Again, America gets it right, Europe gets it wrong
 

French and South African AIDS researchers have called an early halt to a study of adult male circumcision to reduce HIV infection after initial results reportedly showed that men who had the procedure dramatically lowered their risk of contracting the virus.

The study's preliminary results, disclosed Tuesday by the Wall Street Journal, showed that circumcision reduced the risk of contracting HIV by 70 percent -- a level of protection far better than the 30 percent risk reduction set as a target for an AIDS vaccine.

According to the newspaper account, the study under way in Orange Farm township, South Africa, was stopped because the results were so favorable. It was deemed unethical to continue the trial after an early peek at data showed that the uncircumcised men were so much more likely to become infected.

All of the men in the study had been followed for a year, and half the men had been followed for the full 21 months called for in the original study design, according to the Wall Street Journal, which obtained a draft copy of the study.

Begun in August 2002, the experiment is one of three closely watched clinical trials in Africa to determine whether there is scientific merit to nearly three dozen less rigorously controlled studies showing that circumcised men were much less likely to become HIV-positive.

The hope is that, lacking a vaccine, the nearly 5 million new HIV infections occurring each year could be slowed by circumcision, the surgical removal of the foreskin -- a simple, low-cost and permanent medical intervention that is a common but controversial cultural practice in much of the world. In Africa, about 70 percent of men are circumcised at birth or during rite-of-passage ceremonies in early puberty.

Medical anthropologists began noticing as early as 1989 that the highest rates of HIV infection in Africa were occurring in regions of the continent where the predominant tribal or religious cultures did not practice circumcision. Adult HIV infection rates above 30 percent are found in Zimbabwe, Botswana, Swaziland and eastern South Africa, where circumcision is not practiced; yet HIV infection rates remain below 5 percent in West Africa and other parts of the continent where circumcision is commonplace.

Laboratory studies have found that the foreskin is rich in white blood cells, which are favored targets of HIV, the virus that causes AIDS. So the theory is that men who are uncircumcised are much more likely to contract the virus during sex with an infected woman, and that the epidemic spreads when these newly infected men have sex with other women within their network of sexual partners.

The lead investigators of the study, Dr. Bertran Auvert of the University of Paris and Adrian Puren of South Africa's National Institute for Communicable Diseases, are not talking. The results were expected to be discussed at an AIDS conference in Rio de Janeiro in three weeks. But word about the findings has been circulating among researchers searching for ways to slow the epidemic.

"I would be thrilled if it works, but we will also need the results of other trials,'' said Johns Hopkins University epidemiologist Ronald Gray, who is conducting, in Uganda, one of two other controlled clinical trials of male circumcision.

Gray's trial, which has completed enrollment of 5,000 men in the Rakai district of Uganda, is not scheduled to end until 2007.

A third trial, under way in Kisumu, Kenya, is still enrolling its quota of 2,700 volunteers and is also expected to be completed in 2007, according to the National Institute of Allergy and Infectious Diseases, which is sponsoring it.

All three trials were designed to compare the HIV infection rates of two groups of HIV-negative men, one-half of whom would agree to be circumcised, the other to be offered only counseling on AIDS prevention. The studies were designed to show whether or not circumcision provided a statistically significant protective effect of at least 50 percent.

The South African study -- if the results are confirmed -- suggests that the level of protection afforded is even higher.

Although the apparent protective effect of circumcision has been noted for more than 20 years, doubts linger as to whether circumcision itself is protective, or whether the lower risk may be the result of cultural practices among those who circumcise. HIV rates are low in Muslim communities, for example, which practice male circumcision but also engage in ritual washing before sex and frown on promiscuity.

E-mail Sabin Russell at srussell@sfchronicle.com.

That's an ass-kicking post and a wealth of information! Thanks.

Been wondering where the hell you have been... :)

"Off with their heads!"

Yes. informative post. Not so sure the Europe "dig" was called for.

The idea of preventing AIDS by circumcision is illogical as preventing breast cancer by cutting off girls' breasts at birth.

The only reason this is an issue is because the Catholic Church and other anti-sex "Christian" groups have been obstructing the distribution of condoms in Africa for moral reasons.

I believe it is going against God's will to cut off the foreskins He gave us! (Even for Jews!) I have never forgiven the doctor who did it to me without my mother's consent.

BTW, previous studies on this subject were invalidated because they did not actually examine the foreskin (or partial lack thereof), but relied on self reports, which turned out to be very inaccurate. I wonder what this study has done to be more scientific.

