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Uganda Epidemic != United States Epidemic

I'm slow getting to this story, but the United States loves irrational fears when it comes to the foreskin, so it's still as relevant today. A re-evaluation of one of the studies used to claim that (voluntary, adult) male circumcision reduces the risk of female-to-male HIV transmission suggests that (voluntary, adult) male circumcision reduces the risk of herpes transmission by 25% and HPV transmission by 30%.

To the extent that adult males want to volunteer for these reasons, so be it. Everyone is entitled to his own decision. Personally, I'd rely on safe sex, not surgery. But that's not how the data are being used in the U.S. Here, it's predictably OMG 25% 30% OMG YOUR SON IS GONNA DIE A SAD HORRIBLE PAINFUL DEATH IF YOU DON'T CIRCUMCISE HIM BEFORE HE HITS THE DOCTORS HANDS IN THE DELIVERY ROOM OMG! OH AND WOMEN PREFER CIRCUMCISED PENISES WINKWINK. From one of the researchers involved:

Dr Judith Wasserheit went on to say: "All providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured."

Again, notice how easily Dr. Wasserheit dropped voluntary and adult from the study's results. If voluntary, adult circumcision was enough to protect the men involved in the study, surely the exact same is capable of protecting American males. Maybe she wants to suggest that the American STD situation is more dire than the situation in Uganda to justify dropping voluntary or adult?

But to her point, all providers for infants have a responsibility to assure that mothers and fathers know the objective status of their son's foreskin health. Almost always that will mean a statement that no intervention is indicated or warranted. There is no defensible reason to impose surgical risks for a surgery that is a) not needed and b) can be postponed until the child can choose. That was the ethical standard applied in the study. American public health officials have not explained why American infant males should be provided fewer ethical protections.

As the BBC journalist shows, it's possible to find different views. First, the key point that everyone forgets in the hysteria:

The reason why a foreskin might increase the risk of infection with various viruses is unclear.

Whatever the data reflect, this should not be forgotten. It's reasonable to consider the possibility that there is a methodological flaw, for example. What if improper controls existed? What if the timeline was too short? This should not be ruled out, which further highlights the already clear ethical flaw in pushing these results as an excuse to circumcise infant males. And what if the mechanism suggests that some level of female genital cutting would also reduce risks? Would the current advocates endorse that research, or are findings like the current re-evaluated study merely a solution in search of problems?

Dr Colm O'Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an "obsession" with circumcision being the answer to controlling sexually transmitted infections.

He said: "Sure, a dry skinned penis is a bit less likely to contract HIV, herpes and possibly genital warts but it will get infected eventually."

That's what I mean by a flaw in the timeline. If a male has unprotected sex - the only way circumcision could provide protection - with HIV-positive females, he will become infected. The choices are condoms/monogamy/circumcision or condoms/monogamy. Circumcision is superfluous and unnecessary, so infant circumcision is indefensible.

Keith Alcorn, from the HIV information service NAM, also warned against a knee jerk reaction.

He said: "We have to be careful not to take evidence from one part of the world and apply it uncritically to others.

Given the U.S. reaction, it's too late for that.

"Male circumcision will have little impact on HIV risk for boys born in the UK, where the risk of acquiring HIV heterosexually is very low.

The same applies to the United States.

Comments

Male Circumcision and HIV Prevention: Is There
Really Enough of the Right Kind of Evidence?
http://www.aidsvaccineclearinghouse.org/pdf/MC/circumcision_dowsett.couch.pdf

Robert Van Howe has some good things to say about HIV in his critique of the AAP policy on routine infant circumcision:
http://pediatrics.aappublications.org/cgi/eletters/119/5/1006#23937

You said everything I've been saying ever since all this news crap broke out yet far more eloquently. Bravo.

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