (2) False. All recipients of medically performed circumcision with counseling are counseled about the need to keep using condom. Studies showed no increase in risky behavior--just a drop in HIV transmission.
How is it a silly argument? There is a finite amount of money in the pot. If you pour money into one method of treatment, less money is given to other methods. Circumcision costs about $250 per circumcision. Health care infrastructure is weak to non-existent. There are going to be many botched circumcisions as corners are cut. It is clear that education, condom-provision and testing facilities will be more effective.
It's a silly argument because you are making an assumption that (a) total funding for HIV prevention is fixed, and that therefore (b) choosing among HIV prevention options is a zero sum game. Your assumption is false. Funding for HIV prevention has been RISING, therefore adding a new method does not mean that funding for other approaches automatically drops. The question is whether male circumcision is a cost-effective approach in areas with generalized epidemics, and the answer is YES.
sltr1 - You are simply wrong about the impact medically performed circumcision with counseling has on HIV transmission through heterosexual sex, as shown by 3 independent controlled clinical studies. As far as cost-effectiveness goes, I know of no other intervention where you can do a one-time intervention and achieve a reduction of 50% in HIV transmission through heterosexual sex thereafter, and circumcision can be done inexpensively, so the ROI of the intervention in QALY is excellent.
I read the article by that title from SAMJ 10/08 v98 #10. (A) It's an opinion piece, not a scientific study. (B) It's filled with logical fallacies and unethical persuasive techniques. (C) It deliberately confuses the distinct issues of adult vs. infant circumcision. UNAIDS/WHO are proposing ADULT circumcision for HIV prevention, not infant circumcision. (D) It sets up straw men such as "coercing adults," which no one is proposing. (E) It misleadingly cherry-picks national statistics ...
... to, like you, incorrectly imply that high circumcision rates don't correlate with lower HIV infection rates and ignores multiple published peer reviewed studies showing the correlation exists. (F) It makes outright false statements such as (a) claiming no explanation for the results of the 3 trials exists [multiple explanations of why circumcision may be protective against HIV do exist] and saying no "field trials" were performed [the studies WERE field trials!]. I could go on. It's crap.
That one's slightly less dishonest because it's at least honest enough to acknowledge that possible explanations for the protective effect DO exist and to acknowledge the research literature correlating high circ rates with low HIV prevalence rates. But since the radical anti-circ activists have justifiably lost the scientific debate about whether MPCWC reduces a male's risk of contracting HIV through heterosexual sex, the article attempts to shift the terms of the debate by inventing ...
... a higher standard of proof and arguing that we need to satisfy that (conveniently for them, arbitrarily high) standard before rolling out the program in practice. It's a contrived argument that's dead wrong and motivated out of a rigid opposition to circumcision for anyone, scientific evidence of protective effect notwithstanding. It's politicized with unscientific and subjective pejorative terms like "masculinist" and the ridiculous claim that HIV/AIDS science is "masculinist." (It's not.)
The article also resorts to unethical persuasion techniques by deceptively suggesting that since differing circ rates can't fully explain all aspects of HIV epidemiology in the U.S., there must be some problem with the evidence of protective effect. There's not. This is called a "straw man." No one is suggesting that male circ is the sole factor determining all aspects of HIV epidemiology in the U.S. It compares the # of articles about adverse affects of circumcision vs hysterectomy, which ...
... is pointless since circumcision is a far more common procedure than hysterectomy and you'd EXPECT a higher absolute number of articles about it (and about adverse effects) on that basis alone. Comparing the % of articles about adverse effects is also pointless. The question is, does MPCWC save lives in areas where HIV is highly prevalent, and the answer is a resounding "yes!" The article also falsely suggests that waiting for the evidence from the trials was a "procedural nicety." It ...
... outrageously claims that since these trials (by design) controlled other variables in order to render a verdict on the single issue of whether MPCWC protecs against HIV infection, the results are therefore "de-contextualised." That's absurd. It then weakly and vaguely claims that "this research methodology has its critics," which is the weakest of all critiques; EVERYTHING, including childhood vaccination, fluoridation of water, and evidence that we landed on the moon has "critics." It ...
... then raises a bunch of potential objections to the methodology (most or all of which were in fact dealt with in the experimental design) and hypothetical reasons without evidence that MPCWC might not work in the "real world." Well, burden of proof is now on the anti-circ activists to demonstrate that MPCWC will fail in general use even though it succeeded in three separate trials with 1000s of participants. I could go on. This article is another desperate attempt by anti-circumcision ...
... activists to raise doubts by any means possible about what three well-designed, well-executed, peer-reviewed studies have shown about MPCWC's efficacy for HIV prevention and to obsfucate the results and change the subject. Compared to the other article, it is "slightly more cleverly-written crap." If these articles are the best the anti-circumcision movement can do, give up now. I lack the time to teach your advocates deductive reasoning and ethical persuasion one YT comment at a time.
(4) These studies didn't test (and don't recommend) "traditional circumcision" (e.g. performed by non-medical personnel). They tested medically performed circumcision with counseling, and it was shown to be safe and effective for reducing risk of HIV transmission. Subjects who were circumcised showed a DECREASE in the rate they contracted HIV and NO increase in the death rate.
Ur full of shit, im circumcised and i use condoms. WTF???!!!!! Ur a fucking retard sltr1. The whole purpose of this study is not implicating anything on saying its ok to have unsafe sex!!!
One of the reasons people do not use condoms is that they say it is less sensitive. So if circumcision reduces the sensitivity, then isn't it logical to think then that condom use would be lower among circumcised men than uncircumcised men? Also try not to post abusive comments - it is rude.
It is fair to ask whether condom usage rates among men would differ between the circumcised men and the controls. My recollection is that the actual studies found no significant difference in condom usage rates. There was definitely no evidence that circumcision *reduced* condom usage or led to *increased* HIV transmission. On the contrary, HIV transmission by heterosexual sex was reduced by 50 percent or more in each of three controlled studies.
Strange that the findings don't make logical sense though isn't it?
A normal person would assume the trials were flawed in some way. They would conduct further trials before rolling it out so hastily with little regard for the consequences.
sltr1 - The findings make perfect logical sense. It is only you who ignore the results of controlled clinical studies, blind yourself to the scientific data, and ignore the distinction between published, peer-reviewed scientific studies on the one hand vs. anti-circumcision web pages with no scientific standing on the other hand. There is no evidence the studies were flawed and no reason to assume so. It is your reasoning that is flawed. There was no "haste."
New Study Shows Condoms 95 Times More Cost-Effective than Circumcision in HIV Battle
Results of a new study, The Cost to Circumcise Africa, published in the International Journal of Mens Health, that compares the cost of male circumcision to the cost of lifetime distribution of free condoms in sub-Saharan Africa, found that condom distribution is 95 times more cost-effective in preventing the same number of infections.
I can't access that article because it requires that you be a paying subscriber. However, I note that a co-author, Ryan McAllister, PhD, is listed as the media contact on the press release from "International Coalition for Genital Integrity." He also displays serious bias in his quote in the press release, referring to "moderate, supposed-effectiveness" in spite of 3 controlled studies showing 50% risk reduction.
All doctors should be "biased" in favour of keeping all healthy body parts intact! Any doctor who advocates taking healthy body parts away, and in the case of an infant or child WITHOUT CONSENT, is less than a good doctor.
He claims "high cost" when medical circumcision with counseling can be performed in Africa for as little as $25 per patient. I don't see how they reach a 95x more cost-effective conclusion either. You can spend $25 to reduce risk by 50% vs. trying to supply condoms for life in rural Africa--that's not cheap when you include transportation, cool storage in warehouse and transit and at the store, etc. A condom stored at 110 degrees isn't reliable!
YT user DancerInTheHeart posted the next comment that will be a reply to this comment. Unfortunately, I accidentally clicked "Remove" instead of "Reply." I recovered the comment from my Inbox and am reposting the comment since they have not responded to my request to repost. The YouTube UI should give you some way to recover comments you've inadvertently deleted, at least during the same session.
by Dancer]African Journal of AIDS Research 2008, 7(1): 1-8 May, 2008 Long-term population effect of male circumcision in generalised HIV epidemics in sub-Saharan Africa In South Africa, mean yearly HIV incidence and net reproduction rate of the epidemic were not lower... with higher levels of... circumcision...study analysis of eight ... countries showed no...difference in seroprevalence in circumcised and uncircumcised groups...three countries...showed higher HIV prevalence among circumcised...
You have to pay to access a copy of that article, and I'm not willing to waste money buying questionable articles in order to waste time debunking them. So I haven't read the whole article, but if you're trying to determine the effect of male circumcision on individual HIV risk, their population survey-based methodology is a fundamentally less-reliable approach than controlled clinical trials because there are so many confounding variables. The evidence from the controlled trials is unambiguous.
TO ALL ANTI-CIRCUMCISION ACTIVISTS: Comments about infant circumcision are off-topic and will be deleted. This video is not about, and does not discuss, infant circumcision. It mentions the use of medically performed circumcision with counseling for consenting adult males to reduce the risk of contracting HIV.
TO ALL ANTI-CIRCUMCISION ACTIVISTS: If you want to post "statistics" here, they must come from a study published in a peer-reviewed scientific journal, and you must provide a full citation (author, title, journal, date, page) for the study, just as I have been doing myself. Like the HIV denialists, you constantly cite "studies" yet you provide no citations, and I'm no longer willing to take it on faith that the never-cited studies are real or that you're citing the data correctly.
The Australian Federation of AIDS Organizations (AFAO) is one of the first medical societies to recommend against male circumcision to combat HIV infection. Their report, issued July 2007, declares: "Male Circumcision has No Role in the Australian HIV Epidemic".
AFAO is not a medical society. They say "AFAO is the national federation for the HIV community response." It's an amalgamation of various non-profit groups. Either you don't know the difference or you don't care and are willfully misrepresenting the nature of that organization.
Aidsvideos, The HIV crisis in the USA and other industrialised nations may be very different in the following ways from the African epidemic: different cultures, sexual practices, virus strains, transmission vectors, and sanitary/ hygienic conditions. Further, I know of no study indicating that in Europe or the USA circumcision slows down the sexual transmission of HIV.
You're speculating without evidence. You're driven by your opposition to circumcision, not by the scientific study results on HIV prevention. We have 3 studies proving that medically performed circumcision with counseling reduces the risk of HIV transmission through heterosexual sex. The burden of proof is on you to show that these results are culturally specific. You have not done so, merely speculated.
People should make decisions based on the best available scientific evidence, not on the speculation of an opinionated YouTube user who strongly opposes the procedure in question for reasons unrelated to HIV.
Seeing as how my comments are "pending approval" I can't tell whether the links I provided will be shown. Anyway, I found three article - one from the Nature website and two from the Washington Post. I did a google search for "Langerin as natural barrier to HIV".
(cont.)I'm excited about this latest research into the functionality of the Langerin gene in relation to HIV. Luckily there were still people who didn't pay attention to "common wisdom" and make the rash decision to chop off their foreskin.