Nonetheless, I believe the theory that it is easy to transmit HIV through the foreskin is probably true and it would be interesting to know if it is true. Uncut guys should be warned about this extra risk if it is true.

But I still think circumcision would be a stupid way to stop new infections. With the billions we are spending, we could give away condoms to everybody who wanted them. It would be much easier and cheaper than cutting off the sex organs of every male.

I'm glad SOMEONE out there knows the Mind Of God.

I've always wondered what He thought about circ.

Now I know.

I'm no Doctor, but simple science has always dictated that dark, moist places are a breeding ground for bacteria and infection. That said, I'm not surprised at this and have heard this years ago actually in regards to HIV infection.

I'm all for reducing HIV infections, yet, this study seems a bit skewed. 70% is a huge contrast and what's up with a vaccine targeted for only a 30% reduction risk? Being in the Social Science field I'm pretty well versed in research methods and know that statitistics are very grey and are almost always skewed towards the agenda of a given issue being measured. Looks like in this case we have science battling religion.

As for circumcision, I consider that genital mutilation and don't think it should be mandatory for anyone. However, nowhere in Cutguys post indicates that as an option so I'll leave it at that.

Im with you scruffy!!!

Welcome back Dr. Danny.....we have speculated on where you were! We figured some nice european vacation spot.

Frankly, I have always been amazed and amused by God's apparent obsession with the penis and foreskin. Hell, maybe I really am made in his image.

As for my absence: has anyone noticed how pathetic this BB has been of late???

Anyone notice Scruffy has been missing? I had to make it look as if he is me...

Teva, I wasn't thinking about you when this was posted. BUT, these are recent, well conducted studies. I like my guys cut, I make no bone (ouch) about it. But as an MD, I do have to face the reality of how "artificial" lopping off a little boys foreskin really is. And I know that the main reason was to stop Victorian boys from jacking off. I ain't Victorian (or English for that matter), and heaven knows, it didn't help me one bit. But 70% reduction in HIV transmission is nothing to be sneezed at.

To have a study this large stopped for ethical reasons says a hell of a lot. America was in the forefront of the AIDS epidemic, and HIV/AIDS is one hell of a minor problem here compared to the rest of the planet. And as we all know, it is pretty rare to find an uncut guy in any locker room here in the States. These studies clearly show that it is NOT a coincidence.

When adults come to me professionally asking about getting circumcised, I almost always discourage it. Now however, if an adult gay man were to come to me and asked about elective circumcision, I honestly think it would be immoral on my part not to encourage him to proceed. So as far as I'm concerned, you guys can rage against your parent's evil intentions, the injustice and how horribly you've been mutilated, but if it saves you just that one time when you got drunk and bare backed that beauty, well, nuff said. Your folks made the RIGHT decision, albeit for the wrong reason! You may not be happy about it, but I'm glad you got mutilated.

As for God's thinking, that is pretty straight forward. (I'm not God, I just stand in for him in real life, and no, I never stay at a holiday inn...) You want to be among the chosen, your dick gets clipped on the eighth day, not a minute sooner. No ifs, ands, or butts. (Actually, the Torah is pretty clear that if an uncle had a bleeding disorder, it was forbidden to circumcise the nephews. Bit of trivia for you, plus an interesting take on medical genetics, circa 3000 BC)

And no, haven't been to Europe for about 3 months, but will be going back for Labor Day. I love the place, even if their politics, strikes, newspapers, and unemployment rates are pathetic. And I've been reading that circumcision is becoming the in thing to do in Germany. Perhaps it's time for me to do a little field research. Any suggestions?

Danny

Sounds to me...
 

...like a cut dick and a condom should keep you safe! If you're cut, be sure to have the condom, too. If you're not cut, use the condom only. You get the idea. In Africa, condoms are often not available or used, so there is a rate of infection that can support studies like this.

I'm not in favor of removing the foreskin (can't spell circum..., & there's no spell check here!). However, with the Catholic Church and other the American Ayatollahs ending the promotion of condoms in Africa (the US will be next, if they get their way!), we may need to go with clipping Africans for now, anyway. It's sad that the one tool we know works is not widely used.

I do wonder, though, what role hygiene plays. Again, I wouldn't count on washing my dick to keep safe, but... As a cut guy, I'm only vaguely aware of proper foreskin maintenance,but I do know it can be done!

And you think Europe's politics are screwed up? They may have given us Kafka, but only the US could produce Billy Graham!

