Letters to the Editor
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Circumcision
Circumcision may reduce the spread of AIDs in Africa, in environments where women may not have the right to refuse sex or require condom use. The study still shows that condom use is much, much more reliable. Men need to wear condoms and women need to require that they do.
We really don't need men telling women that their circumcision means that the woman is less at risk for AIDs. The man may be less at risk of contracting it if he's circumcised and is always the penetrator (Not a given either, right?), but having sex with uncircumcised partners who refuse to wear condoms will not help women. Make him wear the raincoat.
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If this was genital surgery for women...
There would be a hue and a cry of unimaginable proportions. Especially considering some recent studies indicate that circumcision may increase the risk of HIV transmission to a man's female partners. (and one would presume a gay man's partners as well, though who really knows?)
The evidence for this is so sketchy it's ridiculous. I can't even fathom how a recommendation like this passes the ethics boards.
Circumcision should be left where it belongs: as a religious or cultural practice and little more.
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The mechanism
Until the mechanism is known why the results in Africa were so striking, it is suspect to use the findings to create policy. The numbers of men infected were low, and the percentages appear significant. But, the sample size was small. So, this idea that circumcision helps prevent the spread of AIDS is NOT verified. There could be other factors that account for the reduction in infection. It could be that this study was a fluke.
Wait for confirmation from additional studies before assuming that the results are absolutely true.
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The Mechanism
Bushwacker: The study compared men who were circumcised with men who weren't (less foreskin to pick up tiny viruses, get infections, etc.) and the result was that circumcised men got infected less frequently than uncircumcised men. The transmission rates were still much higher than with condom use. The study was performed, in part, because despite the efficacy of condom use, many African women don't have the power or right to demand condom use or refuse sex. Thus the logic was that if circumcision could reduce the rate of transmission even slightly, that would be a net improvement for everyone.
Of course, improving the status of women in Africa so that they can refuse sex or insist on more reliable protection to protect them from AIDs (condoms) would be more effective, but I guess that option isn't on the table. In the U.S., forgoing safe-sex behavior and promoting circumcision is ridiculous.
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why not just promote condom use instead?
Since we know beyond a shadow of a doubt that using condoms is the most effective thing, certainly in comparison to circumcision, why not promote and encourage that instead of asking guys to get themselves mutilated?
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Might circumcision actually increase the risk...
by providing a false sense on invicibility. More thoughtful and educated people will already use condoms or rather practise safe sex in general. People who can be convinced by a policy to have a surgery (on their genitals no less) are not prime candidates to be trusted to make rational decisions afterwards.
As for public health officials, it seems unconscionable to promote an irrevocable surgery when a much more effective and infinitely less invasive means of protection (i.e. condoms) exists (not to mention responsible personal conduct). As always in the circumcision debate I wonder how much greed (money and power for the medical establishment) is at the heart of proponents efforts.
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Confused
But isn't circumcision practiced quite widely in the US already? And men in the US still get AIDS. In fact when the disease first showed up here, I would assume that the vast majority of the men who contracted the disease were circumcized. It seems to me that continuing to push condom use would be the better course.
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“Don’t worry, baby. I’m circumcised!”
Can you imagine? This idea is worse then doing nothing at all.
I think those condoms the city recently started passing out (the ones with the subway logo on them) is a much more helpful idea.
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The foreskin is a sheath...
Which sequesters stuff.
[Old arguments regarding ritual circumcision aside...please.]
That being so, stuff get under and hides in that sheath.
[Wholly appropriate arguments aside too as to the
sometimes painful trial which is circumcision...in the adult.]
Best off and in a bottle (a little like cancer), under the circumstances.
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Upsetting
that so many people think so little of boys.
As that radio doctor said the other day, so much circumcision means that men are less sensitive and need more stimulation during sex. Doc says the fast, frictiony sex portrayed in porno is the style circed men have to use during sex since slow languid sensual sex is out of the question if the guy wants to get off or to even feel much.
It is kind of JUSTICE in reverse that women circ men to not get disease, but the result is that sex is so much LESS than it can be for the women too.
And maybe we do have to appeal to women's vanity to stop this mutilation of boys. After all, if women feel they are missing out on something they can have, much more satisfying sex, they will actually try to get together to stop boy mutilation.
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This is about promoting circumcision, *not* fighting HIV
Why has there been no coverage of :
1) the 2005 study in Tanzania which showed that circumcised *women* had lower rates of HIV
2) the 2007 study that showed that circumcised virgins in Kenya, Lesotho, and Tanzania were more likely to be HIV+ that uncircumcised virgins
3) the 2007 study whose latest findings show that circumcised HIV+ men are more than twice as likely to pass on HIV to their wives
4) the 1993 study that found that "partner circumcision" was "strongly associated with HIV-1 infection [in women] even when simultaneously controlling for other covariates."
5) The fact that the USA has a higher HIV rate than any of the 27 European Union countries, none of which circumcise.
This whole thing is about promoting circumcision, not about fighting HIV. Abstinence, Being faithful, and Condoms (ABC) protect against HIV, so why is anyone trying to promote genital surgery? Circumcised men are less likely to use condoms, so this whole thing will cost lives, not save them.