I expect the Ugandan study will in the not so distant future be shown to be indicative of nothing but correlational evidence - that any benefit of circumcision in HIV prevention had no causal connection to the physiology of the foreskin per se, but moreso with environmental circumstances.
As to a specific comment made in the video, "heterosexual sex" is behaviors ranging anywhere from kissing to anal intercourse. Using that term as if it refers to one particular act obscures things by using needless euphemism and is foolish for anyone in the medical field to do, particularly one focused on disease prevention. Penile-vaginal intercourse is the correct word or phrase.
I think it's tedious and trivial to speak of the supposed limitations of ABC. All of these prevention methods in which people's choices are central, are only strong insofar as people are cooperative. If people were generally cooperative though this virus would never have reached the magnitude that is has. I've seen some slogans stating that prevention is better than a cure. Well, actually no it's not. Seems that that will be ONLY thing that will untimately make a profound difference.
My chief concern, is that American parents are using these African studies to justify continueing the circumcision ritual on non-consenting children and babies, even though the AIDS epidemic has a different dynamic here.
If a man looks at these studies and then decides HIMSELF to get cut, I think he has every right to do so, but no one has a right to force amputation of a healthy functional and erogenous body part of babies.
The trials should have been equally overseen by medics with a less obvious bias. The American pro-circumcision lobby, having failed to convincingly correlate circumcision status with HIV in either Europe or the USA, force a transference of their African findings back to the USA, although there is no evidence that they will be of significance there.
Again, you're now alleging bias on the part of the scientists but not actually showing any evidence of bias in the design or performance of the tests. If you think the trials had flawed methodology or analysis, make your case. But to be blunt, you are a circumcision opponent who simply doesn't like what the clinical trials proved--that medically performed circumcision with counseling reduces the risk a male will contract HIV through heterosexual sex.
You statement that "there is no evidence that they will be of significance" in the USA is scientifically groundless. Three controlled studies have shown that medically performed circumcision with counseling reduces the risk a male will contract HIV through heterosexual sex. With the study results in hand, the burden of proof is on you to show that the results would be specific to Africa. You have not done so, nor are you likely to.
I mentioned the absence of the "double-blind" principle in the African trials to show their inherent weakness. As a European, I note that all three trials were designed and conducted by long-standing proponents of circumcision, mostly from the USA (e.g. Bailey, Moses and Gray), from where the trials were funded.
Now you're attacking the trials based on questioning the beliefs of the experimenters, but that's unscientific. Science is not about "who does it," it's about testing hypothesis and documenting your methodology to enable reproduction, which has been done here. You have shown no evidence that the design of the trials had faults that invalidate the outcome.
Even if this true, it's irrelevant. No one is claiming that all statements by all doctors at all times have always been correct. All we're saying is that three clinical trials have shown that medically performed circumcision with counseling reduces the risk that males will contract HIV through heterosexual sex.
I was giving you the historical context which you could easily verify if you did the research as to why 'involuntary partial genital amputation' activists like myself are justifiably a bit wary of doctors touting the health benefits of circumcision. From my and other activists perspective it seems that every generation there is a new disease of the decade that some doctors use to scare parents into continuing to cut their children.
This video voices the WHO type position. A wing of the UN, the WHO does not recognize that men and boys also suffer from "gender inequality" although that most certainly is the case. There is also little or no evidence that:
-they are taking contradictory data into account when recommending circumcision (like the fact that the USA has a high HIV rate compared to countries with minimal circumcision)
-That they inform people of the medical risks and sexual loss claimed by many to result from circumcision.
No. This video is based on the results of controlled scientific research studies, not a religious or cosmetic belief system. For citations, see the references at the end of the video at the NIH web site. It is you who have a strong anti-circumcision belief system that is not based on science. Nor am I aware of any evidence that women in the U.S. avoid men who are uncircumcised.
AIDSvideos, the African trials, which only show reduced HIV transmission from women to circumcised men, find many sceptics in Europe. Perhaps the major weakness of the trials is that they do not follow the "double-blind" principle which is the basic requirement for the approval of any medicine.
If you stop and think, you'll realize it's impossible to perform a "double blind" trial of an external surgical procedure such as circumcision. It is obvious to both patients and doctors who was circumcised and who was not. However, the inability to perform a "double blind" trial in no way invalidates the control model of the 3 trials which had test subject (circumcised) and controls (uncircumcised), both counseled on HIV prevention. This has been shown once and reproduced twice now.
That's not correct. It's not that the studies "were not completed." They were ended early because the protective effect was so strong that it would have been unethical to continue the study further and deny the uncircumcised men the opportunity to benefit from the results. Statistically significant results (hugely significant, actually) were achieved. Also, post-analysis controlled for the fact that circumcised men might have temporarily abstained, showing that couldn't explain the results.
Present the evidence to grown men and let them decide for themselves if circumcision is the most appropriate action in their case, but you don't have a right to force circumcision on men who don't want it or on male babies who cannot give consent.
That's exactly what this video does: present the evidence to grown men and let them decide for themselves. This video doesn't advocate infant circumcision or forced circumcision of adults.
I know an American mother who said she wasn't sure what to do in the case of her baby, but that when the African Circumcision/AIDS studies became prevalent in the news, that is when she decided she had to circumcise her son. I support voluntary circumcision, but my concern is that these studies will be used to justify involuntary circumcisions.
Thank you for your work in the fight against AIDS:-)
"Studies indicate a considerably higher acceptance for condoms in Europe and Japan, where circumcision is almost never practised. Some have suggested that American men are resisting a layer of latex that would further decrease sensation from a glans already desensitized from circumcision. Moreover, condoms are more likely to fall off the circumcised penis."
-Circumcision and HIV infection: review of
the literature and meta-analysis, Van Howe, International Journal of STD and AIDS, 1999-
In the end, circumcision should only be seen as a last-ditch attempt to contain HIV epidemics in cultures where access and acceptance of condoms is low. In the West, where HIV rates are already pretty low, you would have to circumcise many hundreds of men to prevent a single case of HIV. And that's just not worth it.
I agree with you that: (1) Circumcision is of the greatest potential value for HIV prevention in places where access and acceptance of condoms is low, and (2) for a male in the developed world, using a condom every time should provide excellent risk reduction whether they are circumcised or not, therefore the tradeoff between a potential 50% extra risk reduction and the potential downsides of circumcision is less obvious and depends on your evaluation of the severity of the downsides.
Adult circumcision counseling? US experience shows if fathers are cut, they impose it on sons. Concern grows about genital surgery on unconsenting children and their rights. Doctors introducing this must work with legal community for laws to protect children. Costly surgery that leaves genital wounds? No. Microbicidal gels for both sexes? Yes.
African medical systems are under-developed. Medical circumcision? Wishful thinking. Rural folk with no money/hospitals seek local 'experts' (same unclean knives, razors, etc as in female genital cutting) thus increasing HIV.
Not wishful thinking. These studies prove that medical circumcision with counseling can be done successfully in Africa and that it cuts HIV contraction via heterosexual sex by 50 percent. Will aid and training be necessary? Yes. But it may cost as little as $25 per patient, so it's a very cost-effective prevention measure in areas where HIV risk is high. These studies are NOT testing or advocating unclean circumcision by amateurs.
"These studies prove that medical circumcision with counseling can be done successfully in Africa and that it cuts HIV contraction via heterosexual sex by 50 percent."
Gross misrepresentation of statistics. 50% risk reduction does <i>not</i> translate to 50% less contraction. If you flip a coin once, you'll have 50% chance of landing heads. After only five flips, though, the chance of having landed heads at least once is 96.9%.
No misrepresentation at all; you misunderstood the study results. The studies showed that actual circumcised men having repeated sex over time were 50% less likely to contract HIV than uncircumcised controls OVER THE ENTIRE DURATION OF THE STUDY ... not just for a single sexual contact as you assumed.
There are two things we can deduce from this. One, is that the abstaining period for the circumcised males might have something to do with this. Two, this still doesn't translate into 50% fewer cases of AIDS because the more time you allow for, the more the figure will approach 100%.
No, that analysis is flawed as well. While circumcised men continue having sex, so do the uncircumcised ones. The circumcised men will have a lower risk on each instance (not necessarily exactly 50% per instance, but proven lower) than the uncircumcised men. Therefore, although the % of circumcised men with HIV may grow over time, so should the % of uncircumcised men, and it will grow proportionately faster. Therefore, the long-term average risk reduction may be a steady-state 50%.
I think you misread my comment. The circumcised population of the test was told to abstain from sex for six months while allowing the wound to heal. The control group was not told to abstain, meaning they probably had more exposure. At any rate, the risk reduction is 50% for the amount of exposure given for the duration of the test. The risk of contracting HIV is very very low for a single rump, even for uncircumcised men, but with increased exposure the risk naturally increases as well.
In ANRS 1265 Trial (and I suspect the others), it was six weeks, not six months. They also checked that the abstinent period wasn't the cause of the effect. "(c) To analyze the impact of the 6-wk period of abstinence, the analysis was repeated with the duration of the period M1--M3 reduced by 42 d in the intervention group. Forty-two days was the median (IQR = 28--56) interval between MC and first sexual contact reported by sexually experienced participants of the intervention group."
Citation for previous quote: Bertran Auvert et al. (2005) "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial." PLoS Med 2(11): e298
By the termination of this research, there were so and so many cases of HIV. Had the testing gone on indefinitely, the only truly protective factor would have been prudence. Gone on eternally, they all would eventually have caught HIV. The duration of exposure is important, and you absolutely cannot translate 50% risk reduction into 50% fewer cases of HIV.
"Twenty-two men in the intervention group and 47 in the control group tested positive for HIV when the study was stopped. The 2-year HIV incidence was 2.1% in the circumcision group and 4.2% in the control group (P = .0065). This corresponds to a reduction in the risk of acquiring an HIV infection of 53%." Circumcised men had 53% fewer ACTUAL CASES of HIV [Rev Urol. 2007 Spring; 9(2): 89--90.] This is proof that circumcision itself reduces the risk of contracting HIV.
"Had the testing gone on indefinitely, the only truly protective factor would have been prudence." False and totally illogical. By the same (invalid) reasoning, you could claim that if people have sex using condoms indefinitely, they'll contract HIV, and the only truly protective factor would be prudence. That's not correct either. Both circumcision & condom use reduce risk of contracting HIV. Not to zero, but they reduce it. Reduce risk enough & most people won't contract HIV during lifetime.
"By the same (invalid) reasoning, you could claim that if people have sex using condoms indefinitely, they'll contract HIV"
That's the exact <i>opposite</i> of what I was saying. Condoms=prudence. Circumcision =/= prudence. Either circumcised or uncircumcised + condoms = prudence. Circumcision at best represente risk <i>reduction</i>, not <i>protection</i>.
Remember, condoms are also only risk reduction, not risk elimination. I agree completely that they are an outstanding risk reduction technique, are more effective than circumcision, and are the preferred risk reduction technique for any sexually active person with access to them. But remember that many sub-Saharan males lack any access, reliable access, or sufficient access to condoms.
