Aladdin Sane

I like my circumcised penis, and so does my wife. Now it looks like there may be some additional benefits to having it snipped.
Comments?

Circumcision may offer Africa AIDS hope
Procedure linked to much lower rate of new HIV infections
- Sabin Russell, Chronicle Medical Writer
Wednesday, July 6, 2005

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.

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Arsenic7

This is bullcrap. Sorry.

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MexicanOnABike

i have to agree... i dont see how it could prevent anything.

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bing bing

Hrmm, i'm a little skeptical too.

Daniel_

It's an old hypothesis.

The original research showed a similar level of reduction, but in a very small group of men.

The cells on the inside of the foreskin have an unusual characteristic that they have a very high affinity for virus particles - the justification being that it's something to do with an evolutionary imperative to educate the immune system about bad things as son as you put your knob in them.

Sadly because the immune system is the target of HIV/AIDS it is counterproductive in this case.

The theory goes that if you circumcise men you remove the target cells and reduce infective levels.

So it's good science, not bullshit.

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jaco

I think the important point here is "frown on promiscuity." Teach the ignorant people to quit screwing anything that moves and perhaps they wouldnt let the disease flourish. I also doubt they will be alright with the idea of having part of their penis removed, just sounds like a bad idea in general.

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irateplatypus

it may be true...

but a large part of the horrrendous AIDS and single-mother children rates in Africa is due to cultural stigmas regarding birth control.

if you can't convince people to wrap it, i doubt you'll convince them to cut some off.

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maleficent

and wearing a condom and being sexually responsible reduces it by even more....

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Aladdin Sane

I'm sure you have a rationale for believing this study is "bullcrap," but because you haven't stated it, your reaction appears to be purely emotional. I trust this is not the impression you wanted to leave.

Please tell me us why it is "bullcrap."

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imkeen

Exactly.

Yeah, this is a goofy article. "Yes, I am going to get circumcised because if I have unprotected sex with random strangers, or with women known to have HIV, I'll be less likely to contract AIDS." There's GOOD logic there...

I am circumcised, but my son is not because its a stupid religous, or at least, out-dated concept. If my family has a history of getting finger nail infections, should I cut off my fingers at the first knuckle to prevent the potential for infections?

Daniel_

We are talking about an area of the world where some people believe that sex with a virgin cures AIDS.

I heard an especially distressing story on the BBC Radio4 Africa season about health education workers trying to get across that this is complete garbage, and yet encountering that toddlers were being raped to death in an effort to cure people.

Anything that gets the chance of infection rates falling has got to be worth trying.

If you want to suggest that people in Africa will listen to scientific reason, then can I remind you that schools in the USA are still being told that Intelligent Design is a fair alternative to Darwinian Evolution.

So if people in as rich and well educated country as the US can be so out of phase with most scientists, how do you expect uneducated poor Africans to not doubt science?

Primary research into how HIV is spread is vital to contain and eradicate it. If you cut off a guy's foreskin and he becomes less likely to get AIDS you spent pennies and gave a permanent improvement in his chances. Condoms cost quite a lot if you are going to use them for a lifetime.

Also - it is wrong to judge a culture of promiscuity by the morals of a monogamous one. It doesn't make them bad people just because they have been raised KNOWING that a real man has sex with prostitutes.

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Overhead, the Albatross hangs motionless upon the air,
And deep beneath the rolling waves,
In labyrinths of Coral Caves,
The Echo of a distant time
Comes willowing across the sand;
And everthing is Green and Submarine
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aKula

A follow up study showed that removing the entire penis reduces the risk even more

Gatorade Frost

Interesting. -grabs a butcher's knife- I hope I can help the cause to cure AIDS in this world, just point me in the right directionly

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Aladdin Sane

Wow. I sorta expected to get lots of emotional responses from this article, and boy did I ever. It seems we've all got a dog in this hunt.
Now, does anyone care to address the finding of the scientific study referred to in this article from a detached point of view?

I don't support it, nor do I reject it, out of hand. If it turns out to be a way to limit the transmission of HIV, great. If the study is wrong, fine; lets move on to the next possibility. But shouldn't it be looked at with an open-mind before out and out rejecting it?

I often stop and ask myself if I'm the Church or Galileo.

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maleficent

it's an interesting way of solving a problem, but, I'm of the mindset that education is the best way of solving the problem. How you go about educating people about this problem - other than giving them the facts and letting them make a decision based on said facts (and that doesnt seem to work very well)

if you can't get people to listen to the facts, how on earth are you going to get them to consent to cutting off their foreskin...

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MSD

Ok, so I'm 70% less likely than an uncircumcised man to contact HIV from unprotected sex, and exactly 0% less bitter about having a chunk of my wang sliced off without my consent or knolwedge.

