Wednesday, February 16, 2011

Circumcision Increases the Risk of Contracting HIV

Read more commentary on the flaws of HIV studies here:
http://www.medindia.net/news/healthinfocus/Circumcision-Trials-to-Prevent-HIV-More-Hype-Than-Fact-41236-1.htm


We read headlines that suggest circumcision decreases the risk of HIV. But what if you read that circumcision increases the risk of HIV? Would you stop and stare with shock?

The African HIV studies, besides having numerous methodical flaws, are also comparing apples to oranges. In other words, we can’t take the data from Africa and accurately apply it to the demographic in America. The studies compared male to female transmission, but the majority of HIV cases in America are from male to male transmission. Also, the disease incidence and population differences have not been controlled.

The Centers for Disease Control (CDC) studied circumcision and HIV transmission in America, Canada and the Netherlands to get a more accurate picture.

The information we get on the study is this:
http://www.reuters.com/article/idUSTRE6283Z820100309

A lot of it is summary and commentary. But here are the actual numbers we are given:

"The findings are based on data from 4,889 men who took part in an HIV vaccine trial begun in 1998; 86 percent had been circumcised. During the three-year study, 7 percent of the men became HIV-positive.

When the researchers accounted for other factors -- including demographics, and HIV risk factors like drug use and having unprotected sex -- circumcision showed no effect on the odds of HIV transmission.

Still, Gust and her colleagues point to some limitations of their study, including the relatively small number of uncircumcised men overall and the small number of uncircumcised men who became HIV-positive during the study -- 43"

Most people read the headlines and the commentary, draw their conclusions and move on without much understanding. But what happens if we take a moment to work through the actual numbers?

4,889 men
86% circumcised
7% HIV infection rate
43 intact men became HIV infected

Doing the math:

4205 circumcised men (4,889 * .86) = 4,205
684 intact men (4,889 - 4,205) = 684
342 men infected (4,889 * .07) = 342
43 intact men infected
299 circumcised men infected (342 - 43) = 299
7.11% circumcised men infection rate (299 / 4205) = .0711
6.29% intact men infection rate (43 / 684) = .0629

When you take a moment to do the math, you find out that according to their data, circumcised men experienced a 13% increase in HIV cases.

13% increased infection rate of circumcised group (.0711 - .0629) / .0629 = .1304

But look at that headline! “Circumcision may not cut HIV spread among gay men”

Seeing as how the actual data shows an INCREASE, why is the headline so ambiguous? Why not just say, “Circumcision may increase HIV spread among gay men?”

Too shocking? Why would a reporter avoid a shocking headline?

Grab a bigger cup of coffee and do the math when you read the headlines. J

You can read a meta-analysis here:

See the same thing happening in Africa:

Doctors oppose the use of HIV prevention as an excuse for routine circumcision:

"Debunking the Circumcision Lies” by Indonesia Intactivist

 ==========================================
Debunking Penile Cancer Myth

You said that about 1400 US men get penile cancer and almost all of them were uncircumcised. The fact is that more than 80% of US men were circumcised at that time and the lifetime risk of penile cancer in USA is 1 in 1437 (1:1437 means that 1 man will get penile cancer among 1437 men). Denmark where they have a less than 1% male circumcision rate have 1 in 1964 (1:1964) lifetime penile cancer risk. Reference: "Cold CR,Storms MR,Van Howe RS. Carcinoma in site of the penis in a 76-years-old circumcised man.J Fam Pract 1997;44:407-410".

In developed countries, penile cancer is a relatively rare disease, with an incidence of approximately 1 in 100,000.The absence of RCT evidence, combined with the rarity of penile cancer, suggests that circumcision is not justified for the sole purpose of protecting against penile cancer. Reference: "Policy Statement on Circumcision. Sydney: Paediatrics and Child Health Division, Royal Australasian College of Physicians; 2004.http://www.racp.edu.au/index.cfm?objectid=A4254F55-2A57-5487-DFE129631BCB4C59.".

 ==========================================
Debunking Cervical Cancer Myth

You said that circumcision could reduce HPV infection. Then I will give the study which shows otherwise:

--- Human papillomavirus and circumcision: A meta-analysis ---
By : Robert S. Van Howe
Department of Pediatrics, Michigan State University College of Human Medicine, 1414 W. Fair Avenue, Suite 226, Marquette, MI 49855, USA Accepted 8 August 2006

Summary

Background: Determine the relationship of circumcision status to the risk for genital infection with human papillomavirus (HPV).