Also, bear in mind that this only affects men, not women. 50% of 50% is 25%. Initial findings actually show that circumcision represents an <i>increased</i> risk of <i>transmitting</i> the virus, although this is generally discarded as circumcised men not having allowed the wound to heal. No thorough research has been done on the effect on women, though, as far as I'm aware.
Important to note that if a man doesn't contract HIV (in an encounter in which he would have otherwise) thanks to being circumcised, his subsequent female partners won't contract HIV from him, whereas they would be at risk if he'd become HIV+. So there's an indirect benefit to women. Agree more research is necessary on topics like these.
"No, that analysis is flawed as well. While circumcised men continue having sex, so do the uncircumcised ones."
You <i>still</i> misunderstand my point. During the research period, the circumcised men had less sex than the control group, as they were told to abstain for six months (actually, that could be weeks, come to think of it). Now, not all of them may have waited for so long, but they would certainly wait longer than the control group, who weren't told to abstain at all.
No, I understood your claim perfectly, and there's no evidence it's true. There is no evidence whatsoever that the protective effect observed in the trials was due to the recommendation that circumcised subjects initially abstain from sex. Trials went on long enough that the extremely small risk reduction from initial abstinence can't account for the observed effect.
And even if they had the same amounts of sex, it <i>still</i> wouldn't translate into 50% fewer cases of HIV, because if you keep having unprotected sex, it is not a question of "if", but rather "when", regardless of circumcision status. In fact, it might lead to an <i>increase</i> in HIV contraction, as those who grudgingly would have worn condoms before gleefully discard them now, because they think they're "protected" by circumcision.
"it is not a question if 'if', but rather 'when.'" False. This is a core flaw in your logic. If you reduce risk of HIV transmission enough through circumcision & condom use, etc., vast majority won't ever contract HIV during their lifetime. Therefore it becomes a question of "if during lifetime," not "when during lifetime." You're dogmatically asserting that people are guaranteed to contract HIV if they have sex long enough. The point is if you cut risk far enough, most won't live long enough.
"If you reduce risk of HIV transmission enough through circumcision & condom use, etc., vast majority won't ever contract HIV during their lifetime."
Give credit where credit is due. That's the condom. The vast majority of intact men who wear condoms will never contract HIV in their lifetime, either. The "when" rather than "if" applies where safe sex is <i>not</i> observed.
And I guarantee you that many are going to think that circumcision is "safe enough", just like so many people consider unprotected oral sex to be perfectly safe.
The same thing happened when circumcisions were performed in Britain to prevent syphilis. It might be true that circumcision somehow reduces risks, but the benefits are usually blown way out of proportion, and people get careless.
Now you're making a blanket claim that benefits are "usually blown way out of proportion." Even if that's true, it's only an argument for carefully communicating the message, which is already the goal of WHO, CDC, UNAIDS, etc. Researchers are not claiming circumcision reduces male's risk of contracting HIV by 100%; just by about 50%, which is what 3 studies demonstrated.
So the actual benefits of circumcision will actually be very humble. And that's if we <i>don't</i> take into consideration the psychological aspects. Circumcised men will be less likely to wear condoms because they feel "protected", and women will have one less option to say no to unprotected sex. Circumcision is no silver bullet, but will almost certainly be viewed as such by those who are happy to not wear a condom. But if you keep having unprotected sex, it is only a matter of time.
Neither we nor the study authors are advocating unprotected sex. (The opposite, actually.) But even taking into account possible increased risk-taking by circumcised men, they still had a 50% lower risk of contracting HIV over the course of the study than uncircumcised controls. And those who don't contract HIV won't pass it on to female partners, benefiting them. Agree that circumcised or not, unprotected sex is to be avoided.
James3d, EscapeSociety: It's clear that you are both strongly opposed to circumcision under all circumstances. You are entitled to your opinion, but in your advocacy, please be careful to get the scientific facts correct, e.g. HIV rates by country, correlation with male circumcision rates, relative risks & harms associated with male circumcision and FGM, etc. Also, avoid arguing by analogy as you keep making analogies that are invalid because they equate very different things.
No, you haven't gotten the facts correct. You claimed that high rates of circumcision are correlated with high rates of HIV (actually, reverse is true), and you claimed that the US has one of the highest HIV prevalence rates (actually, it's in the middle).
Yes strongly opposed to cutting the genitals of any unconsenting minor person, male female or intersexed. This is a decision which should be made only with informed consent by the person who owns (is attached to the genitals.)
(cont.) "If male circumcision had been effective, we would not have close to one million people now infected with the HIV/AIDS virus in the United States. This disease infected the circumcised and the intact alike. The lesson must be learned, that the AIDS virus is not caused by, or transmitted by, the presence of natural, normal body parts, but by the transmission of infected semen and blood from an infected person to sexual partners, regardless of circumcision status." (Dr James L. Snyder)
Snyder's attempt to indirectly determine circumcision effectiveness for HIV prevention by looking at raw # of HIV cases in the US is fatally flawed. Many cases were transmitted via gay male sex (for which we have no evidence that circumcision cuts HIV risk) or IV drug use (for which it's irrelevant). There are now 3 studies proving medical circumcision with counseling cuts the risk of contracting HIV through heterosexual sex by 50 percent. That trumps Synder's indirect & confounded reasoning.
Circumcision of infants is fatally flawed. This is not a card game of trumping someone else's work. Synder has delt personally with the most severe cases of damage from infant circumcision. Photos of his unfortunate patients are available on the internet. Only the most hard hearted person in denial would not be moved to wonder why circumcison of children persits after viewing what has been imposed on these people.
Responding to questions about male circumcision as a prevention for AIDS, Dr James L. Snyder, urologist and past president of the Virginia Urological Society said, "Beginning about 1946 we reared a generation in which 90% of the sexually active men were circumcised. When the AIDS epidemic began, the United States had prepared in a fashion which we now are planning to export to the world: mass circumcision of male children." (cont.)
A new study by Dutch molecular biologists shows that on an intact penis Langerhans cells produce Langerin, which is a natural barrier to HIV infection. In view of this finding, all previous studies regarding HIV and circumcision must be reviewed in light of this new information.
Even if that's true, African trials show that having a foreskin creates a greater net risk of contracting HIV. Controlled studies of medically performed male circumcision with counseling in South Africa, Kenya, and Uganda showed reductions of HIV contraction by medically circumcised males (missing their foreskin, Langerhans cells, and Langerin) of 60%, 53%, and 48% respectively compared to uncircumcised controls (with intact foreskin, Langerhans cells, and Langerin per your study).
Even if male circumcision "may reduce" the spread of HIV/AIDS (which is on its way to being discredited) that doesn't eliminate the complications and drawbacks to being circumcised. The foreskin has a concentration of nerve endings that heighten sexual gratification. The foreskin protects the glans of the penis from being keratinized, discolored and dried out...
The research finding that male circumcision with counseling reduces the risk of contracting HIV in heterosexual sex is NOT "on its way to being discredited." Three separate published controlled clinical trials have each found a risk reduction of about fifty percent. There's no evidence that all three trials were flawed or are going to be overturned. This conclusion is becoming scientific consensus as shown by recent WHO expert panel conclusion.
<The research finding that male circumcision with counseling reduces the risk of contracting HIV in heterosexual sex is NOT "on its way to being discredited.">
The Dutch study which states Langerhan cells protect against viruses like HIV doesn't discredit the previous "studies" that Langerhan cells are a magnet for HIV?
Even if it did, the three studies in Africa show that regardless of the role of Langerhan cells promoting or preventing HIV infection, having a medically performed circumcision with counseling cuts your risk of contracting HIV through heterosexual sex by 50 percent. The best way to determine how circumcision affects your risk of contracting HIV is through a controlled clinical trial, which is exactly what these three studies did.
"having a medically performed circumcision with counseling cuts your risk of contracting HIV through heterosexual sex by 50 percent."
How much of that is circumcision, and how much of that is councelling? The circumcised males in the tests were told to abstain from sex for 6 months because the wound was still healing. The control group were not told to abstain from sex. Could this have an impact on the results?
In ANRS 1265 Trial (and I suspect the others), it was six weeks, not six months. They also checked that the abstinent period wasn't the cause of the effect. "(c) To analyze the impact of the 6-wk period of abstinence, the analysis was repeated with the duration of the period M1--M3 reduced by 42 d in the intervention group. Forty-two days was the median (IQR = 28--56) interval between MC and first sexual contact reported by sexually experienced participants of the intervention group."
Source for previous quote: Bertran Auvert et al, "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial." PLoS Med. 2005 November; 2(11): e298.
...Being circumcised under the guise of HIV prevention doesn't make those drawbacks simply disappear. If you abstain from circumcision, you also have zero risk from surgical mishap and surgical infection. You're better off being whole as nature intended you to be.
It's correct that circumcision has risks. So an individual must do a risk-benefit analysis. If you're a poor sexually active heterosexual male in Swaziland with limited/no condom access where the HIV rate is 40%, the HIV prevention risk of circumcision almost certainly outweighs the risks of the procedure. (Of course, they should also consider abstinence until marriage, only having sex when condoms are available, etc.)
Mass circumcision did not protect Americans from AIDS. (Nor has presence of a foreskin caused mass HIV infection in non circumcising countries.) It is arrogant to suggest imposing circumcision on Africa will yield different results. If anything touting circumcision as a preventative for AIDS will increase carelessness for safer sex practices.
Controlled studies of medically performed male circumcision with counseling in South Africa, Kenya, and Uganda showed reductions of HIV transmission by 60%, 53%, and 48% respectively compared to uncircumcised controls. The counseling makes it clear you still have to practice safer sex; no effect of increased unsafe sex increasing HIV transmission was shown. No one is IMPOSING circumcision on Africa; more men are now voluntarily requesting it than health clinics can keep up with.
<No one is IMPOSING circumcision on Africa; more men are now voluntarily requesting it than health clinics can keep up with.>
Men are made to believe their own foreskin will lead to their death through AIDS. This fear is instilled into them by the media and propaganda and so they "volunteer" because of pressure and fear.
There is no evidence of a "propaganda" campaign that is panicking people into irrationally choosing male circumcision. Men in Africa know that HIV is prevalent and that they are at high risk. They've heard that medical circumcision lowers their risk and therefore are making an intelligent, informed decision to reduce their risk. How about giving these responsible adult males credit for being intelligent, thinking human beings and respecting the informed choice they are making?
< There is no evidence of a "propaganda" campaign that is panicking people into irrationally choosing male circumcision. >
What do you call this vid that's telling people to have themselves circumcised to reduce the chances of them getting HIV/AIDS? You don't think you're being part of that bandwagon that's making people believe they're better off being circumcised rather than being genitally intact?
This video is not TELLING people to have themselves circumcised. It is correctly stating based on research study results that this is one option men may choose to reduce their risk of contracting HIV through heterosexual sex. This video is simply educating people about research findings. "Bandwagon" is a gratuitously pejorative term.
The propaganda campaign is the one going on in the USA where those who make their living from routine infant circumcison are foaming at the mouth quoting the African statistics to dupe another generation into cutting their children.