Jinn

I think all the circumcised men out there just had a little "yipee" in their head. Not to say that they'd use this as a prevention mechanism, but finding out you're less likely to die of a horrible disease.. that's a good thing. I'm not religious at all but if I have a son he WILL be circumcised. Not simply because of this, but because it is a cleanliness issue in general. The uncircumcised penis is more susceptible to a host of other viruses, as well.

This study was done to provide more evidence to back up the previous studies which had shown the exact same thing -- good science, bad reporting.

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Sugar&Spice

when was the last time you were a drunk horny guy at a bar

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Anomaly_

It seems to be a reasonable method for limiting the rate of infection. Within African communities that are receiving foreign government aid, or even domestic aid, circumcision should probably be mandatory at birth. It has also been known that circumcised men are less likely to transmit HPV (which is linked to cervical cancer) to their partners, so again I ask, why "bullcrap"? It would be wonderful if education were more effective, but until it penetrates the cultural barrier significantly, I see no reason to shun more practical solutions.

maleficent

Cute...

So drunkeness negates responsibility? If this drunk guy got into a car and drove, he should be let off the hook for being drunk? Being drunk does not absolve a person from responsibility.... Their life could possibly depend on it.

Just as I would expect a person to know their limits and know that they should not be driving a car when drunk - maybe they should also know their limits and know they shouldn't be having unprotected sex... No matter how good those beer goggles make her look...

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Sugar&Spice

Mal..I agree with you. My bf posted that under my name.

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Grey2000

Here's a thought.

If being circumcised reduces the risk of HIV infection by 70%, and given that most african males are circumcised....

How come so many african males are HIV positive ?

Seems like the theory doesn't quite match the reality.

hrandani

Two things.

The last paragraph of that article, and

If you only got 70% of the HIV particles present onto your business...

That's still 30% more than you wanted.

itch vaccine

I read this article elsewhere. I find it interesting that's all. Just a coincidental research? Like everything else such as ruining the joints on your thumbs due to excessive SMS-typing, or going blind due to drinking to much Diet Cola.

Anyways, I don't get what you're saying. This just means that, I want 40% of HIV present in my body?

Err... don't think so. 0% would be nice though.

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Grey2000

In other words,

Surely it doesn't matter what the 'risk factor' is re circumcision, its unprotected sex itself that causes the problem.

So who cares about the percentages ?Its still not safe enough to take a risk with.

Therefore, is there any point at all in hacking off forekskins on the basis of Aids prevention ?

cyrnel

I'd have to know more about the study. Did they provide a healing-time delay before starting the comparison? If not, how long after the procedure did these guys have any interest in sex? I've had ingrown hairs that kept me from wanting to plant willy for a week. Guessing getting chopped is somewhat more traumatic.

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reiii

The AIDS crisis has a social component but I dont think lack of education is the problem. Condoms are just not culturally compatible . Just read up about all the failed condom+ pamphlet campaigns theyve launched in afflicted countries. The health workers can talk until they are blue in the face about how AIDS is transmitted and how condoms will save lives, but it doesnt change anything. Asking an African man to don a condom is considered emasculating. The men consider unprotected sex a matter of entitlement, and the women have literally zero say.

That being said, how do you think they will react to a circumcision campaign?

I'd also like Grey2000 to back up your statement that most African men in affected regions are circumcised. From what I read, it varies wildly from region to region:

http://www.stwr.net/modules.php?name...owpage&pid=166

this article gives 70% as the general (not regio specific) percentage of circumcised men, but many are circumcised in right of passage ceremonies after puberty, which does not confer the same protection.

http://www.sfgate.com/cgi-bin/articl...ype=printableL

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Sage

Man, you guys also have to think about the society in Africa- apparenlty it's totally socially acceptible for a married man to have one to five girlfriends on the side, and a married woman to have at least one boyfriend. So it's not just "being promiscuious," but it's an ingrained part of society for people to sleep around. Combine that with the social stigma about wearing a condom, and you can totally see why there's an AIDS epedemic in Africa.

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Rippley

http://www.cirp.org/library/disease/HIV/vanhowe4/

This article, while I have NOT read it all, seems to point in the exact opposite direction.
Furthermore, while by now means an authority albethey well researched, Penn & Teller did a Bullshit on circumcision of men, where this theory was taken apart. Unfortunately Showtime's website is open only to US computers, and I'm in scandinavia...

Personally I think its complete crap. There is no difference, medically, between cut and uncut, as long as proper hygiene(sp?) is observed.

My 2 cents...

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zen_tom

The findings don't help anyone at all, promote more dis-information, and provide an impractical and expensive method (surgury) of not providing very good protection against HIV. Sounds fantastic.

