Back on 20-Nov WaylonSmithers inadvertently started another circumcision discussion that partially hijacked the original thread of 16-Nov – see related link below.  Since that wasn’t the point of the original thread and there were some significant ongoing studies on the subject, I decided not to comment at that time.  There has been some significant news today on this front:

http://www.msnbc.msn.com/id/16184582/

Over the past decade or so there has been much debate on this subject with various studies going back and forth on the issue.  The two clinical trials mentioned in the article above were originally scheduled to be completed next year – the fact that they were terminated early is an indication of the efficacy of circumcision in reducing the risk in HETEROSEXUAL transmission of HIV.  These two trials had been initiated and rigorously designed with the objective of providing a definitive answering to this debate.  See this link below for more background:

http://www.who.int/mediacentre/news/notes/2006/np18/en/index.html

One of the ongoing sources of debate was why this might be the case.  Many of these speculations were answered a few years ago when it was determined that, among other possible contributors, the type of cells contained in the foreskin were more susceptible to uptake of the virus.  A circumcision fact sheet also released in August of this year by the CDC contains a great deal of informative information on this subject and cites four studies that have confirmed the biological plausibility of transmission in uncircumcised men:

http://www.cdc.gov/hiv/resources/factsheets/PDF/circumcision.pdf

Unfortunately this is a pdf file and I cannot excerpt the discussion for inclusion herein, you’ll have to follow the link above if you’re interested – it’s on the very first page of the six page report.  As additional background here is another pdf file of the primary source article in the American Journal of Pathology cited by the CDC in their fact sheet:

http://ajp.amjpathol.org/cgi/reprint/161/3/867 (you may have to click on the “Begin manual download” link to get this pdf file to load)

I realize that all this is in the “way too much information” category but it seems topical and relevant and I thought some of you might wish to be made aware of today’s news.

Regards,

TS Tempted


-- Modified on 12/13/2006 10:05:01 AM

I too read several of these very same studies...though I am circumsized, I come into contact with many European and some American hobbyists that are not...I personally love an uncircumsized gentleman, as long as he fully understands the importance of being extremely clean, because let's face it, they require extra hygienic attention...so many fail to fully pull back the foreskin and properly cleanse the member when they bathe...yet the most importance is still amiss, STD prevention whether circumsized or not, period..."cover up", relax and enjoy the ride...wet kisses, TS Rachel

Notwithstanding this study, there is still no substitute for safe sex, meaning the use of a condom during penetrative sex, vaginal or anal.  While confirmed transmission of HIV orally is rare and comparatively much less risky (and probably requires additional factors such as cuts, abrasions and/or open sores in the mouth), instances of such transmission are not unkown – see related link below.

“There are lies, damned lies and statistics.” – Mark Twain

IMHO injected drug use (IDU) is by far the highest risk factor for transmission of HIV; however, in the U.S. 65% of the 28,143 newly reported HIV/AIDS cases in 2004 in MEN occurred from male-to-male sexual contact and 78% of the 10,410 new cases in 2004 among women occurred from ‘high risk’ heterosexual contact (meaning contact with someone known to have or at high risk for HIV infection).  Overall, IDU was a contributing factor in less than 20% of all new HIV/AIDS cases in 2004.

For more information on the latest US statistics available see the following links:

A Glance at the HIV/AIDS Epidemic
http://www.cdc.gov/hiv/resources/factsheets/At-A-Glance.htm
in a printable pdf format:
http://www.cdc.gov/hiv/resources/factsheets/PDF/At-A-Glance.pdf

HIV/AIDS Surveillance - General Epidemiology
http://www.cdc.gov/hiv/topics/surveillance/resources/slides/general/flash/index.htm
A detailed set of slides on the 2004 statistics (in Flash Format but also available in pdf and PowerPoint).

2006 marked the 25th anniversary of the first reported cases of what is now known as AIDS.  Since then it has been estimated that worldwide over 25 million have died and over 40 million may be living with the disease.  One million people in the U.S. may be living with the disease.  See the joint statement on the anniversary from the senior directors of the NIH:

http://www.nih.gov/news/pr/jun2006/niaid-01.htm

IMHO ignorance and poverty still remain the greatest obstacles to control and eradication of this devastating disease.  To that effect I wholeheartedly support the One Campaign, among others.  You probably already know about this effort - see www.one.org where you can join with over 2 million others who have signed The One Declaration in support of this cause:

“WE BELIEVE that in the best American tradition of helping others help themselves, now is the time to join with other countries in a historic pact for compassion and justice to help the poorest people of the world overcome AIDS and extreme poverty.