Baby boys and minors who are routinely circumcised certainly didn't volunteer to have their genitals modified, or more accurately, mutilated. Does the fear and paranoia of AIDS justify taking away someone's human rights?
This video is not taking a position on circumcision of minors, which is a more complex question since it involves parents giving consent for irreversible elective surgery when minors are too young to make an informed decision themselves. It's stating the simple fact that research studies have shown that adult males reduce their risk of contracting HIV through heterosexual sex by 50 percent if they have a medical circumcision and receive counseling when compared to uncircumcised controls.
<This video is not taking a position on circumcision of minors>
You're still being part of the position that's stating by surgically amputating the foreskin, one is less likely to contract HIV. Parents of newborn baby boys are now even more persuaded to circumcise their baby boys under this belief. Whether one is circumcised as an infant, minor, or an adult, the claim is still the same: surgically amputate the foreskin, you're less likely to contract HIV.
I'm stating the research findings that circumcised adult males are less likely to contract HIV than controls. I'm stating nothing about infant circumcision. You seem to be suggesting that I should suppress scientific research findings about HIV prevention in adults to avoid encouraging infant circumcision. Well, that's nonsense. HIV is a health emergency and research findings about safe, effective prevention techniques for consenting adults must be made widely known.
By not taking a position you are condoning it. The transperent flaw in this AIDS/circumcison bandwagon is those who support it seem unable to announce a distinction between adults making informed choices and genital surgery being imposed on infants.
Taking no position is not condoning something; it's simply taking no position. I'm under no obligation to state a position on every issue in the world, nor do I have time to develop one. I have a job, not-for-profit, a life, etc. I am perfectly able to distinguish between adult and infant circumcision and am just saying what controlled studies have shown: medical circumcision with counseling is one option for adult males who wish to reduce their risk of contracting HIV.
If someone states they have no position on important issues (war, racism, sexism, genital mutilation, global warming, etc.) such a person may be perceived as dull, vapid, immature, socially conditioned not to be able to think for them self or maybe just needs more time to consider the facts. You aggressively campaign for adults to be circumcised saying you have fully researched the issue of male circumcision, yet claim to take "no position" on infant circumcision. Something is wrong here.
Nothing's wrong; I'm just busy and not on call to develop and articulate positions on issues whenever a YouTube commenter demands. To the extent that I have an opinion, I probably lean against infant circumcision on the grounds that it's a procedure with risks that could be performed prior to sexual activity when the person is old enough to decide for themselves, and I'm unaware of any important benefits prior to that time. But again, I haven't researched those tradeoffs.
More to the point: James3D and EscapeSociety: You need to realize that the rude, hectoring, demanding, extremist tone you are taking in your advocacy actually tends to alienate people who might find you more convincing if you took a more reasoned (and friendly!) tone in your advocacy efforts. There are many important issues in the world today and not everyone else is on call to drop everything and develop positions on the particular one(s) you two are most concerned about.
A Dutch study published March 4, 2007 states that Langerhan cells found in the foreskin are a natural barrier to viruses, including HIV. This would explain why nations that do not routinely circumcise their males have the lowest rates of HIV in the world, while nations like the USA and Ethiopia who do routinely circumcise their males, have the highest rates of HIV in the world.
So Dr.,
I just need a stright answer is using condom correctly means preventing AIDS ?
kaled17 2 years ago
This is Eric; I'm not a doctor. The straight answer is that "using a condom correctly every time for every sexual act greatly reduces, but does not completely eliminate, the risk of contracting or transmitting HIV." See our vid "The Importance of Condom Compliance" for more info.
AIDSvideos 2 years ago
Dr. Kuhn:
1. Do you believe that circumcision as a HIV reduction strategy should be performed only on adult men with their informed consent, or should nations implement a neonatal circumcision program so that there is no risk of men potentially saying "no" to the procedure later in life?
2. What do you think about research pointing to female circumcision as a potential method of HIV risk reduction?
zdarkstar20001 2 years ago
This is Eric. Dr. Kuhn doesn't monitor or respond to these comments. We are not advocating infant circumcision, as repeatedly noted previously in the thread. There is NO evidence published in peer-reviewed scientific journals that female genital mutilation has any positive effects that even make up for, much less outweigh, its massive documented harmful affects such as infection, higher death rate in childbirth, higher rate of obstetric fistula, etc. FGM kills and must be abolished.
AIDSvideos 2 years ago
Thsnk You for sharing this info!
It will SAVE lives! Esp. innocent women and childrens!
Helives!
helivestubes 3 years ago
Hmm ... something new. Circumcision reduces the risk of contracting HIV. I seriously didn't know that before.
onotheo 3 years ago
It doesn't . In the USA, the rate of HIV is higher than in Europe where the circ rate is near zero.
sltr1 2 years ago
sltr1 - I don't know whether your statement about the rate of HIV in the U.S. vs. "Europe" is correct (first of all, you'd have to define what you meant by "Europe" for us to even evaluate your claim). However, I do know that research has clearly, unambiguously shown that higher circumcision rates in nations and regions correlate with lower HIV prevalence rates. So even if your cherry-picked comparison of the U.S. vs. Europe is correct, it would be trumped by the worldwide evidence.
AIDSvideos 2 years ago
Cherry picked? You make it sound like my argument isn't sound.
I mean by Europe - nations with equivalent GDP and culture, such as France, Germany and Netherlands:
advocatesforyouth. org/publications/factsheet/fsest. htm
You cannot compare differing cultures as there are many confounding factors present. If you are to perform circ it must have a big effect, to counteract the downsides. It clearly doesn't.
This page presents the faults of the African trials:
circumstitions. com/HIV-SA. html
sltr1 2 years ago
Your argument is NOT sound. You are showcasing your inability to perform valid deductive reasoning. In one breath you cite the inability to compare "differing cultures" because of "confounding factors," then in the next breath you arbitrarily assert that France, Germany, and Netherlands have "equivalent GDP and culture." That's the essence of cherry picking. I'm sure the French and Germans would love to learn that their cultures are "equivalent" to that of the U.S.
AIDSvideos 2 years ago
Methodologically sound BROAD studies show there's a correlation between LOW rates of circumcision and HIGH rates of HIV. "Four ecological studies show the clear geographical correlation of high HIV prevalence and areas where male circumcision is rare." [Wilson & de Beyer, "Male Circumcision: Evidence and Implications," HIV/AIDS M&E - Getting Results, World Bank Global AIDS Program, citing Auvert et all 2001, UNAIDS 2004, USAID/AIDSMark 2003. See related Mehendale 1996, Gray 2000, Cameron 1989.]
AIDSvideos 2 years ago
They may not be exactly alike, but they are certainly closer to each other than Africa and the USA. Yet as you can see from the links I posted 5 days ago, these trials are being used to promote routine infant circ in the USA. So who here has invalid inductive reasoning?
sltr1 2 years ago 2
So saying all this, using circumcision as another tool to prevent HIV should be abandoned. It is a waste of resources and sends out the wrong message. It is more likely to increase HIV contraction.
sltr1 3 years ago 3
You can draw any incorrect conclusion you like when you ignore the results of controlled, replicated, peer-reviewed published scientific research studies and focus instead on hypothetical risks for which there is no evidence in practice. You're demonstrating the classic thinking pattern of radical anti-circumcision activists: "never let the facts get in the way of an opinion." You can believe 3 controlled studies, or you can believe YT user sitr1 "because he says so." Your choice, your life.
AIDSvideos 3 years ago
Who are you speaking to ? I doubt many Africans have internet access. If you are speaking to people in developed countries , it has already been acknowledged that there is no epidemic outside of Africa. It is localized to men who have sex with men communities and in Russia there is slight concern over infection due to drug injection.
The real problem is education,. Many Africans now see circumcision as full-protection.
sltr1 3 years ago 4
This video is intended to educate a global audience about additional ways of preventing the spread of HIV beyond the original "ABC" approach. I agree that male circumcision is of greater importance for preventing the spread of HIV in places like Africa that have (a) a generalized heterosexual epidemic, and (b) limited access to condoms, than in developed countries. I'm all in favor of educating people to understand that circumcision doesn't GUARANTEE you won't contract HIV.
AIDSvideos 3 years ago
The claims of "reduction in HIV contraction in circumcised men" is being used as a reason to circumcise babies in the USA though. Do you think that is acceptable?
Are you proposing routine infant circumcision for African babies too?
sltr1 2 years ago
I am not aware of any evidence that there is a medical need for circumcision of infants, and as noted previously, this video is not about infant circumcision and discussion of infant circumcision is off-topic. I see no reason that one can't wait until a male decides they wish to be sexually active and then let them decide whether or not to be circumcised at that point.
AIDSvideos 2 years ago
Clearly the researchers who ran this study think differently:
online. wsj. com/article/SB123802256715541879. html
It will have an effect on the routine infant circumcision debate in the USA:
voices. washingtonpost. com/checkup/2009/03/should_you_circumcize_your_son. html
sltr1 2 years ago
8) Circumcision has been shown to have no effect on other STI's. On the other hand presence of another STI, such as genital ulcers dramatically increases HIV transmission.
9) Post-circumcision the chances of contracting HIV dramatically increase.
10) Circumcised men have been shown to engage more in anal sex which is more risky.
sltr1 3 years ago 2
(8) Not sure about what the data shows re: circumcision and transmission of *other* STDs, but the evidence on circumcision and HIV is clear as shown by 3 separate controlled clinical trials in Africa: circumcision reduces the rate at which men contract HIV through heterosexual sex by 50%. It's true that having other STDs will increase your risk contracting/transmitting HIV, but that's an argument for treating other STDs and has no bearing on whether circumcision reduces HIV transmission.
AIDSvideos 3 years ago
(9) It's true that IMMEDIATELY after circumcision (during the wound recovery period) risk of HIV transmission is increased if the person has sex, but the men are counseled NOT to have sex during that period and the studies clearly showed that there was a DECREASE in the HIV contraction rate by men, not an INCREASE, so there's no evidence that this hypothetical risk is causing problems in actual practice.
AIDSvideos 3 years ago
Oh and men are going to listen to counseling. These are people who think that sleeping with a virgin will rid them of HIV. Google the "Hawthorn effect".
You missed out 10.
sltr1 3 years ago 8
sitr1 - I'm under no obligation to waste my time refuting every claim without evidence that you make. You have provided no scientific study reference for your claim that "Circumcised men have been shown to engage more in anal sex which is more risky" so I'm not going to waste time refuting your claim. Either start providing references from peer-reviewed studies published in scientific journals to support your claims, or stop spamming the comments with your claims.
AIDSvideos 3 years ago
Sltr1- Don't try to change the topic. The topic is "HIV" not other stds. It's more easier for anyone to contract an std (such as genital herpes or chlamydia)in comparison to hiv. I know people who've been to thailand and have contracted herpes and not hiv due to unsafe sex. The topic of HIV in this case is different because of not only how its transmitted and how fragile the virus is. Ur just continuously in denial like those other foreskin fundamentalists. Accept the fact, period!!!
Fallujah25 3 years ago
5)Circumcisions reduces sensation. Which means more men will engage in sex without condom.