Yeah, rite:)
 

Much as I like to agree with our resident MD here, and much as I absolutely could not care less, if my partner happens to be UC or C, I am afraid, he got it very wrong this time.

Little first-hand experience and possibly a few road trips (or an extensive search) will show that the USA/Canada have a very comparable standard of living, real purchasing power per capita, etc. to Western and Central Europe. Equally so, relatively very few males in Western and Central Europe happen to be cut, in contrast to the number of cut guys in Northern America. Since 'Again America gets it right, Europe gets it wrong', wouldn't we all agree that the prevalence rates of infection in Western and Central Europe must be higher than the prevalence rates in Northern America?

Ouups, we shouldn't agree that hastily! Sure, the Europeans got it all wrong and the Americans got it all right. That's why the prevalence rates in Western and Central Europe range between 0.2% and 0.3%. The North American prevalence rates, I mean the 'right ones' are 0.3% to 1%. So the UNAIDS concluded that the average prevalence rate in Western and Central Europe for 2002-2004 stays at 0.3%, whereas the average prevalence rate in Northern America for the same period stays at 0.6%. Damned Europeans, who got it all wrong and have half the prevalence rates compared to the right Americans. Go, figure...

The truth is that Western and Central European governments, NGOs, etc. have spent much more resources on educating the general public. Over the years, that work and that investment have richly paid off.

For more, go to:

[url=http://www.unaids.org/wad2004/EPIupdate2004_html_en/epi04_03_en.htm#TopOfPage]

Just my 2 cents...

KD:D

Question the research
 

As the social scientist say. Statistics do not lie, but statisticians do. There are many variables that would have to be answered to determine the validity of the study.
Some unofficial ones that come to mind:

For how long did the adult men that obtained circumcisions refrain from sex after surgery?
Was there a change in their sex partnering patterns?
Was there an increase in condom availability post surgery ? You get the picture.

The practice of foreskin removal in N. American has political and religious historical origins, not clinical ones.

Although I do not have a preference in my partners foreskin status, the process just seems unnatural. Besides there are many nerve endings in the foreskin which can add to sexual pleasure.

Thinking that America always gets things right and Europte always gets them wrong is a result of American nationalism and an unfimiliarity with European history resulting in xenophobia. A good example of that is how the Bush administration is refusing to give money for AIDS research to Africa, and other countries, if birth control and abortion are even mentioned. They are also moving to deny Federal economic support to states and local govs that teach sex education, except abstinance. I don't need to cite this because it is general information easily found. In conclusion, if that is "getting it right" then "right" has a new definition.

With such deep insight and so many facts at your fingertips, it is no wonder you guys just keep losing elections! (Thank heavens!)

Why we contribute a dime to that hell hole is beyond me, but be that as it may, ol' W had dumped MORE $$$ into Africa than Bill the rapist. Check on line for NIH funding.

And why should my very hard earned tax dollars go to support Mugabe in Zimbab, who steals white land, then proceeds to wreck his economy, or to So Africa, whose brilliant post aparthied president STILL denies that AIDS is a result of infection with HIV. Hell, it's my money, and my family needs it more than they do. I don't need Chirac's hand in my pocket

Now how much did you say France and Germany have contributed to that garden of eden?

Off with their foreskins!

Good science doesn't have borders, it also needs good interpretation
 

I have been puzzled how some good but very limited evidence has been again turned into a political snotfest. Let's look at the evidence here:

1) 70% reduction in transmission in 1.5 years is all fine, but if you extend the timeframe beyond that you're still talking about a lot of people with HIV. I don't see how this obviates condoms in favor of snipping the foreskin.

2) The study finds that uninfected men who insert are less likely to contract the disease; that's nice, but it doesn't give much hope to women who will continue to contract the disease from HIV-infected men. The only possible beneficiaries here are uninfected uncut men who start severely curtailing their partners.

3) It's virtually irrelevant to the epidemic in European and American men because they are getting infected as receptive partners. Anyone who starts barebacking with cut guys thinking they are lowering their risk are foolish.

If you keep your eyes on the science, there's some good stuff here. If you turn it into a political football, everybody loses.

Where, exactly, did anyone here advocate NOT using condoms?

No one said that circ is an alternative to safer sexual practices.

Being circ'd won't "prevent" infection. Being uncut doen't mean you will be infected. It's a matter of risk.

Not everyone who gets barebacked with an infected partner gets infected, in fact, most don't. (DON'T DO IT!!). Sucking off an infected cock is much safer than riding one. It's all a matter of degree.

