Month: March 2007

From the Washington Post article I mentioned in yesterday’s entry, this:

The young and hip at ground zero of the AIDS epidemic meet, drink and pair off under the knowing gaze of bartender Brian Khumalo. Sometimes they first buy a three-pack of condoms from the box he keeps by the liquor, sometimes not.

Night after night they return for the carefree, beery vibe, with the same partners or new ones, creating a web of sexual interaction. A growing number of studies single out such behavior — in which men and women maintain two or more ongoing relationships — as the most powerful force propelling a killer disease through a vulnerable continent.

This new understanding of how the AIDS virus attacks individuals and their societies helps explain why the disease has devastated southern Africa while sparing other places. It also suggests how the region’s AIDS programs, which have struggled to prevent new infections even as treatment for the disease has become more widely available, might save far more lives: by discouraging sexual networks.

I want to pound my head on my keyboard. Education and behavioral changes are the answer? Who would’ve thunk it? Until societies address these real issues, promoting circumcision will not achieve the significant success now touted. That exacerbates the violation being committed against children. Once societies address these issues, any alleged benefits of circumcision will not be sufficient to excuse the violation.

Still, it’s easier to run with what is accepted than what is valid:

A second key factor helping the virus spread through southern Africa is low rates of circumcision. Before European colonialists arrived, most tribes in the region removed the foreskins of teenage boys during manhood rituals. Those rites, which were discouraged by missionaries and other Westerners who regarded them as primitive, have gradually declined as the region rapidly modernized.

Essentially, it’s our fault. We stopped them from being smart. Please. Before we get to that, we should analyze how “key” this second factor really is.

Dozens of studies, including three experimental trials conducted in Africa in recent years, show that circumcised men are much less likely to contract HIV because the most easily infected cells have been removed.

Those men are less likely to contract HIV within the short time frame covered by the studies before the researchers decided that circumcision is wonderful and should be offered to all men. No long-term research has been done, other than the very big, albeit unscientific, circumcision experiment carried out by American parents. Why focus on that and the easy comparison to Europe’s infection rate among mostly intact males when we can instead blame the African HIV epidemic on those Europeans? Ugh.

These factors, researchers say, explain how North Africa, where Muslim societies require circumcision and strongly discourage sex outside monogamous and polygamous marriages, has largely avoided AIDS. They also explain why the epidemic is far more severe south of the Sahara, where webs of multiple sex partners are more common, researchers say.

West Africa has been partially protected by its high rates of circumcision, but in southern and eastern Africa — which have both low rates of circumcision and high rates of multiple sex partners — the AIDS epidemic became the most deadly in the world.

The same logic that suggests circumcision as a viable HIV prevention strategy would also suggest that all societies should convert to Islam. It only depends on how far you want to go beyond the actual cause. This simply reveals the difference between people who believe circumcision prevents HIV infection and people who know that circumcision may only delay HIV infection, should the circumcised male engage in irresponsible behavior. That’s the true scenario where we can assess “other things being equal”.

People are determined to believe that circumcision is the ideal prevention for HIV. The problem with this flawed idea rests in one simple truth: too many overlook any other factor that might impact risk far more than keeping intact genitals. It’s far easier to rush to this surgery because it’s accepted. It helps that the victim can’t fight back, though civilized people won’t acknowledge it in quite those terms. Usually some notion of “best interests” will follow the decision.

Unfortunately, there are other factors involved in life. It’s foolish to believe that such extreme choices can exist in a vacuum devoid of any drawbacks. Yet, people do. For example, Andrew Sullivan conceded a stance that he was not justified in conceding. Long-time readers will remember that I hammered this at the time. In my response I quoted a study that included the phrase “other things being equal” to describe how circumcision will protect. I said it then, and here it is again: all other things are not equal.

This bears significance now because Mr. Sullivan links to this story from the Washington Post, via Steve Sailer, about promiscuity in Africa. I’ll get to that story in another entry, but Mr. Sailer comments on the article with this:

Another contributor to the high rates of AIDS in Southern/Eastern Africa besides multiple concurrent partners and lack of circumcision is the bizarre fetish for “dry sex,” which I would guess doesn’t exist among West Africans because (thankfully) you never hear about it among their African-American cousins.

To which Mr. Sullivan responds:

Dry sex?

This is inexcusable. For someone who is now willing to endorse allowing parents to circumcise their sons to prevent (an unlikely) HIV infection if they “believe that diminishing their child’s future sexual pleasure is worth the benefit of extra protection from HIV,” there is an obvious burden not to be blind-sided by a known risk factor in the spread of HIV in Africa. Depending on the prevalence of “dry sex,” it’s reasonable to suspect that this has a far greater impact on the transmission rate than intact genitals. Intact or circumcised, dry sex will lead to abrasions and tears, and as a result, blood. If that blood is tainted with HIV, no lack of foreskin is going to save the male. He is betting on luck alone.

The sensible stance recognizes that parents can never know how their children will behave. But “dry sex” is not generally considered a cause of significant HIV infection in the United States, or the rest of the industrialized world. The risk of HIV infection in America is, in fact, quite low for heterosexual males having unprotected sex with HIV-positive women. This destroys any myth that parents have a right to make a permanent surgical decision for their child that clearly diminishes his sexual sensitivity.

Fear is not enough. Logic and liberty demand that we must look past fear. If adult males wish to have themselves circumcised to prevent HIV, we should not stop them. But advocating or permitting infant circumcision as a means to prevent future HIV infection is merely bowing before fear without concern for understanding.