6)Circumcision hinders your ability to masturbate because the gliding action of the skin is lost. So, more likely to engage in penetrative sex (without condom).
7)The randomized trials have a number of methodological flaws. Circumcision has been shown to have no effect on HIV/STI rates in the USA compared to other non-circumcising countries.
sltr1 3 years ago 2
(5) Regardless of what the effect of circumcision on sensitivity is or is not, you're speculating about hypothetical resulting behavior changes in the absence of any evidence. Studies showed no increase in the rate of risky behavior by circumcised subjects. (6) Again, speculation in the absence of evidence. (7) You claim that 3 separate controlled trials approved for publication in peer-reviewed journals had "flaws" yet you fail to state what those "flaws" were.
AIDSvideos 3 years ago
Why do you put so much faith in these studies ? Is it not possible that the authors have some other agenda? If the authors have been preaching this message for so long and their livelihood depended on it, do you really think they would allow a study that found that they were wrong all this time? What would happen then? there funding would dry up and they would have to find another job. I am asking you to use common sense rather than relying on a flawed study.
sltr1 3 years ago 5
I am believing the studies because they are three independent, peer-reviewed controlled scientific trials. There's no better way of answering a scientific question than that. The studies have been reviewed by scientific experts and not shown to have any significant flaws. The burden of proof is now on YOU to demonstrate significant flaws in those studies. You haven't. You simply assert without evidence that they are flawed.
AIDSvideos 3 years ago
There are many problems with the "circumcision as an extra tool in the fight" argument.
1)By pouring resources into circumcision you take away resources from other (more effective) methods of prevention.
2)By using circumcision as a tool you are giving the message that it is OK to have unprotected sex. So you increase HIV risk behavior.
4)Many circumcisions are botched. A lot of people die from circumcision in Africa. (this is not a reason to put more money in to oversee it better)
sltr1 3 years ago 4
(1) Silly argument that you could make against all other proven effective techniques for HIV prevention such as condoms, education, etc. Most methods (except abstinence and faithfulness) cost money. Circumcision is no different but it's been proven safe and effective in clinical studies. (2) False. All recipients of medically performed circumcision with counseling are counseled about the need to keep using condom. Studies showed no increase in risky behavior--just a drop in HIV transmission.
AIDSvideos 3 years ago
How is it a silly argument? There is a finite amount of money in the pot. If you pour money into one method of treatment, less money is given to other methods. Circumcision costs about $250 per circumcision. Health care infrastructure is weak to non-existent. There are going to be many botched circumcisions as corners are cut. It is clear that education, condom-provision and testing facilities will be more effective.
sltr1 3 years ago 5
It's a silly argument because you are making an assumption that (a) total funding for HIV prevention is fixed, and that therefore (b) choosing among HIV prevention options is a zero sum game. Your assumption is false. Funding for HIV prevention has been RISING, therefore adding a new method does not mean that funding for other approaches automatically drops. The question is whether male circumcision is a cost-effective approach in areas with generalized epidemics, and the answer is YES.
AIDSvideos 3 years ago
If the funding is rising then - why not put it into more effective methods - you know, ones without any downsides.
my argument still stands. As I explained below circ will either have no effect or it will increase the rate of HIV spread.
Read this article in the South African medical Journal by googling "neonatal circumcision does not reduce hiv infection rates"
sltr1 2 years ago
sltr1 - You are simply wrong about the impact medically performed circumcision with counseling has on HIV transmission through heterosexual sex, as shown by 3 independent controlled clinical studies. As far as cost-effectiveness goes, I know of no other intervention where you can do a one-time intervention and achieve a reduction of 50% in HIV transmission through heterosexual sex thereafter, and circumcision can be done inexpensively, so the ROI of the intervention in QALY is excellent.
AIDSvideos 2 years ago
Did you not read the article then?
sltr1 2 years ago
I read the article by that title from SAMJ 10/08 v98 #10. (A) It's an opinion piece, not a scientific study. (B) It's filled with logical fallacies and unethical persuasive techniques. (C) It deliberately confuses the distinct issues of adult vs. infant circumcision. UNAIDS/WHO are proposing ADULT circumcision for HIV prevention, not infant circumcision. (D) It sets up straw men such as "coercing adults," which no one is proposing. (E) It misleadingly cherry-picks national statistics ...
AIDSvideos 2 years ago
... to, like you, incorrectly imply that high circumcision rates don't correlate with lower HIV infection rates and ignores multiple published peer reviewed studies showing the correlation exists. (F) It makes outright false statements such as (a) claiming no explanation for the results of the 3 trials exists [multiple explanations of why circumcision may be protective against HIV do exist] and saying no "field trials" were performed [the studies WERE field trials!]. I could go on. It's crap.
AIDSvideos 2 years ago
I know it is an opinion piece. You can't just assume that there are no flaws in a study. What do you think of this one then.
Male Circumcision and HIV Prevention: Is There Really Enough of the Right Kind of Evidence?
cirp. org/library/disease/HIV/dowsett2007/
sltr1 2 years ago
That one's slightly less dishonest because it's at least honest enough to acknowledge that possible explanations for the protective effect DO exist and to acknowledge the research literature correlating high circ rates with low HIV prevalence rates. But since the radical anti-circ activists have justifiably lost the scientific debate about whether MPCWC reduces a male's risk of contracting HIV through heterosexual sex, the article attempts to shift the terms of the debate by inventing ...
AIDSvideos 2 years ago
... a higher standard of proof and arguing that we need to satisfy that (conveniently for them, arbitrarily high) standard before rolling out the program in practice. It's a contrived argument that's dead wrong and motivated out of a rigid opposition to circumcision for anyone, scientific evidence of protective effect notwithstanding. It's politicized with unscientific and subjective pejorative terms like "masculinist" and the ridiculous claim that HIV/AIDS science is "masculinist." (It's not.)
AIDSvideos 2 years ago
The article also resorts to unethical persuasion techniques by deceptively suggesting that since differing circ rates can't fully explain all aspects of HIV epidemiology in the U.S., there must be some problem with the evidence of protective effect. There's not. This is called a "straw man." No one is suggesting that male circ is the sole factor determining all aspects of HIV epidemiology in the U.S. It compares the # of articles about adverse affects of circumcision vs hysterectomy, which ...
AIDSvideos 2 years ago
... is pointless since circumcision is a far more common procedure than hysterectomy and you'd EXPECT a higher absolute number of articles about it (and about adverse effects) on that basis alone. Comparing the % of articles about adverse effects is also pointless. The question is, does MPCWC save lives in areas where HIV is highly prevalent, and the answer is a resounding "yes!" The article also falsely suggests that waiting for the evidence from the trials was a "procedural nicety." It ...
AIDSvideos 2 years ago
... outrageously claims that since these trials (by design) controlled other variables in order to render a verdict on the single issue of whether MPCWC protecs against HIV infection, the results are therefore "de-contextualised." That's absurd. It then weakly and vaguely claims that "this research methodology has its critics," which is the weakest of all critiques; EVERYTHING, including childhood vaccination, fluoridation of water, and evidence that we landed on the moon has "critics." It ...
AIDSvideos 2 years ago
... then raises a bunch of potential objections to the methodology (most or all of which were in fact dealt with in the experimental design) and hypothetical reasons without evidence that MPCWC might not work in the "real world." Well, burden of proof is now on the anti-circ activists to demonstrate that MPCWC will fail in general use even though it succeeded in three separate trials with 1000s of participants. I could go on. This article is another desperate attempt by anti-circumcision ...
AIDSvideos 2 years ago
... activists to raise doubts by any means possible about what three well-designed, well-executed, peer-reviewed studies have shown about MPCWC's efficacy for HIV prevention and to obsfucate the results and change the subject. Compared to the other article, it is "slightly more cleverly-written crap." If these articles are the best the anti-circumcision movement can do, give up now. I lack the time to teach your advocates deductive reasoning and ethical persuasion one YT comment at a time.
AIDSvideos 2 years ago
(4) These studies didn't test (and don't recommend) "traditional circumcision" (e.g. performed by non-medical personnel). They tested medically performed circumcision with counseling, and it was shown to be safe and effective for reducing risk of HIV transmission. Subjects who were circumcised showed a DECREASE in the rate they contracted HIV and NO increase in the death rate.
AIDSvideos 3 years ago
Thanks for setting the record straight with these foreskin fundamentalists.
Fallujah25 3 years ago
Ur full of shit, im circumcised and i use condoms. WTF???!!!!! Ur a fucking retard sltr1. The whole purpose of this study is not implicating anything on saying its ok to have unsafe sex!!!
Fallujah25 3 years ago
One of the reasons people do not use condoms is that they say it is less sensitive. So if circumcision reduces the sensitivity, then isn't it logical to think then that condom use would be lower among circumcised men than uncircumcised men? Also try not to post abusive comments - it is rude.
sltr1 2 years ago
It is fair to ask whether condom usage rates among men would differ between the circumcised men and the controls. My recollection is that the actual studies found no significant difference in condom usage rates. There was definitely no evidence that circumcision *reduced* condom usage or led to *increased* HIV transmission. On the contrary, HIV transmission by heterosexual sex was reduced by 50 percent or more in each of three controlled studies.
AIDSvideos 2 years ago
Strange that the findings don't make logical sense though isn't it?
A normal person would assume the trials were flawed in some way. They would conduct further trials before rolling it out so hastily with little regard for the consequences.
sltr1 2 years ago
sltr1 - The findings make perfect logical sense. It is only you who ignore the results of controlled clinical studies, blind yourself to the scientific data, and ignore the distinction between published, peer-reviewed scientific studies on the one hand vs. anti-circumcision web pages with no scientific standing on the other hand. There is no evidence the studies were flawed and no reason to assume so. It is your reasoning that is flawed. There was no "haste."
AIDSvideos 2 years ago
What can you tell me about dry sex?
sltr1 3 years ago
International Journal of Men's Health
October 15, 2008
New Study Shows Condoms 95 Times More Cost-Effective than Circumcision in HIV Battle
Results of a new study, The Cost to Circumcise Africa, published in the International Journal of Mens Health, that compares the cost of male circumcision to the cost of lifetime distribution of free condoms in sub-Saharan Africa, found that condom distribution is 95 times more cost-effective in preventing the same number of infections.
DancerInTheHeart 3 years ago 5
I can't access that article because it requires that you be a paying subscriber. However, I note that a co-author, Ryan McAllister, PhD, is listed as the media contact on the press release from "International Coalition for Genital Integrity." He also displays serious bias in his quote in the press release, referring to "moderate, supposed-effectiveness" in spite of 3 controlled studies showing 50% risk reduction.
AIDSvideos 3 years ago
All doctors should be "biased" in favour of keeping all healthy body parts intact! Any doctor who advocates taking healthy body parts away, and in the case of an infant or child WITHOUT CONSENT, is less than a good doctor.
EnoFrisk 3 years ago 2
He claims "high cost" when medical circumcision with counseling can be performed in Africa for as little as $25 per patient. I don't see how they reach a 95x more cost-effective conclusion either. You can spend $25 to reduce risk by 50% vs. trying to supply condoms for life in rural Africa--that's not cheap when you include transportation, cool storage in warehouse and transit and at the store, etc. A condom stored at 110 degrees isn't reliable!
