Friday, February 27, 2009

More on last post...

This comment was left in response to my last post. I thought it was really insightful and summed up a lot I wasn't able to put on paper. Thanks Mark Lyndon (email - for taking your time to share your thoughts with my blog readers.

The studies which allegedly show a reduction in HIV among circumcised men are indeed highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the oft-reported 65%, and several of the subjects disappearing. The fact that one study described circumcision as "comparable to a vaccine of high efficacy" seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised.

Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of "dry sex".

The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circed men than intact men, yet they've just started a nationwide circumcision campaign. Other countries where circumcised men are *more* likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, Swaziland, and Tanzania. That's seven countries where men are more likely to be HIV+ if they've been circumcised.

Cameroon: table 16.9, p17 (4.1% v 1.1%)
Ghana: table 13.9 (1.6% v 1.4%)
Lesotho: table 12.9 (22.8% v 15.2%)
Malawi: table 12.6, p257 (13.2% v 9.5%)
Rwanda: , table 15.11 (3.5% v 2.1%)
Swaziland table 14.10 (21.8% v 19.5%)

Something is very wrong here. These people aren't interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them.

If you read those reports btw, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn't refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they'd be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.

Circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.

ABC (Abstinence, Being Faithful, Condoms) works against HIV. Circumcision appears not to. Remember that circumcision won't make any difference unless someone is having unsafe sex with an HIV+ partner.

Female circumcision seems to protect against HIV too btw, but we wouldn't investigate cutting off women's labia, and then start promoting that.

For a good summary of the case against promoting circumcision in Africa, see this link:

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