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Circumcision and AIDS – Revisited

Byoliveridley

condom.jpg

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!

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    Note that there is currently a HUGE loophole in the senate version of the bill, it permits smoking in “private clubs”. Many bars in NC designate themselves as “private clubs” to circumvent prohibition era (or thereabouts) laws that mandate liquor serving establishments to get a certain percentage of their revenue from food. So, my favourite Chapel Hill drinking establishment, The Dead Mule (no website, sorry!) is supposedly a “private club” – You supposedly pay a one time membership fee (usually less than 5 bucks), and are supposed to “sign in” any members and guests. This was all a farce anyway, and the Mule got extremely smoky, it was quite disgusting after a while.

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    House members passed a tougher version last month, meaning that lawmakers will still have to work out a compromise, assuming the Senate passes the measure in a second vote on Monday. The bill passed Thursday by an eight-vote margin, 26-18, so that seems likely.

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    Sure makes my graduate work in air quality seem a little tame!

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    Sodat Fat

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