AIDSvideos 3 years ago
YT user DancerInTheHeart posted the next comment that will be a reply to this comment. Unfortunately, I accidentally clicked "Remove" instead of "Reply." I recovered the comment from my Inbox and am reposting the comment since they have not responded to my request to repost. The YouTube UI should give you some way to recover comments you've inadvertently deleted, at least during the same session.
AIDSvideos 3 years ago
by Dancer]African Journal of AIDS Research 2008, 7(1): 1-8 May, 2008 Long-term population effect of male circumcision in generalised HIV epidemics in sub-Saharan Africa In South Africa, mean yearly HIV incidence and net reproduction rate of the epidemic were not lower... with higher levels of... circumcision...study analysis of eight ... countries showed no...difference in seroprevalence in circumcised and uncircumcised groups...three countries...showed higher HIV prevalence among circumcised...
AIDSvideos 3 years ago
You have to pay to access a copy of that article, and I'm not willing to waste money buying questionable articles in order to waste time debunking them. So I haven't read the whole article, but if you're trying to determine the effect of male circumcision on individual HIV risk, their population survey-based methodology is a fundamentally less-reliable approach than controlled clinical trials because there are so many confounding variables. The evidence from the controlled trials is unambiguous.
AIDSvideos 3 years ago
TO ALL ANTI-CIRCUMCISION ACTIVISTS: Comments about infant circumcision are off-topic and will be deleted. This video is not about, and does not discuss, infant circumcision. It mentions the use of medically performed circumcision with counseling for consenting adult males to reduce the risk of contracting HIV.
AIDSvideos 4 years ago
TO ALL ANTI-CIRCUMCISION ACTIVISTS: If you want to post "statistics" here, they must come from a study published in a peer-reviewed scientific journal, and you must provide a full citation (author, title, journal, date, page) for the study, just as I have been doing myself. Like the HIV denialists, you constantly cite "studies" yet you provide no citations, and I'm no longer willing to take it on faith that the never-cited studies are real or that you're citing the data correctly.
AIDSvideos 4 years ago
The Australian Federation of AIDS Organizations (AFAO) is one of the first medical societies to recommend against male circumcision to combat HIV infection. Their report, issued July 2007, declares: "Male Circumcision has No Role in the Australian HIV Epidemic".
psandbergnz 4 years ago 2
AFAO is not a medical society. They say "AFAO is the national federation for the HIV community response." It's an amalgamation of various non-profit groups. Either you don't know the difference or you don't care and are willfully misrepresenting the nature of that organization.
AIDSvideos 4 years ago
Aidsvideos, The HIV crisis in the USA and other industrialised nations may be very different in the following ways from the African epidemic: different cultures, sexual practices, virus strains, transmission vectors, and sanitary/ hygienic conditions. Further, I know of no study indicating that in Europe or the USA circumcision slows down the sexual transmission of HIV.
psandbergnz 4 years ago 2
You're speculating without evidence. You're driven by your opposition to circumcision, not by the scientific study results on HIV prevention. We have 3 studies proving that medically performed circumcision with counseling reduces the risk of HIV transmission through heterosexual sex. The burden of proof is on you to show that these results are culturally specific. You have not done so, merely speculated.
AIDSvideos 4 years ago
People should make decisions based on the best available scientific evidence, not on the speculation of an opinionated YouTube user who strongly opposes the procedure in question for reasons unrelated to HIV.
AIDSvideos 4 years ago
Seeing as how my comments are "pending approval" I can't tell whether the links I provided will be shown. Anyway, I found three article - one from the Nature website and two from the Washington Post. I did a google search for "Langerin as natural barrier to HIV".
brox285 4 years ago
(cont.)I'm excited about this latest research into the functionality of the Langerin gene in relation to HIV. Luckily there were still people who didn't pay attention to "common wisdom" and make the rash decision to chop off their foreskin.
brox285 4 years ago
I expect the Ugandan study will in the not so distant future be shown to be indicative of nothing but correlational evidence - that any benefit of circumcision in HIV prevention had no causal connection to the physiology of the foreskin per se, but moreso with environmental circumstances.
brox285 4 years ago
As to a specific comment made in the video, "heterosexual sex" is behaviors ranging anywhere from kissing to anal intercourse. Using that term as if it refers to one particular act obscures things by using needless euphemism and is foolish for anyone in the medical field to do, particularly one focused on disease prevention. Penile-vaginal intercourse is the correct word or phrase.
brox285 4 years ago
I think it's tedious and trivial to speak of the supposed limitations of ABC. All of these prevention methods in which people's choices are central, are only strong insofar as people are cooperative. If people were generally cooperative though this virus would never have reached the magnitude that is has. I've seen some slogans stating that prevention is better than a cure. Well, actually no it's not. Seems that that will be ONLY thing that will untimately make a profound difference.
brox285 4 years ago
My chief concern, is that American parents are using these African studies to justify continueing the circumcision ritual on non-consenting children and babies, even though the AIDS epidemic has a different dynamic here.
If a man looks at these studies and then decides HIMSELF to get cut, I think he has every right to do so, but no one has a right to force amputation of a healthy functional and erogenous body part of babies.
painfulquestioning 4 years ago 2
The trials should have been equally overseen by medics with a less obvious bias. The American pro-circumcision lobby, having failed to convincingly correlate circumcision status with HIV in either Europe or the USA, force a transference of their African findings back to the USA, although there is no evidence that they will be of significance there.
sandbergnz 4 years ago 2
Again, you're now alleging bias on the part of the scientists but not actually showing any evidence of bias in the design or performance of the tests. If you think the trials had flawed methodology or analysis, make your case. But to be blunt, you are a circumcision opponent who simply doesn't like what the clinical trials proved--that medically performed circumcision with counseling reduces the risk a male will contract HIV through heterosexual sex.
AIDSvideos 4 years ago
You statement that "there is no evidence that they will be of significance" in the USA is scientifically groundless. Three controlled studies have shown that medically performed circumcision with counseling reduces the risk a male will contract HIV through heterosexual sex. With the study results in hand, the burden of proof is on you to show that the results would be specific to Africa. You have not done so, nor are you likely to.
AIDSvideos 4 years ago
I mentioned the absence of the "double-blind" principle in the African trials to show their inherent weakness. As a European, I note that all three trials were designed and conducted by long-standing proponents of circumcision, mostly from the USA (e.g. Bailey, Moses and Gray), from where the trials were funded.
sandbergnz 4 years ago 4
Now you're attacking the trials based on questioning the beliefs of the experimenters, but that's unscientific. Science is not about "who does it," it's about testing hypothesis and documenting your methodology to enable reproduction, which has been done here. You have shown no evidence that the design of the trials had faults that invalidate the outcome.
AIDSvideos 4 years ago
Historically doctors have claimed that circumcision prevents/cures the following: masturbation, nocturnal emissions, syphilis, epilepsy, bedwetting, rape, curvature of the spine, bladder infections, clubfoot, neuralgia, crossed eyes, blindness, deafness, dumbness, urinary and rectal incontinence, tuberculosis, penile cancer, prostate cancer, venereal disease, tongue cancer, nervousness, urinary tract infections, and group B streptococcal disease.
painfulquestioning 4 years ago 4
Even if this true, it's irrelevant. No one is claiming that all statements by all doctors at all times have always been correct. All we're saying is that three clinical trials have shown that medically performed circumcision with counseling reduces the risk that males will contract HIV through heterosexual sex.
AIDSvideos 4 years ago
I was giving you the historical context which you could easily verify if you did the research as to why 'involuntary partial genital amputation' activists like myself are justifiably a bit wary of doctors touting the health benefits of circumcision. From my and other activists perspective it seems that every generation there is a new disease of the decade that some doctors use to scare parents into continuing to cut their children.
painfulquestioning 4 years ago 4
This video voices the WHO type position. A wing of the UN, the WHO does not recognize that men and boys also suffer from "gender inequality" although that most certainly is the case. There is also little or no evidence that:
SportsDrinker 4 years ago 7
-they are taking contradictory data into account when recommending circumcision (like the fact that the USA has a high HIV rate compared to countries with minimal circumcision)
-That they inform people of the medical risks and sexual loss claimed by many to result from circumcision.
SportsDrinker 4 years ago 2
No. This video is based on the results of controlled scientific research studies, not a religious or cosmetic belief system. For citations, see the references at the end of the video at the NIH web site. It is you who have a strong anti-circumcision belief system that is not based on science. Nor am I aware of any evidence that women in the U.S. avoid men who are uncircumcised.
AIDSvideos 4 years ago
AIDSvideos, the African trials, which only show reduced HIV transmission from women to circumcised men, find many sceptics in Europe. Perhaps the major weakness of the trials is that they do not follow the "double-blind" principle which is the basic requirement for the approval of any medicine.
psandbergnz 4 years ago
If you stop and think, you'll realize it's impossible to perform a "double blind" trial of an external surgical procedure such as circumcision. It is obvious to both patients and doctors who was circumcised and who was not. However, the inability to perform a "double blind" trial in no way invalidates the control model of the 3 trials which had test subject (circumcised) and controls (uncircumcised), both counseled on HIV prevention. This has been shown once and reproduced twice now.
AIDSvideos 4 years ago
That's not correct. It's not that the studies "were not completed." They were ended early because the protective effect was so strong that it would have been unethical to continue the study further and deny the uncircumcised men the opportunity to benefit from the results. Statistically significant results (hugely significant, actually) were achieved. Also, post-analysis controlled for the fact that circumcised men might have temporarily abstained, showing that couldn't explain the results.
AIDSvideos 4 years ago
Present the evidence to grown men and let them decide for themselves if circumcision is the most appropriate action in their case, but you don't have a right to force circumcision on men who don't want it or on male babies who cannot give consent.
compassionateman 4 years ago 6
That's exactly what this video does: present the evidence to grown men and let them decide for themselves. This video doesn't advocate infant circumcision or forced circumcision of adults.
AIDSvideos 4 years ago
Thank you for clarifying that.
I know an American mother who said she wasn't sure what to do in the case of her baby, but that when the African Circumcision/AIDS studies became prevalent in the news, that is when she decided she had to circumcise her son. I support voluntary circumcision, but my concern is that these studies will be used to justify involuntary circumcisions.
Thank you for your work in the fight against AIDS:-)
compassionateman 4 years ago
"Studies indicate a considerably higher acceptance for condoms in Europe and Japan, where circumcision is almost never practised. Some have suggested that American men are resisting a layer of latex that would further decrease sensation from a glans already desensitized from circumcision. Moreover, condoms are more likely to fall off the circumcised penis."
-Circumcision and HIV infection: review of
the literature and meta-analysis, Van Howe, International Journal of STD and AIDS, 1999-
SportsDrinker 4 years ago 6
How much risk do lesbians have of contracting hiv? They never seem to catch hiv.