WE RECOGNIZE that a pact including such measures as fair trade, debt relief, fighting corruption and directing additional resources for basic needs – education, health, clean water, food, and care for orphans – would transform the futures and hopes of an entire generation in the poorest countries, at a cost equal to just one percent more of the US budget.

WE COMMIT ourselves - one person, one voice, one vote at a time - to make a better, safer world for all.”

Be safe,

TS Tempted


-- Modified on 12/13/2006 11:30:56 AM

Much of it catalogued here, with actual references to the studies at the article's end if you care to look:  http://www.cirp.org/library/disease/HIV/.  Of particular interest are studies that find no corelation between circumcision and HIV infecfection or an increase in HIV infection due to circumcision:  Lauman et. al.(increased risk w/circumcision), Storms, Nicoll, Carael, Barongo, Grosskurth et. al., Tanne (increased risk w/circumcision), Van Howe (increased risk w/ circumcision), Gray and collegues, Grulich and collegues, The Chochran Systemic Review

Regarding specifically the protective effect of foreskin:  Prakash and collegues, Fleiss et al., Lee-Huang and collegues, Fleiss, Hodges, and Van Howe, Van Howe, Hill (summary of protective mechanism), and Dezutti.

MSNBC's version of "today's news" does not reflect a comprehensive portrait of the existing research.

That’s by far one of the best links I’ve come across summarizing the history of this debate on circumcision and HIV/AIDS since its beginning in 1986.  CIRP.org is also a very interesting website with lots of additional information about the general issues of circumcision.  

I too have been very skeptical of any benefit from circumcision because, no matter what, other risk factors are simply much more important.  As of this writing you will note that the webpage Horizononfire has linked to was last updated on 27-Nov-06 and before this latest announcement.  As the information from these new studies becomes published and more widely available we shall have to wait and see along what lines the debate continues to develop.

The conclusions in the CIRP report are based heavily upon the Cochrane Review of 2003 and one thing that was called for at that time was a series of controlled studies that would address the confounding factors that had been identified in analyzing the relationship of HIV infection to male circumcision.  The new studies that have been underway this past year were designed to address these issues and only time will tell if they can withstand academic scrutiny of their preliminary results.

For those who may choose not to avail themselves of Horizononfire’s link here are a few interesting quotes from that webpage:

“…the consideration of circumcision with regard to STD and AIDS prevention does not apply to children. Kept intact from birth, they can weigh the issue for themselves when they are old enough to consent.”

“The conditions in Africa are very different from those in the developed world. It would be wrong to apply findings from Africa to the developed nations.”, e.g. a study from 1997 is cited which found no prophylactic effect on the incidence of HIV infection in the U.S. where circumcision was prevalent.

“Whether circumcision status plays a role in HIV risk or not, it is important to recognize that HIV can be prevented through several known very effective means, such as condom use, and limiting exposure to multiple partners. Rather than advocating circumcision, given the existing evidence, it would be appropriate to advocate better public health education, so that individuals can make appropriate decisions regarding their own sexual behavior.”

Regards,

TS Tempted


-- Modified on 12/13/2006 12:29:53 PM

is never 'in date'.  I'm not fronting this site as the be all end all of all circumcision based HIV research even though it is updated until Novemember (last month) of 2006.  You are now forecasting that the current research will tell what the researchers obviously want to tell and that is that circumcision will irrefutably reduce hiv transmission as this current study is not completed.  Funny they need to do this 'study' when it's been done over and over and over again probably at taxpayer's expense.  You and I both know the study will tell what the researchers want it to tell.  Someone will then come along with a 'new study' that tries to determine the same thing and lo and behold will refute the old study.  These researchers have to keep in business or they do not get paid.

Earlier you credited a quote to Mark Twain that should be attributed to Benjamin Disraeli, "There are three kinds of lies: lies, damned lies, and statistics."  I now quote you another Benjamin Disraeli wisdom, "He uses statistics as a drunken man uses lampposts - for support rather than for illumination."  I keep this in mind when reading any statistic related research.  Often statistic research objectively analyzed leads me to know the limits of the research and not to grant the conclusions of it's authors.


-- Modified on 12/13/2006 1:18:27 PM

IDU could potentially be a zero risk for HIV if there were no sharing of needles taking place--i.e. if needles were widely available.So, that makes IDU and sexual transmission comparison

In most European countries that I know of needles are cheaply sold in pharmacies.

