Re: Circumcision Doesn't Lessen HIV Transmission. Black males killing off women with AIDS.
Andrew Usher
> http://www.forbes.com/feeds/hscout/2009/07/16/hscout629070.html
>
> THURSDAY, July 16 (HealthDay News) -- Circumcision doesn't
> reduce transmission of HIV from infected men to women, says a
> study that included 922 HIV-infected men in Uganda.
I'm not going to be persuaded by one study that circumcision doesn't
make a difference when it's already well established and accords with
common sense. Even this comment -
> The study results shouldn't deter programs working to increase
> circumcision services for men at risk for HIV, wrote Dr. Jared
> M. Baeten of the University of Washington in Seattle and
> colleagues in an accompanying commentary.
from an author of the study acknowledges that.
Andrew Usher
Jake Waskett
> On Jul 18, 5:16 am, Certain Death <inva...@nowhere.com> wrote:
>> http://www.forbes.com/feeds/hscout/2009/07/16/hscout629070.html
>>
>> THURSDAY, July 16 (HealthDay News) -- Circumcision doesn't reduce
>> transmission of HIV from infected men to women, says a study that
>> included 922 HIV-infected men in Uganda.
>
> I'm not going to be persuaded by one study that circumcision doesn't
> make a difference when it's already well established and accords with
> common sense.
The subject of this study is different from previous studies.
It is well established that circumcision protects (partially) against
transmission from women to men.
This study is about transmission from men to women.
Andrew Usher
> The subject of this study is different from previous studies.
Ah, I see.
> It is well established that circumcision protects (partially) against
> transmission from women to men.
It didn't seem clear, and I automatically assumed it was an effort
to deny the circumcision/HIV connection (we know there have
been enough of those).
> This study is about transmission from men to women.
I guess it makes sense that that direction might not be
significantly effective. Have there been any other studies
confirming this?
This would also say that circumcision would not be much
help for gay man, almost all of whose infections are
contracted from receptive anal sex.
Andrew Usher
windinghighway
transmission from men to women. But as uncircumcised men are more
likely to be infected, they are more likely to pass on infection to
women by the usual means. Thus, women (and gay men) are at a greater
risk of infection from an uncircumcised man.
Jake Waskett
> Jake Waskett wrote:
>> This study is about transmission from men to women.
>
> I guess it makes sense that that direction might not be significantly
> effective. Have there been any other studies confirming this?
There have been a number of previous studies, all of which were
observational, some of which indicated that there might be a protective
effect. But this study is an RCT - a much stronger study design - and
consequently carries considerably more weight.
> This would also say that circumcision would not be much help for gay
> man, almost all of whose infections are contracted from receptive anal
> sex.
Agreed. There is, however, some evidence (albeit far from conclusive)
that circumcision is of some benefit to gay men who exclusively take an
insertive role.
Jake
Jake Waskett
Indeed. But the purpose of the study was to assess whether circumcision
might reduce the probability of transmitting HIV. Some observational
studies indicated that it might (the hypothetical mechanism is unclear, at
least to me), so it was worth evaluating in an RCT, if only to further our
understanding of how circumcision is effective.
Andrew Usher
> > This would also say that circumcision would not be much help for gay
> > man, almost all of whose infections are contracted from receptive anal
> > sex.
>
> Agreed. There is, however, some evidence (albeit far from conclusive)
> that circumcision is of some benefit to gay men who exclusively take an
> insertive role.
Why would it be different than for heterosexuals here? The only reason
I
could think of is that the foreskin is especially damaged during anal
sex,
and I don't think that's true.
Andrew Usher
windinghighway
If the virus is present in the rectum (or vagina) then a foreskinned
insertor is more likely to become infected because the virus seems
able to directly infect the langerhans cells of the foreskin. Also,
foreskinned men are more likely to suffer from several other STDs that
might provide a portal for viral entry.
Andrew Usher
> If the virus is present in the rectum (or vagina) then a foreskinned
> insertor is more likely to become infected because the virus seems
> able to directly infect the langerhans cells of the foreskin. Also,
> foreskinned men are more likely to suffer from several other STDs that
> might provide a portal for viral entry.
That's what I would think but this study seems to contradict it, at
least
for heterosexuals (presumably vaginal sex). It's only one study, and
as
I said it needs confirmation.
Andrew Usher
Jeffrey Ventura-Morell
If half the energy that has been placed on promoting male circumcision
were placed on awareness about condoms, it would have much greater
effect. The risk you run by saying circumcision alone reduces risk is
that it does not take into account that once circumcised men may fell
as if they are automatically protected. What does this mean for
women? Circumcision does nothing to reduce their risk, if anything it
may disempower them by giving men one more reason to not use condoms.
My fear is that simplistic solutions that do not involve comprehensive
education will only exacerbate the problem long term. I hope that I
am wrong but my feeling is that in a few years time we will see a
surge in HIV cases where circumcision is adopted as prevention.