Male Circumcision Ineffective in HIV Battle According to Future HIV Therapy Report

Salem-News.com called foul on the original reports that circumcision helped reduce HIV/AIDS in Africa, now our belief is proven.

(WEST LAFAYETTE, Indiana) - Promoting male circumcision in Africa is risky and dangerous and could lead to more HIV infections, warns a new paper published in the May issue of Future HIV Therapy.

Promoting circumcision will drain millions, possibly billions, of dollars away from more effective prevention strategies, and cause tens of thousands of infections and other surgical complications.

Promoting male circumcision in Africa is risky and dangerous and could lead to more HIV infections, warns a new paper published in the May issue of Future HIV Therapy.

Lead author Dr. Lawrence Green says, "Having served on both the US Preventive Services Task Force and the Community Preventive Services Task Force, which do systematic reviews of research to arrive at government-supported evidence-based guidelines for practice, I believe the African studies on the basis of which some are promoting circumcision as HIV prevention would be classified at best as 'insufficient evidence’ by both panels."

"Promoting circumcision will drain millions, possibly billions, of dollars away from more effective prevention strategies," cautions co-author John Travis, MD, "and cause tens of thousands of infections and other surgical complications, further straining an already overwhelmed healthcare system and undermining the current ABC (abstinence, be faithful, and use condoms) campaigns by creating a false sense of immunity and increasing risk-taking behaviors. African males are already lining up to be circumcised, believing that they will no longer need to wear condoms, and this is a serious concern."

Travis says, "The African studies were conducted in atypically sanitary clinics with highly skilled operators and cannot be extrapolated to the general population. The studies have been criticized for their poor science including: the men were paid to be circumcised, received free condoms and extensive education, and the studies were halted after only 21 to 24 month periods."

During the course of these studies, 77 fewer circumcised than uncircumcised males contracted HIV, however, the circumcised group needed to refrain from sex to recoup from surgery, and they were receiving extensive monitoring and counseling about sexual behavior. Also, hundreds of study participants were lost to follow-up.

"There is not enough evidence to conclude circumcision would offer any real long-term benefit in the HIV battle. Even if circumcision did reduce the risk of HIV infections, condoms and safe-sex practices are still far more effective. If an individual is engaging in high-risk behavior, he and his partner are at risk, regardless of whether he is circumcised or not."

The paper also cautions against neonatal circumcision for HIV prevention, stating it is unethical to circumcise an infant for a possible benefit 15–20 years later, if at all, to reduce the risk of contracting an adult-acquired disease for which there are far more effective prevention strategies available.

Circumcision proponents, hailing from English-speaking countries, have been intensely lobbying world health agencies to adopt male circumcision as an additional HIV-prevention tool based on the release of three African randomized clinical trials reporting reduced HIV infections during their study periods.

Many sources of data contradict the claim that circumcision protects against HIV. The United States has one of the highest rates of circumcision and HIV infection in the developed world. European nations, which rarely practice circumcision, have very low rates of HIV. Numerous regions in Africa show higher rates of HIV in circumcised populations compared to uncircumcised populations.

For example, 2004 data from Lesotho show HIV infection of 15 percent for uncircumcised males and 23 percent for circumcised males. A 2007 study showed that, once commercial sex worker patterns were taken into consideration, circumcision status was irrelevant in HIV infection rates.

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Vipin October 21, 2012 3:37 am (Pacific time)

What do you say in response to these meiacdl organizations statements against infant male circumcision? 2004 College of Physicians and Surgeons of British Columbia, Infant Male Circumcision: “Current understanding of the benefits, risks and potential harm of this procedure no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and meiacdlly unnecessary intervention.”2003 British Medical Association, The Law and Ethics of Male Circumcision: Guidance for Doctors: “The meiacdl benefits previously claimed have not been convincingly proven… The British Medical Association considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it.”2002 Royal Australian College of Physicians, Policy Statement on Circumcision:“There is no meiacdl indication for routine male circumcision.”2002 American Academy of Family Physicians, Position Paper on Neonatal Circumcision: “Evidence from the literature is often conflicting or inconclusive… A physician performing a procedure for other than meiacdl reasons on a nonconsenting patient raises ethical concerns.”2000 American Medical Association (AMA), Report 10 of the Council on Scientific Affairs: “Virtually all current policy statements from specialty societies and meiacdl organizations do not recommend routine infant circumcision…The AMA supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.” 1999 American Academy of Pediatrics, Circumcision Policy Statement: “Existing scientific evidence … [is] not sufficient to recommend routine neonatal circumcision.”1996 Canadian Paediatric Society, Neonatal Circumcision Revisited: “Circumcision of newborns should not be routinely performed.”1996 Australian Medical Association, Circumcision Deterred: “The Australian College of Paediatrics should continue to discourage the practice of circumcision in newborns.”1996 British Medical Association, Circumcision of Male Infants: Guidance for Doctors: “To circumcise for therapeutic reasons where meiacdl research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”1996 Australasian Association of Paediatric Surgeons, Guidelines for Circumcision: “The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants, or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce [foreskin], based on the current evidence available… We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce.”

Joe May 14, 2008 3:59 pm (Pacific time)

For those interested in the full text on which this story was based, it can be found here: http://www.futuremedicine.com/doi/pdf/10.2217/17469600.2.3.193

Hugh May 14, 2008 2:58 pm (Pacific time)

The famous "60% reduction in HIV" amounted to a total of, as the story says, 77 fewer men with HIV - out of 10,900 men who entered the trials. That's nearly 5,500 circumcisions to prevent (or delay) 77 cases. It's hard to believe a proper cost-benefit analysis was done (counting ALL the costs) before the policy was decided on. Several times more circumcised men dropped out of the studies, their HIV status unknown, than the total of men known to have HIV - enough to completely nullify the results. If you'd undergone a painful and marking operation to prevent HIV, and then learnt you had it (and they were encouraged to get tested separately), wouldn't you feel pretty sour towards the scientists who had done that to you? So those men would be more likely to drop out than others. Two different methods of circumcision were used in the trials, one removing much more mucosa than the other - yet the "reduction" in HIV was the same. Doesn't this make the elaborate theories, about how circumcision works to prevent HIV by removing mucosa, suspect? Non-sexual transmission, and the testimony of subjects with HIV that they hadn't had sex, was ignored, and non-sexual transmission is known to be important in Africa.

john doe May 14, 2008 1:34 am (Pacific time)

Circumcision has done nothing to prevent HIV/AIDS in the USA. HIV/AIDS is a behavioral issue, not an anatomy issue. Stop mutilating baby boys genitals.

Jenifer Saroian May 13, 2008 9:55 pm (Pacific time)

This has GOT to be the dumbest thing I've ever heard...unless they are planning to surgically install permanent condoms with each circumcision, it just doesn't make any more sense than to say women who have undergone cosmetic surgery have fewer STDs. Wouldn't a manadory class, "CONDOMS; Uses and Effects" for all 10 to 14 year olds, be less expensive, pose fewer health risks, and involve the same counseling and monitoring as the circumcision study group ? Sigh... On the other hand, seriously botched circumcisions, or infections resulting in loss of the penis may be effective...

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Male Circumcision Ineffective in HIV Battle According to Future HIV Therapy Report

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