The only reason I can think anyone would want to promote this idea would be to bolster the pointless pro-circumcision lobby that seems to think this is an important issue.

The scientists involved should try concentrating on something that will actually help rather than promote ideas that will only ever help (at best) 50% of the population.

Jinn

It seems a lot of you have missed the point (as I see it). I don't think findings like this could be used to actively suggest that ADULT males be circumcised. What fully grown man wants a knife anywhere near it?

However, this study and others can conclusively show that a circumcised baby will be less likely to die later in life. A doctor, for example, could say:

Congratulations, Mr. and Ms. Noyiakjiali, you're the proud parents of a baby boy! Are you going to get him circumcised? It could reduce his risks of infections, illness, and even HIV --later in life-- if he has unprotected sex!

Why NOT use this when it COULD help? There are dozens of studies that show airborne and fluid-transfered infections more readily host in the inner area of the foreskin (not present in a circumcised male). HIV, to me, falls into this category.

Rippley that is quite a sound article and I thank you for linking it. I did find one sentence that made me chuckle:

Long-distance truck drivers??!





EDIT to add: The article you linked was written in 1999, in response to the "three dozen less rigorously controlled studies"...

-- from the OP's article.

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Jinn

Also -- from another study:

Some of the medical reasons parents choose circumcision are to protect against infections of the urinary tract and the foreskin, prevent cancer, lower the risk of getting sexually transmitted diseases, and prevent phimosis (a tightening of the foreskin that may close the opening of the penis). Though studies indicate that uncircumcised boys under the age of five are 20 times more likely than circumcised boys to have urinary tract infections (UTIs), the rate of incidence of UTIs is quite low. There are also indications that circumcised men are less likely to suffer from penile cancer, inflammation of the penis, or have many sexually transmitted diseases.

Another one:

Uncircumcised males have a slightly greater chance of urinary tract infection (UTI) in the first year of life than males who have been circumcised. Later in life, an uncircumcised male also has a slightly greater chance of contracting a sexually transmitted disease (STD) than a circumcised male.

Circumcision reduces the risk of penile cancer, which is a very rare condition. Circumcision can also reduce the risk of cervical cancer in sexual partners later in life.

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Suave

It obviously doesn't work that well if ~70% of African men are circumcised and yet they're still contracting AIDS at an alarming rate. Whatever the deal is, no one's dick is getting clipped at birth in my family.

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Lead543

The only thing I've heard uncircumsized men getting more of are infections...from not washing under the foreskin.

If you have sex with someone with HIV, chances are you'll catch it...protective hood or not.

Ustwo

The foreskin became pretty useless once we developed clothing.

The only reason I've heard for keeping it is potential 'better' sexual stimulation, but god help me if I wanted sex even more.

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reiii

actually if it is vaginal sex and you are the male... the chances are more like 5 in 10,000, per sexual encounter.

it is still roulette with 2000 chambers :/

source:
http://www.thebody.com/Forums/AIDS/S...t/Q166119.html

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Daniel_

Long distance truckers are studied because they are reputed to have a girl at every truck stop.

The incidence of STDs in uncircumcised men is accounted for by the hypothesis that the foreskin keeps the area moist, and the STD infective agent bacteria, fungus, or virus) in contact with the moistened area.

Also - if there is a given percentage chance of an individual skin cell admitting the virus, less skin cells on the end of the penis = less chance of infection.

The report I read covered infantile circumcision as a factor in reducing transmission rates in adults.

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╔═════════════════════════════════════════╗
Overhead, the Albatross hangs motionless upon the air,
And deep beneath the rolling waves,
In labyrinths of Coral Caves,
The Echo of a distant time
Comes willowing across the sand;
And everthing is Green and Submarine
╚═════════════════════════════════════════╝

Charged-GHB

heres a scientific explanation. The way i learned it, STD's can only
be transmitted by an exchanging of fluids. Basically what happens during
sex is that the friction between the penis and the vagina creates small,
microscopic cuts on both partners, and this is how someone gets aids.

The foreskin creates more friction, leading to supposedly better sex and more cuts

Daoust

This circumcision, uncircumcision argument has been going around since the Abrahamic covenant.
For every article stating the benefits of helmets, there's one stating the benefits for anteaters. A new article comes out every 5-10 years and people all buy into it, and then it changes.
In the end I'm sure STD prevalence will have nothing to do with what's on the end of your dick, with the exception of a condom.

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zinter

Many opinions showed that the medical advantages are considered to be slight, because conditions such as phimosis and cancer of the penis are rare even in men who have not been circumcised. Overall, the minor benefits of circumcision seem to be contrabalanced by the minor risks so this operation is neither essential nor detrimental to a boy's health. About HIV protection the same opinion, no advantage.