Even the French, staunch defenders of the foreskin are being forced to admit that the rate of infection is much lower in circ'd guys than uncut ones. To the point that the very poor vaccine which is currently in the works, from a statistical standpoint, is much less effective than having been circ'd in the first place. This isn't an all or nothing issue.

As for me, when I mess around, I much prefer the look (and perhaps the false sense of security) of a cut partner. And I enjoy my uncut men for hand jobs only. My preference. When I am pronounced grand iatollah of America, the infidels will all be cut.

Cutguy:

Tehre is a Vaccine in the works for AIDS? You shitting me? I enver thought I'd hear the day that a virus could have a vaccine because of their mutation rate. Please tell us more.

See below for responses:

Actually, there are several vaccines in the works, and none of them are particulary effective. That's the point of this study. The benefits of the vaccine are so inferior, at least statistically, to the efficacy of being circumcised when compared to being uncircumcised, that the trials of the vaccine are almost unethical to carry out.

Math and stats are NOT my forte. Several other guys who post can give you much more info than I can. BUT: If you vaccinate 10,000 guys at high risk, and after 1 year 10 become infected with HIV compared to 12 out of 10,000 who were not vaccinated, you would have a vaccine that isn't particularly effective. But if half of the 10,000 were cut, and half were not, and 9 of those who became infected were uncut, and and all 12 of in the placebo group were uncut, that would strongly suggest that being circumcised played a major role in the guys NOT becoming infected.

Proof? No. But really, really powerful data suggesting that we just might have a powerful weapon at our disposal, if only it were used. I don't expect a mass movement toward circumcision world wide. I know we do it out of habit here in the States. But from what I'm reading on the internet, the rate is definitely increasing in Australia, the Korean's love it, its becoming almost common in Germany, and so on...

Personally, I like the look. Medically, I think you have to be nuts, for many reasons beyond HIV, to keep that smelly flap of skin

Danny

Maybe nobody said it here, but this is the thinking in Africa.

I just stopped by a university medical library to pull the latest scientific papers about circumcision and AIDS in Africa. These papers are very clear that they are investigating circumcision as an alternative to using condoms for two reasons -- 1.) People don't like to use them and will "slipup"; but of more importance, 2.) The Catholic and Christian missionaries are blocking the distribution of condoms in Africa.

The primary purpose of these studies is NOT to find out if the foreskin transmits HIV better than other skin surfaces. Although, this is an interesting medical research question.

BTW, cutguy, I don't know if I found the exact paper your newspaper article clipping is referring to, but the latest papers (published in last several months) have cautions in their discussion/conclusion section about the accuracy of their circumcision data. I am not sure why it such a big deal for research doctors to ask the subjects to drop their pants and measure their foreskin (or lack thereof) with scientific rigor. (excuse the pun) But this important variable is not being measured very well.

Unfortunately this study does not take into consideration some socioeconomic factors that plague African nations - the very ones who have the high incidences of AIDS and the very ones who were studies. Circumcised men in this region have better access to cleaner standards of living as they have the economic stature to elect circumcision.

With that said, it's true that the men with foreskin are at higher risk, but the post earlier where they stated that circumcision is like cutting off women's breast to avoid breast cancer is a good point.

Finally, consider this. If they circumcised all the men in Africa, I guarantee you that the AIDS rate will still be higher and that it will continue to outpace the rest of the world's.

AIDS is not a cut/uncut debate - it's one of ignorance and/or irresponsible behavior.

Here's the link to a 26 July, 2005 BBC news story http://news.bbc.co.uk/go/pr/fr/-/2/h...th/4719409.stm that says UN health agencies want to use circumcision as a method to stop AIDS, if it is proven effective.

The same illogic of using circumcision for disease prevention would also say we should extract everybody's teeth to prevent tooth decay and the resulting infections that kill many people in Africa.

Actually, when recurrent endocarditis or meningitis can be traced to gum/dental disease, the treatment is to remove the teeth.

I know it is politically incorrect for a gay male to approve of circumcision, but I'm afraid that when it comes to saving lives, I'm not particularly politically correct.

Circing is a tool in this war. To abandon it or ignore it as a valid option when we have so little else is just plain stupid.

Calling Doctor Moron
 

Cutting off healthy tissue to prevent HIV is something I'd expect from a doctor who thinks health care should be reserved for the well-heeled.