They are lucky, they can be primuscuos if they choose, my god friend does have a lot of partners, no hiv.
chapeauetbarbe 4 years ago
In the end, circumcision should only be seen as a last-ditch attempt to contain HIV epidemics in cultures where access and acceptance of condoms is low. In the West, where HIV rates are already pretty low, you would have to circumcise many hundreds of men to prevent a single case of HIV. And that's just not worth it.
Gilmaris 4 years ago 3
I agree with you that: (1) Circumcision is of the greatest potential value for HIV prevention in places where access and acceptance of condoms is low, and (2) for a male in the developed world, using a condom every time should provide excellent risk reduction whether they are circumcised or not, therefore the tradeoff between a potential 50% extra risk reduction and the potential downsides of circumcision is less obvious and depends on your evaluation of the severity of the downsides.
AIDSvideos 4 years ago
Adult circumcision counseling? US experience shows if fathers are cut, they impose it on sons. Concern grows about genital surgery on unconsenting children and their rights. Doctors introducing this must work with legal community for laws to protect children. Costly surgery that leaves genital wounds? No. Microbicidal gels for both sexes? Yes.
ts56 4 years ago 2
African medical systems are under-developed. Medical circumcision? Wishful thinking. Rural folk with no money/hospitals seek local 'experts' (same unclean knives, razors, etc as in female genital cutting) thus increasing HIV.
ts56 4 years ago 3
Not wishful thinking. These studies prove that medical circumcision with counseling can be done successfully in Africa and that it cuts HIV contraction via heterosexual sex by 50 percent. Will aid and training be necessary? Yes. But it may cost as little as $25 per patient, so it's a very cost-effective prevention measure in areas where HIV risk is high. These studies are NOT testing or advocating unclean circumcision by amateurs.
AIDSvideos 4 years ago
"These studies prove that medical circumcision with counseling can be done successfully in Africa and that it cuts HIV contraction via heterosexual sex by 50 percent."
Gross misrepresentation of statistics. 50% risk reduction does <i>not</i> translate to 50% less contraction. If you flip a coin once, you'll have 50% chance of landing heads. After only five flips, though, the chance of having landed heads at least once is 96.9%.
Gilmaris 4 years ago 2
No misrepresentation at all; you misunderstood the study results. The studies showed that actual circumcised men having repeated sex over time were 50% less likely to contract HIV than uncircumcised controls OVER THE ENTIRE DURATION OF THE STUDY ... not just for a single sexual contact as you assumed.
AIDSvideos 4 years ago
"OVER THE ENTIRE DURATION OF THE STUDY"
There are two things we can deduce from this. One, is that the abstaining period for the circumcised males might have something to do with this. Two, this still doesn't translate into 50% fewer cases of AIDS because the more time you allow for, the more the figure will approach 100%.
Gilmaris 4 years ago 2
No, that analysis is flawed as well. While circumcised men continue having sex, so do the uncircumcised ones. The circumcised men will have a lower risk on each instance (not necessarily exactly 50% per instance, but proven lower) than the uncircumcised men. Therefore, although the % of circumcised men with HIV may grow over time, so should the % of uncircumcised men, and it will grow proportionately faster. Therefore, the long-term average risk reduction may be a steady-state 50%.
AIDSvideos 4 years ago
I think you misread my comment. The circumcised population of the test was told to abstain from sex for six months while allowing the wound to heal. The control group was not told to abstain, meaning they probably had more exposure. At any rate, the risk reduction is 50% for the amount of exposure given for the duration of the test. The risk of contracting HIV is very very low for a single rump, even for uncircumcised men, but with increased exposure the risk naturally increases as well.
Gilmaris 4 years ago 2
In ANRS 1265 Trial (and I suspect the others), it was six weeks, not six months. They also checked that the abstinent period wasn't the cause of the effect. "(c) To analyze the impact of the 6-wk period of abstinence, the analysis was repeated with the duration of the period M1--M3 reduced by 42 d in the intervention group. Forty-two days was the median (IQR = 28--56) interval between MC and first sexual contact reported by sexually experienced participants of the intervention group."
AIDSvideos 4 years ago
Citation for previous quote: Bertran Auvert et al. (2005) "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial." PLoS Med 2(11): e298
AIDSvideos 4 years ago
By the termination of this research, there were so and so many cases of HIV. Had the testing gone on indefinitely, the only truly protective factor would have been prudence. Gone on eternally, they all would eventually have caught HIV. The duration of exposure is important, and you absolutely cannot translate 50% risk reduction into 50% fewer cases of HIV.
Gilmaris 4 years ago 2
"Twenty-two men in the intervention group and 47 in the control group tested positive for HIV when the study was stopped. The 2-year HIV incidence was 2.1% in the circumcision group and 4.2% in the control group (P = .0065). This corresponds to a reduction in the risk of acquiring an HIV infection of 53%." Circumcised men had 53% fewer ACTUAL CASES of HIV [Rev Urol. 2007 Spring; 9(2): 89--90.] This is proof that circumcision itself reduces the risk of contracting HIV.
AIDSvideos 4 years ago
"Had the testing gone on indefinitely, the only truly protective factor would have been prudence." False and totally illogical. By the same (invalid) reasoning, you could claim that if people have sex using condoms indefinitely, they'll contract HIV, and the only truly protective factor would be prudence. That's not correct either. Both circumcision & condom use reduce risk of contracting HIV. Not to zero, but they reduce it. Reduce risk enough & most people won't contract HIV during lifetime.
AIDSvideos 4 years ago
"By the same (invalid) reasoning, you could claim that if people have sex using condoms indefinitely, they'll contract HIV"
That's the exact <i>opposite</i> of what I was saying. Condoms=prudence. Circumcision =/= prudence. Either circumcised or uncircumcised + condoms = prudence. Circumcision at best represente risk <i>reduction</i>, not <i>protection</i>.
Gilmaris 4 years ago 2
Remember, condoms are also only risk reduction, not risk elimination. I agree completely that they are an outstanding risk reduction technique, are more effective than circumcision, and are the preferred risk reduction technique for any sexually active person with access to them. But remember that many sub-Saharan males lack any access, reliable access, or sufficient access to condoms.
AIDSvideos 4 years ago
Also, bear in mind that this only affects men, not women. 50% of 50% is 25%. Initial findings actually show that circumcision represents an <i>increased</i> risk of <i>transmitting</i> the virus, although this is generally discarded as circumcised men not having allowed the wound to heal. No thorough research has been done on the effect on women, though, as far as I'm aware.
Gilmaris 4 years ago 3
Important to note that if a man doesn't contract HIV (in an encounter in which he would have otherwise) thanks to being circumcised, his subsequent female partners won't contract HIV from him, whereas they would be at risk if he'd become HIV+. So there's an indirect benefit to women. Agree more research is necessary on topics like these.
AIDSvideos 4 years ago
"No, that analysis is flawed as well. While circumcised men continue having sex, so do the uncircumcised ones."
You <i>still</i> misunderstand my point. During the research period, the circumcised men had less sex than the control group, as they were told to abstain for six months (actually, that could be weeks, come to think of it). Now, not all of them may have waited for so long, but they would certainly wait longer than the control group, who weren't told to abstain at all.
Gilmaris 4 years ago 2
No, I understood your claim perfectly, and there's no evidence it's true. There is no evidence whatsoever that the protective effect observed in the trials was due to the recommendation that circumcised subjects initially abstain from sex. Trials went on long enough that the extremely small risk reduction from initial abstinence can't account for the observed effect.
AIDSvideos 4 years ago
And even if they had the same amounts of sex, it <i>still</i> wouldn't translate into 50% fewer cases of HIV, because if you keep having unprotected sex, it is not a question of "if", but rather "when", regardless of circumcision status. In fact, it might lead to an <i>increase</i> in HIV contraction, as those who grudgingly would have worn condoms before gleefully discard them now, because they think they're "protected" by circumcision.
Gilmaris 4 years ago 2
"it is not a question if 'if', but rather 'when.'" False. This is a core flaw in your logic. If you reduce risk of HIV transmission enough through circumcision & condom use, etc., vast majority won't ever contract HIV during their lifetime. Therefore it becomes a question of "if during lifetime," not "when during lifetime." You're dogmatically asserting that people are guaranteed to contract HIV if they have sex long enough. The point is if you cut risk far enough, most won't live long enough.
AIDSvideos 4 years ago
"If you reduce risk of HIV transmission enough through circumcision & condom use, etc., vast majority won't ever contract HIV during their lifetime."
Give credit where credit is due. That's the condom. The vast majority of intact men who wear condoms will never contract HIV in their lifetime, either. The "when" rather than "if" applies where safe sex is <i>not</i> observed.
Gilmaris 4 years ago 3
And I guarantee you that many are going to think that circumcision is "safe enough", just like so many people consider unprotected oral sex to be perfectly safe.
Gilmaris 4 years ago 3
The same thing happened when circumcisions were performed in Britain to prevent syphilis. It might be true that circumcision somehow reduces risks, but the benefits are usually blown way out of proportion, and people get careless.
Gilmaris 4 years ago
Now you're making a blanket claim that benefits are "usually blown way out of proportion." Even if that's true, it's only an argument for carefully communicating the message, which is already the goal of WHO, CDC, UNAIDS, etc. Researchers are not claiming circumcision reduces male's risk of contracting HIV by 100%; just by about 50%, which is what 3 studies demonstrated.
AIDSvideos 4 years ago
So the actual benefits of circumcision will actually be very humble. And that's if we <i>don't</i> take into consideration the psychological aspects. Circumcised men will be less likely to wear condoms because they feel "protected", and women will have one less option to say no to unprotected sex. Circumcision is no silver bullet, but will almost certainly be viewed as such by those who are happy to not wear a condom. But if you keep having unprotected sex, it is only a matter of time.
Gilmaris 4 years ago
Neither we nor the study authors are advocating unprotected sex. (The opposite, actually.) But even taking into account possible increased risk-taking by circumcised men, they still had a 50% lower risk of contracting HIV over the course of the study than uncircumcised controls. And those who don't contract HIV won't pass it on to female partners, benefiting them. Agree that circumcised or not, unprotected sex is to be avoided.
AIDSvideos 4 years ago
James3d, EscapeSociety: It's clear that you are both strongly opposed to circumcision under all circumstances. You are entitled to your opinion, but in your advocacy, please be careful to get the scientific facts correct, e.g. HIV rates by country, correlation with male circumcision rates, relative risks & harms associated with male circumcision and FGM, etc. Also, avoid arguing by analogy as you keep making analogies that are invalid because they equate very different things.
AIDSvideos 4 years ago
"in your advocacy, please be careful to get the scientific facts correct"
We did. You were just dismissing them offhand because they conflicted with what you believed.
"avoid arguing by analogy as you keep making analogies that are invalid because they equate very different things"
You are mistaken. They are very valid. You simply chose not to diverge from your narrow point of view.
EscapeSociety 4 years ago 2
No, you haven't gotten the facts correct. You claimed that high rates of circumcision are correlated with high rates of HIV (actually, reverse is true), and you claimed that the US has one of the highest HIV prevalence rates (actually, it's in the middle).