But I digress... My point was to say that comparing IDU and sexual activity as HIV transmission methods is not entirely comparing apples to apples--exactly because there is a "100% safe" (as far as HIV is concerned...) IDU method, to never share a needle. Whereas with sex, there is always a minimal risk involved, whtever the precautions may be (I guess one could have sex in a space suit and that would be risk-free )

Goethe (uncircumsized)

... No research to my knowledge has ever refuted that safe sex practices do not curb transmission of HIV.  You are running into media bias in your research.  It is well documented that gay men are responsible for most new cases of HIV, despite the portrayal from many media sources that IV drug users are to blame.  They are politicizing disease and masking the truth.

Horizononfire:

Sorry if I’ve punched your buttons here but I don’t think you and I are really very far apart on this matter.  The circumcision hypothesis was first proposed twenty years ago.  Since then there has been a tremendous amount of research into HIV/AIDS, some good, some bad, some obviously politicized.  In spite of this a lot has been learned and a lot of original myths regarding this tragic disease have been debunked.  It seems that the debate on circumcision has gone back and forth and I would generally agree with you that it has been pretty inconclusive.  The news here is that very recent high quality work appears to be supportive of the hypothesis and I am keeping an open mind and look forward to further reports and analysis.  I am very interested to learn more about these recent findings and will carefully consider the sources but so far I am impressed that they have been of the highest caliber and have attempted to address the shortcomings of previous work on the subject.

My sources said the quote was Twain, but even if it was originally Disraeli, my purpose in using it was to point out that I share your healthy skepticism of all these sorts of studies.  However, I do not share your cynicism that all such research on the subject is biased and beyond hope of any objectivity and usefulness.  I believe that there is a lot of good work being done on this and many other controversial subjects.  The number of ethical researchers out there who are primarily interested in objective results far outweigh the ones with obvious biases and agendas.  Having said that I also happen to agree with Theodore Sturgeon that “Ninety percent of everything is crap” and a healthy degree of skepticism must be exercised in most matters.  Whatever it shortcomings, without ‘epidemiology’ Dr. Snow might have never have discovered the connection between unsanitary water in a public well in the Soho district of London and a cholera outbreak in 1854.  

I quite like your other quote from Diraeli as well and will endeavor to try and keep both in mind when thinking about any of these ‘studies’ in the future.  Here’s another quote I like, also purportedly from Mark Twain:  “A lie can travel half way around the world while the truth is putting on its shoes.”  Let’s take a careful look at these new reports when they finally come out and measure them objectively against the previous studies and the standards that have been set for them in the Cochrane Review of three years ago that forms so much of the basis for the conclusions in the report you have cited in your link.  

I think you and I would also agree that, regardless of the outcome of this research, circumcision is likely no more than a side show in the overall HIV epidemic.  As to the African studies, maybe what we are seeing is really nothing more than the old adage for practicing safe penetrative sex and good personal hygiene; however, in regions without a predominance of these two characteristics circumcision just might make a difference.  I am completely sympathetic for the very difficult implications this has for public health officials in these regions – maybe encouraging safer sex means encouraging more male circumcisions, not exactly a great answer but maybe a practical one nevertheless.

Fundamentally I think whether or not any INDIVIDUAL genetic male is circumcised has little to do with his own personal odds of contracting any STD.  In the final analysis with respect to HIV, I believe that circumcision will largely be a matter of personal preference PROVIDED the genetic male in question has good personal hygiene and practices safe penetrative sex.   My own personal hypothesis is that such a man may be at far less risk STATISTICALLY of contracting HIV than John Q. Public, perhaps even if they are as active sexually as a TS or male escort.  [I’ll even go way out on a limb here and hypothesize that this might hold true even for ‘uncovered’ oral sex, so long as oral hygiene and health remains good and any oral sex on males is not to ‘completion’ (giving male oral sex without completion seems to be of relatively low risk, also quite possibly for a variety of sound pathological reasons).]

For example, there have even been studies which show the incidence of HIV/AIDS among various populations of prostitutes in developed or industrialized countries (who are not IDU) to be no worse and in some cases less than that of the general public – see this summary article http://www.thebody.com/cria/winter06/sex_workers.html.  This is because “the public” represents a cross section of all people and will include, by definition, its share of IDU, unsafe sex practitioners, other unsanitary practices and accidental exposures.  Personally I am far more worried when I see the U.S. Red Cross fined $5.7 million recently for violating blood-safety laws and the terms of a 2003 consent decree which settled charges that the Red Cross had committed “persistent and serious violations” of federal blood safety rules dating back 17 years – see http://www.msnbc.msn.com/id/15925111/.  

