Day: April 16, 2009

Circumcision and AIDS – Revisited


A post I wrote quite a while back on circumcision and AIDS remains my most commented post ever. In it (if you’re too lazy to click) I said that while research indicating a reduction in HIV infection in circumcised men was promising, there were a couple of concerns. One, that this could be a distraction from the single most effective prevention measure (no, not abstinence!), condom use. And two, that in certain cultures, especially among Hindus, this would be an absolute no no because circumcision is identified with being Muslim.

Anyway, in a review article, the Cochrane Centre in South Africa summarizes results from a meta analysis of a number of trials indicating a 50% reduction in HIV incidence among circumcised males. At this point in time, it is clear that circumcision is effective in reducing HIV incidence among heterosexual males. Based on this, the institute encourages the widespread use of circumcision as an AIDS prevention strategy.

So, am I still circumspect? Absolutely. I am still concerned that this research will be misinterpreted in a way that discourages condom use. In fact, the authors note that circumcised men indulged in more risky behaviour. Also, the incidence of HIV in the women these men were sleeping with increased from 9.6% to 13.8%, a 40% uptick. This increase was not statistically significant. No arguing with that, though the study was stopped early once it was clear that the men were helped, never mind the women, or reaching statistical significance in their case.

Given that it is very unclear what the effects of circumcision are on anything other than circumcised penises, which are only one half of the equation (or less!), I don’t think it is responsible to call for widespread use of circumcision as a public health strategy for the prevention of HIV until its effects on the other parties are known. While people are aware of this issue, I don’t think the science or the cultural landscape promote the use of circumcision as a HIV prevention strategy until its proven that women are not at risk from increased HIV incidence either biologically from a yet unknown mechanism, or socially from increased risk taking.

Men have more power in most societies to demand and receive sex on their terms. So the male centric nature of this research, and the conclusions drawn are disturbing. How irresponsible is it to encourage a public health strategy that appears to increase risk taking behaviour among men when the effects on the women are yet unknown, with only a statistically “insignificant” 40% increase in HIV incidence among women being observed?

I am. for very good reason, still circumspect on circumcision.

Whisky flavoured condoms courtesy bruno  girin’s photostream used under a creative commons license. Now how’s that for a turn on, whisky!

Health Canada report ties asbestos to lung cancer

Health Canada sat for more than a year on a report by a panel of international experts that concludes there is a “strong relationship” between lung cancer and chrysotile asbestos mined in Canada.

Health Canada received the report in March 2008, resisting calls from the panel chairman to release the findings despite his plea last fall that the delay was “an annoying piece of needless government secrecy.”

Canwest News Service obtained the report under Access to Information legislation, but the request took more than 10 months to process.

Vancouver Sun

Yes, dog bites man anywhere else except Canada, which has a hard time accepting that it routinely exports products that kill people. The “annoying piece of needless government secrecy” is neither needless or annoying. It protects a dying industry with a few, powerful stakeholders in Quebec, an important swing political province, so there’s need for it! Annoying – your seat “buddy” on the bus yammering on their cellphone, cancer, well, I don’t know, you tell me!

Expect little to change from this report. It does mention that there is little danger from “Canadian exposure levels”, conveniently forgetting that 90% of the export is to developing countries where there are fewer safeguards. This feeds into the Canadian government line that “chrysotile” is safe if used correctly. If you think this line of reasoning is familiar, it is. The tobacco industry used it routinely till recently.