Thursday, July 26, 2012

Circumcision and AIDS

The matter of fact way that people state that circumcision decreases the risk of HIV on a 60% (without the small letter) shows how all it matters is to have a certain number to be able to impress people and they won't question the meaning of it. There are documented flaws to the studies, one of them being that the number of men who dropped out from the study was larger than the difference between the infected men in both group, which means that those dropped outs would be enough to completely change the results of the study.

The other problem is that this is a study in correlationship, but it's not a controlled experiment. There is no way to run a controlled experiment. Each individual in the group goes his own way, having sex his own way with whoever, doing whatever during this time, and at certain intervals he's checked whether he's infected or not. There are just too many variables.

A real experiment would require having a number of females, having a number of males, the males would have to have sex with the same females, and they would have to be kept isolated during the study to rule out any external variables. That would be a controlled experiment. Of course that's not feasible nor ethical. But anything else is only an statistical lost in a number of variables too large.

There are other issues with circumcision as prevention: circumcised men are not estimated to be 95 or 97% protected. They are estimated to have 60% less chances than intact men, which means this is a relative percentage. What it really means is that they calculated that the chances were reduced from 2 point something to one point something. The fact that it is not such an incredible reduction means that unless you can trust these men to reduce promiscuity and practice safe sex, you are not really protecting anything and you are placing females at disadvantage. The same females that are now asking "are you circumcised?" are going to be later pressured into having unprotected sex because "baby, I'm circumcised, I can't get the virus" (which is false), and there is not going to be anything to protect them. An infected circumcised man is just as likely as an infected intact man to pass the virus to a female partner.

While everybody is quoting those 3 studies that show the 60% reduced rate, few are quoting the studies that show no change or the studies that show males being equally likely to pass the virus to female. Another fact that is omitted is quite simple: "The CDC also cautions that the results of the studies in Africa can not necessarily be applied to United States."

Another commonly ignored fact is that the reduced chance of infection applies only to heterosexual relationships, and only to the man. Circumcision would not prevent infection in women, men in homosexual relationships or through non-sexual ways.

One fear is that too many resources are spent on something that is ineffective (even if it halves the chance of infection to the male). Another fear is that instead of the quoted "voluntary" circumcision, we are going to see forced circumcision of minors (similar to the one practiced among Jews, Muslims and Americans), and even forced circumcision of adults -either by the means of actual physical force -mobs have already been reported chasing men to check their circumcision status and force circumcise them) or by peer pressure -as an intact man would be seen as irresponsible and undesirable.

Some people are already speaking against this:

Michael Weinstein, President of the AIDS Healthcare Foundation, states that concentrating on circumcision is a diversion, and Timothy Stamps, health advisor for Zimbabwe's president, said that "circumcision had led to men being more reckless in sleeping around". "Young men are happier to take risks and chances without the use of condoms or any other preventive measures because they are told circumcision will protect them," he said.

Personally, I believe that placing your trust in a 60% reductions is like playing Russian roulette. I believe that condoms, safe sex and committed relationships are the real way to curb down AIDS. I, however, am not a medical doctor, not a health professional, not a scientist, so I don't have the authority to judge the studies. What I know is that there is no solid explanation of why circumcision would prevent infection. There are hypothesis, but that's just it, hypothesis, which is like saying, speculations.

However, if an adult wants to get circumcised because he believes that it will give him an extra protection, that's fine, it's his body, it's his choice. Just be informed that this is not a surgical condom, it's not an immunization, and don't get it into the culture that this is the way to be.

But what I DO have an issue with, and the reason why the intactivists have a problem with circumcision being promoted as THE tool to fight AIDS, is that once this 60% number is embedded in the mass conscience, we can ignore the context, we can ignore the fine print, the details, and promote mutilation as the magical medicine. People will quote it without thinking about what it means, and they will use it to justify the continuous cycle of routine circumcision of infants. After all, there are people out there like Brian Morris and Bertran Auvert who continue promoting myths and more myths about circumcision, sometimes reaching out to people like Bill Gates. I personally think that they are giving the Bill and Melinda Gates foundation a run for their money, which would explain why MSNBCNews continues promoting circumcision through propaganda disguised as journalism.

I particularly love when medical communities present studies and surveys to "prove" that "women may prefer circumcised partners, according to a new survey". That's when I nod my head. So if a survey would prove that men prefer "partners with big breasts", would we use it to market breast enhancement operations? Or if a survey would prove that men prefer partners with little or non minor labia, would we use it to promote labiaplasty of adults? Would parents then proceed to perform labiaplasty on their baby daughters because it would hurt less than doing it in adulthood and their husbands and lovers would thank them? Yes, this is a reference to Female Genital Mutilation.

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