BTW I concede goethe’s point that an IDU that only uses clean needles is of no greater risk than anyone else for contracting HIV.   I agree that it is unconscionable that clean needles are not as readily available in this country as they are elsewhere in the developed or industrialized world.  This is probably a very important part of the reason that U.S. infection rates have been substantially above those in other industrialized countries.  Horizononfire is also quite right with respect to his point about IDU, it may be the highest risk factor, but as I pointed out in my post “Still No Substitute for Safe Sex” above, it is a contributor in less than 20% of all newly reported cases of HIV/AIDS.  Male-to-male sexual contact is the greatest single contributor with over half, or approximately 51%, of all newly reported cases (slide 7 in my link in the post above to the CDC’s “HIV/AIDS Surveillance - General Epidemiology” slide set).

Like you Horizononfire, I’ll continue to look skeptically at what I am told by public officials, scientists, academics, clergy and even TER hobbyists who may also have some self-interest at stake in their positions but I’ll also try to keep an open mind and will allow myself to be persuaded by a preponderance of reliable evidence and informed opinion.  And yes that means taking even your opinions into serious consideration as I have a great deal of respect for your tenure and contributions to this forum.  I agree that the jury is still out on the issue of HIV and male circumcision, but for me the fat lady is warming up her singing voice and the pigs are beginning to exercise their newly grown wings.

Respectfully submitted,

TS Tempted


-- Modified on 12/13/2006 9:28:03 PM

I realize I am probably boring everybody with this but I’ll follow-up with this link to a more in depth report on the announcement today by the New York Times:

http://www.nytimes.com/2006/12/14/health/14hiv.html?ei=5094&en=299e031e4a678f86&hp=&ex=1166158800&adxnnl=1&partner=homepage&adxnnlx=1166112026-OjwIVCZM7C5Vcm+pMnisHg

In case the link doesn’t work here are some excerpts:

“…two trials, conducted by researchers from universities in Illinois, Maryland, Canada, Uganda and Kenya, involved nearly 3,000 heterosexual men in Kisumu, Kenya, and nearly 5,000 in Rakai, Uganda. None were infected with H.I.V. They were divided into circumcised and uncircumcised groups, given safe sex advice (although many presumably did not take it), and retested regularly.

The trials were stopped this week by the N.I.H. Data Safety and Monitoring Board after data showed that the Kenyan men had a 53 percent reduction in new H.I.V. infection. Twenty-two of the 1,393 circumcised men in that study caught the disease, compared with 47 of the 1,391 uncircumcised men.

In Uganda, the reduction was 48 percent.”

I tend to agree with Horizononfire, such small numbers are not exactly overwhelming, but I think they are certainly significant and they have persuaded the researchers involved anyway.

“…the directors of the two largest funds for fighting the disease said they would consider paying for circumcisions in high-risk countries.”

“‘This is very exciting news,’ said Daniel Halperin, an H.I.V. specialist at the Harvard Center for Population and Development, who has argued that circumcision slows the spread of AIDS in the parts of Africa where it is common."

“…experts also cautioned that circumcision is no cure-all. It only lessens the chances that a man will catch the virus; it is expensive compared to condoms, abstinence or other methods; and the surgery has serious risks if performed by folk healers using dirty blades, as often happens in rural Africa.”

“Circumcision should be used with other prevention methods, he said, and it does nothing to prevent spread by anal sex or drug injection, ways in which the virus commonly spreads in the United States.”

“Male circumcision also benefits women. For example, a study of the medical records of 300 Ugandan couples last year estimated that circumcised men infected with H.I.V. were about 30 percent less likely to transmit it to their female partners.

Earlier studies on Western men have shown that circumcision significantly reduces the rate at which men infect women with the virus that causes cervical cancer. A study published in 2002 in The New England Journal of Medicine found that uncircumcised men were about three times as likely as circumcised ones with a similar number of sexual partners to carry the human papillomavirus.

The suspected mechanism was the same — cells on the inside of the foreskin were also more susceptible to that virus, which is not closely related to H.I.V.”

While these studies may have merit when applied to large populations, I would personally still conclude that circumcision for someone who has exceptional personal hygiene and practices safe sex is of little real benefit and purely a matter of personal choice.

Regards,

TS Tempted


-- Modified on 12/14/2006 8:07:16 AM