Author: Tony

This is the last one for the day, I promise.

Earlier today I asked whether or not new findings on HIV prevention might generate an “Oops?” from circumcision advocates. I’ll ask again:

Men with HIV who get circumcised hoping they will be less likely to transmit the AIDS virus may have a greater-than-normal risk of infecting their partners if they resume sexual activity too soon after the operation.

That observation — drawn from preliminary analysis of a study in Uganda — threatens to complicate efforts to tout circumcision as a new weapon against HIV in Africa.

The men in question already had HIV when circumcised. There should be no surprise that they can infect their female partners. Perhaps it’s surprising that the risk is greater than normal, but the bottom line is that the eventuality of infection is a given. Circumcision will only delay the inevitable. This coincides with the truth that responsible, safe sex practices are the only prevention, whether the individuals involved are intact or circumcised, HIV-positive or HIV-negative.

Instead, we’re left with this sentiment¹:

Specifically, it suggests that public health campaigns promoting circumcision must also include messages, directed principally at women, warning of the extreme hazard of intercourse with HIV-positive men who have just had the procedure.

There were obvious reasons not to rush head-first, unthinking into promoting circumcision before these findings. Researchers, politicians, and parents didn’t want to hear this before. Will they now, even though these efforts should’ve been seen as complicated from the beginning, with adequate restraint applied?

¹ Full Disclosure: I exchanged e-mails with the reporter for this story, David Brown, after he wrote a story on circumcision and HIV prevention in August. We had a brief exchange, but my questions were inadequately addressed. Our disagreement partially focused on this statement about the educational approach needed. From that article:

The FGM issue is more complex than the simple view that women are mutilated to damage their sexuality while men are mutilated to provide them with medical benefits. That begs addressing the specific issue of male circumcision with a skeptical eye. Instead, he seemed to approach the complex ethical and scientific aspects of male circumcision with the same faulty assumptions accepted by society in general, even when the facts we discussed contradicted his statements. This is not surprising, but it’s also not advisable for a reporter, in my opinion.

Unlike the scientists, politicians, and parents who couldn’t wait to proclaim victory when a few studies showed a correlation between the male foreskin and HIV infection, I will not make bold pronouncements about these findings.

Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that “eats up” invading HIV — possibly keeping the spread of the AIDS more contained than it might otherwise be.

Even more important, enhancing the activity of this protein, called Langerin, could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host.

However, “we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection,” said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

You’ll recall, of course, that the primary “benefit” of male circumcision as a defense against HIV is that it removes many Langerhans cells. Read through most of the articles in the last year or so on this topic and you’ll see “scientists believe”. Not “scientists know,” but “scientists believe”. Oops?

The question mark on the end of my last sentence is intentional. I have no idea how substantial this research is, or whether it can be replicated. I’m willing to read this last qualification in the story and understand that life is often more complicated than controlled findings.

[Dr. Jeffrey Laurence, director of the Laboratory for AIDS Virus Research at the Weill Cornell Medical College] did offer one note of caution, however.

“In the test tube, this is a very important finding,” he said. “But there are many things in the test tube that don’t occur when you get into an animal or a human. Having said that, though, this is a very intriguing finding.”

Instead of the glee that my viewpoint is now supported, I’ll approach this with caution, the same way circumcision supporters should approach the recent findings on HIV. I suspect the difference is that I know I don’t need science to validate my stance. I’m correct before we get to the science. Circumcision advocates rush to every justification. Why?

But looking at the science, we’re finding information in the short-term. It’s reassuring to project that information long-term, but we must remain open to the possibility that we’re wrong. That is true of any new discovery, but it should be required when the decision is to alter a human body. We should add another, higher standard because that body does not belong to us.

If researchers verify these new findings through real-world tests, will anyone apologize for rushing to circumcise as many males as possible? The answer is an obvious “no”. Those now advocating circumcision will still fall back on the tried-and-true defenses. We’ll okay some version of “alright, it’s not important, but still…“. I can accept that if someone makes decisions about his own body and life. I can’t accept that when someone makes it about someone else’s body and life. But still… isn’t enough.