The hygenic practices in Africa are a big part of the reason HIV travels so fast through that culture. Open sores on genitilia are not unusual.

Circumcision in this country has always been a procedure in search of a justification. But it supplies a good revenue stream to the medical community so they love it.

Oh, and you people have won elections before but every period of republican rule is followed by LONG periods of liberalism. Check out what happened in the 30s or 60s when republicans dropped off to 20% and 35% control of Congress. Your ideology's policies always hurt MANY more than they help, not to mention that we still control 48% of EVERYTHING.

This next time the republicans stumble we'll see universal healthcare and very progressive taxation make a comeback.


Where will the selfish go then?

"Ask not what your country can do for you. Ask what you can do for your country."

"I voted for the war before I voted against it"

What was liberalism, I am afraid, is now called Republicanism or Libertarianism. It is a concept the Democratic party abandoned sometime around Jimmy Carter. The aberation that is referred to as "liberalism" today is moribund, and probably has not chance whatsoever of coming back in my lifetime. (Thank God!). You don't win elections and the hearts and minds of people by losing elections, and going out of your way to lose elections!

Having someone else do your thinking for you, or expecting your neighbor to financially support your victimization is fine, if that's what you want. Just include me out. I moved from NY to the South for a reason. The good citizens of Mass. and NY stay there for a reason.

As for the insult of restricting healthcare to the well heeled, are you talking about National Health in Great Britain or Medicare in Canada? I'm afraid that I for one do not believe in restricting medical care through rationing. Forces too many foreigners to come to the US for medical care. (Don't believe me? Go into any municipal hospital in New York City, Miami, Detroit, Buffalo. I don't make this stuff up. I'm not that good!)

And yes, if cutting off healthy tissue saves a few more lives from the ravages of HIV, I say sharpen the scalpels boys, Medicaid don't pay for clean ones.

Most people I know, inlcuding myself, stay here in MA because we like the change of seasons, the rich history, the architecture, the culture and it's a great place to get a top notch education, no matter what your political agenda. Did you forget our Govenor is Romney by the way? Also, I love living in a city where I can escape to a natural paradise like Provincetown with just a 90 minute boat ride. Just a few things that keep us here.

Oh yeah, The Fenway Community Health Center in Boston has been a leading force regarding HIV research and progress in treatment. Something you seem to be very concerned with. Funny though, the FCHC is one of those places supported by their neighbors. Oh yeah, the neighbors also support clean needle exchanges to cut down on HIV infections. Damn, the nerve of these fucking liberals. That money could have been spent better in my back pocket instead of supporting these people who victimize themselves by getting infected with HIV.

Just got a little pissed off when I read that.

No, doctor, Canadians are not crowding the hallways of American hospitals. What's happenning is this. Americans, by the busload - especially poor seniors - are crowding Toronto drugstores looking for affordable medications.

Poor misguided doc moron
 

If the republicans the doc so loves get their way, health care will be decoupled from employment. It's part of their "ownership society". This is how it will work: We'll all have to carry expensive catastrophic care and all other charges- doctor visits, medications, etc.- will have to be paid out of pocket. Bascially it'll pit doctors against patients overwhelmed with $160 office visits. Good luck collecting, doc.

Oh, and as the other poster said, the myth of american health care besieged by Canadians is crap. Canada rations on the ability to wait, we ration on the ability to pay. The difference? The Canadian eventually gets taken care of. The only people coming here for medical care are the wealthy Canadians pissed that their government won't give them that tummy tuck or facelift TOMORROW.

Our health care system rates 37th in the world after all those countries that have socialized it. For the top 10% it is the BEST while the middle faces reductions in access and quality. The bottom in this country gets health care equivalent to sub-Saharan Africa. Pretty picture? Even Vietnam has just announced universal health care for everyone under 12. As rich as this pisspoor country is, we've been outdone by VIETNAM. A tip of the hat to the new conservatism and its inherent selfishness and greed for keeping us behind.

As for who runs the country: We're still living under the system put in place by LIBERALS when they ruled for almost a CENTURY. The best thing would be for the conservatives to actually make some headway witht their stalled agenda. They'll be gone very quickly if that happens.

The Medicaid thing? 70% of the money goes to nursing home care to take care of the well-heeled who hide their assets, plead poverty and then let Medicaid pick up the tab. It preserves their heirs inheritance and cheats the rest of us. The only people I know participating in such scams are all REPUBLICANS. Funny thing, huh?

Keep snipping off that healthy tissue. Gotta make another payment on the Range Rover.......