AIDSvideos 4 years ago
Yes strongly opposed to cutting the genitals of any unconsenting minor person, male female or intersexed. This is a decision which should be made only with informed consent by the person who owns (is attached to the genitals.)
james3d 4 years ago 2
(cont.) "If male circumcision had been effective, we would not have close to one million people now infected with the HIV/AIDS virus in the United States. This disease infected the circumcised and the intact alike. The lesson must be learned, that the AIDS virus is not caused by, or transmitted by, the presence of natural, normal body parts, but by the transmission of infected semen and blood from an infected person to sexual partners, regardless of circumcision status." (Dr James L. Snyder)
james3d 4 years ago 3
Snyder's attempt to indirectly determine circumcision effectiveness for HIV prevention by looking at raw # of HIV cases in the US is fatally flawed. Many cases were transmitted via gay male sex (for which we have no evidence that circumcision cuts HIV risk) or IV drug use (for which it's irrelevant). There are now 3 studies proving medical circumcision with counseling cuts the risk of contracting HIV through heterosexual sex by 50 percent. That trumps Synder's indirect & confounded reasoning.
AIDSvideos 4 years ago
Circumcision of infants is fatally flawed. This is not a card game of trumping someone else's work. Synder has delt personally with the most severe cases of damage from infant circumcision. Photos of his unfortunate patients are available on the internet. Only the most hard hearted person in denial would not be moved to wonder why circumcison of children persits after viewing what has been imposed on these people.
james3d 4 years ago 3
Responding to questions about male circumcision as a prevention for AIDS, Dr James L. Snyder, urologist and past president of the Virginia Urological Society said, "Beginning about 1946 we reared a generation in which 90% of the sexually active men were circumcised. When the AIDS epidemic began, the United States had prepared in a fashion which we now are planning to export to the world: mass circumcision of male children." (cont.)
james3d 4 years ago 3
A new study by Dutch molecular biologists shows that on an intact penis Langerhans cells produce Langerin, which is a natural barrier to HIV infection. In view of this finding, all previous studies regarding HIV and circumcision must be reviewed in light of this new information.
james3d 4 years ago 5
Even if that's true, African trials show that having a foreskin creates a greater net risk of contracting HIV. Controlled studies of medically performed male circumcision with counseling in South Africa, Kenya, and Uganda showed reductions of HIV contraction by medically circumcised males (missing their foreskin, Langerhans cells, and Langerin) of 60%, 53%, and 48% respectively compared to uncircumcised controls (with intact foreskin, Langerhans cells, and Langerin per your study).
AIDSvideos 4 years ago
Even if male circumcision "may reduce" the spread of HIV/AIDS (which is on its way to being discredited) that doesn't eliminate the complications and drawbacks to being circumcised. The foreskin has a concentration of nerve endings that heighten sexual gratification. The foreskin protects the glans of the penis from being keratinized, discolored and dried out...
EscapeSociety 4 years ago 3
The research finding that male circumcision with counseling reduces the risk of contracting HIV in heterosexual sex is NOT "on its way to being discredited." Three separate published controlled clinical trials have each found a risk reduction of about fifty percent. There's no evidence that all three trials were flawed or are going to be overturned. This conclusion is becoming scientific consensus as shown by recent WHO expert panel conclusion.
AIDSvideos 4 years ago
<The research finding that male circumcision with counseling reduces the risk of contracting HIV in heterosexual sex is NOT "on its way to being discredited.">
The Dutch study which states Langerhan cells protect against viruses like HIV doesn't discredit the previous "studies" that Langerhan cells are a magnet for HIV?
EscapeSociety 4 years ago 3
Even if it did, the three studies in Africa show that regardless of the role of Langerhan cells promoting or preventing HIV infection, having a medically performed circumcision with counseling cuts your risk of contracting HIV through heterosexual sex by 50 percent. The best way to determine how circumcision affects your risk of contracting HIV is through a controlled clinical trial, which is exactly what these three studies did.
AIDSvideos 4 years ago
"having a medically performed circumcision with counseling cuts your risk of contracting HIV through heterosexual sex by 50 percent."
How much of that is circumcision, and how much of that is councelling? The circumcised males in the tests were told to abstain from sex for 6 months because the wound was still healing. The control group were not told to abstain from sex. Could this have an impact on the results?
Gilmaris 4 years ago 6
In ANRS 1265 Trial (and I suspect the others), it was six weeks, not six months. They also checked that the abstinent period wasn't the cause of the effect. "(c) To analyze the impact of the 6-wk period of abstinence, the analysis was repeated with the duration of the period M1--M3 reduced by 42 d in the intervention group. Forty-two days was the median (IQR = 28--56) interval between MC and first sexual contact reported by sexually experienced participants of the intervention group."
AIDSvideos 4 years ago
Source for previous quote: Bertran Auvert et al, "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial." PLoS Med. 2005 November; 2(11): e298.
AIDSvideos 4 years ago
...Being circumcised under the guise of HIV prevention doesn't make those drawbacks simply disappear. If you abstain from circumcision, you also have zero risk from surgical mishap and surgical infection. You're better off being whole as nature intended you to be.
EscapeSociety 4 years ago 2
It's correct that circumcision has risks. So an individual must do a risk-benefit analysis. If you're a poor sexually active heterosexual male in Swaziland with limited/no condom access where the HIV rate is 40%, the HIV prevention risk of circumcision almost certainly outweighs the risks of the procedure. (Of course, they should also consider abstinence until marriage, only having sex when condoms are available, etc.)
AIDSvideos 4 years ago
Mass circumcision did not protect Americans from AIDS. (Nor has presence of a foreskin caused mass HIV infection in non circumcising countries.) It is arrogant to suggest imposing circumcision on Africa will yield different results. If anything touting circumcision as a preventative for AIDS will increase carelessness for safer sex practices.
james3d 4 years ago 5
Controlled studies of medically performed male circumcision with counseling in South Africa, Kenya, and Uganda showed reductions of HIV transmission by 60%, 53%, and 48% respectively compared to uncircumcised controls. The counseling makes it clear you still have to practice safer sex; no effect of increased unsafe sex increasing HIV transmission was shown. No one is IMPOSING circumcision on Africa; more men are now voluntarily requesting it than health clinics can keep up with.
AIDSvideos 4 years ago
<No one is IMPOSING circumcision on Africa; more men are now voluntarily requesting it than health clinics can keep up with.>
Men are made to believe their own foreskin will lead to their death through AIDS. This fear is instilled into them by the media and propaganda and so they "volunteer" because of pressure and fear.
EscapeSociety 4 years ago 3
There is no evidence of a "propaganda" campaign that is panicking people into irrationally choosing male circumcision. Men in Africa know that HIV is prevalent and that they are at high risk. They've heard that medical circumcision lowers their risk and therefore are making an intelligent, informed decision to reduce their risk. How about giving these responsible adult males credit for being intelligent, thinking human beings and respecting the informed choice they are making?
AIDSvideos 4 years ago
< There is no evidence of a "propaganda" campaign that is panicking people into irrationally choosing male circumcision. >
What do you call this vid that's telling people to have themselves circumcised to reduce the chances of them getting HIV/AIDS? You don't think you're being part of that bandwagon that's making people believe they're better off being circumcised rather than being genitally intact?
EscapeSociety 4 years ago 4
This video is not TELLING people to have themselves circumcised. It is correctly stating based on research study results that this is one option men may choose to reduce their risk of contracting HIV through heterosexual sex. This video is simply educating people about research findings. "Bandwagon" is a gratuitously pejorative term.
AIDSvideos 4 years ago
The propaganda campaign is the one going on in the USA where those who make their living from routine infant circumcison are foaming at the mouth quoting the African statistics to dupe another generation into cutting their children.
james3d 4 years ago 5
Baby boys and minors who are routinely circumcised certainly didn't volunteer to have their genitals modified, or more accurately, mutilated. Does the fear and paranoia of AIDS justify taking away someone's human rights?
EscapeSociety 4 years ago 4
This video is not taking a position on circumcision of minors, which is a more complex question since it involves parents giving consent for irreversible elective surgery when minors are too young to make an informed decision themselves. It's stating the simple fact that research studies have shown that adult males reduce their risk of contracting HIV through heterosexual sex by 50 percent if they have a medical circumcision and receive counseling when compared to uncircumcised controls.
AIDSvideos 4 years ago
<This video is not taking a position on circumcision of minors>
You're still being part of the position that's stating by surgically amputating the foreskin, one is less likely to contract HIV. Parents of newborn baby boys are now even more persuaded to circumcise their baby boys under this belief. Whether one is circumcised as an infant, minor, or an adult, the claim is still the same: surgically amputate the foreskin, you're less likely to contract HIV.
EscapeSociety 4 years ago 2
I'm stating the research findings that circumcised adult males are less likely to contract HIV than controls. I'm stating nothing about infant circumcision. You seem to be suggesting that I should suppress scientific research findings about HIV prevention in adults to avoid encouraging infant circumcision. Well, that's nonsense. HIV is a health emergency and research findings about safe, effective prevention techniques for consenting adults must be made widely known.
AIDSvideos 4 years ago
By not taking a position you are condoning it. The transperent flaw in this AIDS/circumcison bandwagon is those who support it seem unable to announce a distinction between adults making informed choices and genital surgery being imposed on infants.
james3d 4 years ago 5
Taking no position is not condoning something; it's simply taking no position. I'm under no obligation to state a position on every issue in the world, nor do I have time to develop one. I have a job, not-for-profit, a life, etc. I am perfectly able to distinguish between adult and infant circumcision and am just saying what controlled studies have shown: medical circumcision with counseling is one option for adult males who wish to reduce their risk of contracting HIV.
AIDSvideos 4 years ago
If someone states they have no position on important issues (war, racism, sexism, genital mutilation, global warming, etc.) such a person may be perceived as dull, vapid, immature, socially conditioned not to be able to think for them self or maybe just needs more time to consider the facts. You aggressively campaign for adults to be circumcised saying you have fully researched the issue of male circumcision, yet claim to take "no position" on infant circumcision. Something is wrong here.
james3d 4 years ago 4
Nothing's wrong; I'm just busy and not on call to develop and articulate positions on issues whenever a YouTube commenter demands. To the extent that I have an opinion, I probably lean against infant circumcision on the grounds that it's a procedure with risks that could be performed prior to sexual activity when the person is old enough to decide for themselves, and I'm unaware of any important benefits prior to that time. But again, I haven't researched those tradeoffs.
AIDSvideos 4 years ago
More to the point: James3D and EscapeSociety: You need to realize that the rude, hectoring, demanding, extremist tone you are taking in your advocacy actually tends to alienate people who might find you more convincing if you took a more reasoned (and friendly!) tone in your advocacy efforts. There are many important issues in the world today and not everyone else is on call to drop everything and develop positions on the particular one(s) you two are most concerned about.
AIDSvideos 4 years ago
A Dutch study published March 4, 2007 states that Langerhan cells found in the foreskin are a natural barrier to viruses, including HIV. This would explain why nations that do not routinely circumcise their males have the lowest rates of HIV in the world, while nations like the USA and Ethiopia who do routinely circumcise their males, have the highest rates of HIV in the world.