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Sunday, Nov 8, 2009
Betcha didn't know that circumcision is one of the major reasons for the season! The Syrian-Greeks in charge of Judea at the time banned some Jewish religious practices; chief among them was the Covenant of Abraham, Bris Milah, circumcision. The Chashmonayim family got so fed up they led the revolt that kicked the Greeks out.
Some of these letters sound like creationist arguments, "I just don't buy it, even though I haven't bothered to learn the last thing about it." Dude, use the internet. PubMed, WHO, UNAIDS, NIH, something.
One suspected biological mechanism for why circumcision reduces HIV transmission is that the foreskin has a high count of CD4 cells, the white blood cells that HIV latches onto and uses to replicate itself. That's the major idea in play right now. It's been observed for a while that HIV transmission rates were lower in places that had higher rates of circumcison, but people thought there were other factors related to both that might explain the relationship. That's why they did these randomized trials, to isolate that it was, in fact, the circumcision.
The ethics of doing it on babies are certainly worth discussing -- the main problem with waiting is that it's a bit more complicated to do in adults because there are more blood vessels in the adult foreskin. There's also another question about when "adulthood" begins for deciding: Just before people start having sex? Or when we commonly think people can make their own decisions?
The behavioral issues are also worth discussing. We all balance the risks we're willing to take, and so it's challenging to get across the message that circumcision still means condom use and other protective behavior (abstinence, fewer sex partners). But it's giant drop in transmission akin to what researchers expect to see from a good vaccine (the nature of HIV makes a super effective vaccine pretty unlikely). It can't be ignored.
And it hasn't been ignored. Since the first trial ended, there has been rising demand for male circumcision (http://www.who.int/bulletin/volumes/84/7/news10706/en/), and that demand will only increase. Encouragement is hardly necessary. What is necessary is ensuring that males have access to safe, sterile, hygenic surgeries that they want.
Would there be an HIV problem if we eliminated anal sex? Whether men on men or men on women. Your figures of one in 1000 or 2000 for vaginal sex are pretty long odds. What are the odds in anal intercourse? T-cells are dense in the lower digestive tract, so transmission is very likely, much more so than in vaginal sex. Why is there such resistance to discussing the most likely vector? There is an incredible desperation to blame heterosexual sex as being equivalent to homosexual anal sex as a vector. It isn't. Cut out the buggery and you will essentially eliminate HIV.
I can't help but wonder how many people who argue in favor of male circumcision are actually uncircumcised men.
So far, I haven't yet seen a single man with a foreskin arguing in favor of circumcision. In fact, all of the proponents of circumcision seem to be either women, or circumcised men.
It is arguable that many of those men may be making the pro-circumcision argument in order to allay their own fears that they may have forever lost something which they would have valued, had they been allowed to keep it.
I'm not arguing that circumcision does not reduce HIV transmission. Although frankly scientists and doctors have made enough errors in the past to make me think twice before allowing someone to chop off my foreskin, or that of any child, on the basis of a study. But in any case, the aforementioned women and circumcised men are unable to weigh both sides of the issue. They can point to hypothetical reductions in the rate of HIV transmission, but they cannot speak to the negative side of the circumcision equation. There is still some debate over the range of benefits which the foreskin provides, but certainly circumcision often results in reduced sensation and sexual pleasure, as well as lessened protection of the glans.
And frankly, we're born with it, which seems to indicate that the foreskin serves a useful function. It seems entirely possible that the foreskin may provide benefits which we're not yet aware of, in addition to those that we already know. Certainly the history of medicine shows that in every past case in which the surgical removal of a body part was popularly practiced, the custom was eventually found to be at best unnecessary, and often actually damaging. Even the appendix, which is admittedly useless, is normally not removed until it has shown itself likely to cause problems for the patient.
As it stands, it seems to me that practicing wide-scale surgical removal of substantial amounts of sensitive tissue from male sexual organs is an extreme reaction to an issue that can be addressed by other means. As someone else here pointed out, complete removal of the penis would reduce the chance of transmission of HIV to zero (well, not really, but it would certainly reduce it quite a bit). Yet no one is seriously suggesting instituting a general program of penis removal.
So it interests me that those supporting circumcision seem to be only those with nothing to lose - so to speak.
Duh anal sex is more dangerous than vaginal sex for many reasons. What I learned in sex ed is that the anal tissue is more likely to tear thereby causing semen to come into contact with blood.
Eliminating anal sex is not the answer. You CAN use a condom with anal sex just for the purpose of preventing this disease! Also condoms help prevent UTIs in the "top" partner, even if both are perfectly healthy. Have tons of anal sex, just wrap it first.
Also, routine infant circumcision is barbaric. There's no good reason to do it. A normal baby boy is perfect just the way he is. If a man wants to do it of his own volition for any reason that's one thing; doing it to a baby is quite another.
Obviously foreskin removal in a hospital is not equivalent to some of the butchery practiced on girls, like clitoridectomy or sewing up the vagina. BUT that doesn't make it okay. If infant circumcision of boys is okay with you, than African families who want to notch a girl baby's labia in a hospital setting should be okay with you too.
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