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Earlier male circumcision may help to slow rates of HIV, HPV transmission in South Africa
TAMPA, Fla. (Oct. 6, 2011) – According to Anna R. Giuliano, Ph.D., program leader in cancer epidemiology at Moffitt Cancer Center in Tampa, Fla., and colleagues in the Netherlands, earlier circumcision of males in South Africa may be a positive step in slowing the spread of both HIV and the human papillomavirus (HPV). Their commentary and data were published in a recent issue of the British medical journal The Lancet Infectious Diseases (Vol. 11) 581-582.
"Countries with high incidences of HIV also have high incidences of cancer-related HPV," said Giuliano. "This is especially true in South Africa."
Commenting on a study related to circumcision and HIV and HPV transmission, Giuliano and her colleagues note that studies have shown that circumcision of HIV-infected men does not reduce HPV transmission to their female partners. Many factors may account for this lack of efficacy. However, Giuliano and colleagues suggest that the high prevalence of HPV among the HIV-infected men (73 percent in the intervention group and 69 percent in the control group) and the high prevalence of HIV among the female partners of greater than 60 percent, relates to the lack of efficacy of male circumcision. In that study, it was pointed out that the high and sustained prevalence of HPV among the HIV-infected individuals is "likely to overwhelm any preventative effect of circumcision."
"Male circumcision is important for reduction of not only HIV infection but also HPV infection in HIV-negative men and their female partners," said Giuliano. "However, its efficacy seems limited to HIV-negative men. These results suggest the need for early circumcision to achieve maximum effectiveness in populations with a high incidence of HIV and cervical cancer."
For maximum reductions in HIV and HPV infections and related diseases in women, such as cervical cancer, the researchers recommend that both circumcision and HPV vaccination of the male population should be delivered prior to sexual debut.
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Why the enthusiasm for
Why the enthusiasm for genital surgery? Have we given up on condoms? Circumcision really doesn't seem to help much in the real world.
From the USAID report "LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS"
"There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".
http://www.info.gov.za/issues/hiv/survey_2009.htm
From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
"the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
Another tendentious study .
Another tendentious study . .
No good study has shown that circumcision protects against cervical (or penile) cancer. The link with HPV, a very common virus that the body readily sheds, is shaky.
Anna Giuliano has earlier published studies of HPV from which she's tried to extract an excuse to cut babies. One pools men from Mexcio, Brazil and the USA and attributes the differences to circumcision. Guess where most of the circumcised men were!
"Delivering" male circumcision "before sexual debut" (cutting part of their genitals off before they know how they work) makes consent that much less informed (and neonatal circumcision denies any possibility of consent) and makes sure circumcsed men never know what they are missing.
Stop being such
Stop being such alarmists.
I've been circumcised since a neonate and I get along just fine. HIV free, HPV free.
Nobody wants to 'cut babies' more than the next guy.
Find a real cause to champion.
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