Methods: A MEDLINE search and a review of references in published articles were used to identify publications from peer-reviewed journals in Index Medicus with data on circumcision status in patients with and without HPV infections. Inclusion criteria included diagnosis by culture, biopsy, or PCR, determination of circumcision status by physical examination, and multiple site sampling including the shaft of the penis. A meta-analysis was performed with sensitivity analyses.

Results: Sixteen articles contained data on circumcision status in patients with and without HPV infections. Eight studies used accurate diagnostic methods. ONLY THREE ARTICLES SATISFIED THE STRICT INCLUSION CRITERIA. THERE WAS NO SIGNIFICANT ASSOCIATION BETWEEN CIRCUMCISION STATUS AND HPV INFECTION (random-effects model summary effect OR Z 1.20, 95%CI Z 0.80–1.79) IN THESE THREE STUDIES. If the eight studies using accurate diagnostic methods are adjusted for the method of determining circumcision status and failure to sample the penile shaft using meta-regression the summary effects odds ratio is 1.25 (95%CI Z0.95–1.67).

Conclusions: THE MEDICAL LITERATURE DOES NOT SUPPORT THE CLAIM THAT CIRCUMCISION REDUCES THE RISK FOR GENITAL HPV INFECTION. TO CORRECTLY ASSESS THE RISK OF HPV INFECTION IN CIRCUMCISED MALES, THE PENILE SHAFT NEEDS TO BE SAMPLED FOR HPV INFECTION.
==========================================

Debunking Urinary Track Infection and Sexually Transmitted Infection Myth

Based on the recent study (January 12,2010 research) of Annals and Family Medicine,there is no RCTs that reported on the association between neonatal nontherapeutic circumcision and sexually transmitted infection, penile cancer, urinary tract infection, or HIV/AIDS could be identified. NO RCTs that reported on the association between nontherapeutic male circumcision and penile cancer or urinary tract infections could be identified.

The circumcision itself is a surgery with a risk of danger to infants, so it is a risk without established benefit.

The absence of RCT evidence, in addition to the incidence of urinary tract infection in normal boys of approximately 1% to 2%, makes it unlikely that preventive circumcision of normal boys would outweigh the adverse events associated with the procedure. Reference : "Policy Statement on Circumcision. Sydney: Paediatrics and Child Health Division, Royal Australasian College of Physicians; 2004.http://www.racp.edu.au/index.cfm?objectid=A4254F55-2A57-5487-DFE129631BCB4C59." and "Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. CMAJ. 1996;154(6):769–780."

==========================================
Debunking HIV Lies

You said that male circumcision reduces the risk that men will contract HIV through intercourse with infected women by about 70 percent, according to a study reported in The Wall Street Journal (July 5, 2005).

But the more recent study shows that circumcision allegedly only reduces 53% of HIV infection in Kenya based on:
http://www.sciencedaily.com/releases/2007/02/070223103150.htm.

One study shows a protective effect of the prepuce (foreskin) for HIV/AIDS infection. The apocrine glands in the inner prepuce secrete a lysozyme that reportedly kills HIV-1 in vitro (Siegfried N, Muller M, Volmink J, et al. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst Rev. 2003;(3)CD003362).

The file below shows how the Langerhans cells protect the body from HIV infection:
http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf. Langerhans cells are removed during routine infant circumcision.

A meta-analysis found that circumcised sub-Saharan African men had a significantly lower risk of acquiring HIV/AIDS after nontherapeutic male circumcision. It is not clear whether the findings from these African trials can be extrapolated to other countries with ready access to condoms and a lower prevalence of HIV/AIDS.

There are many countries in Africa where the AIDS rate in circumcised men is more than uncircumcised men.

Country,% infected circumcised men,% infected uncircumcised men :
Cameroon, 4.1, 1.1
Ghana, 1.6, 1.4
Lesotho, 22.8, 15.2
Malawi, 13.2, 9.5
Rwanda, 3.5, 2.1
Swaziland, 21.8, 19.5
Tanzania, 6.5, 5.6
Reference : National surveys (http://www.measuredhs.com/countries/)

The Uganda research which had 4,996 men aged between 15 and 49 years old participants showed that after 24 months, 964 of the original 2387 men of the circumcised men had been retained of whom 22 had contracted HIV. 980 of the 2430 uncircumcised men had been retained of whom 45 had contracted HIV

(http://hivinsite.ucsf.edu/InSite?page=jl-11-03 Male Circumcision for HIV Prevention in Men in Rakai, Uganda: A Randomised Trial).

But we can’t ignore the glaring flaws in the study:

- About 40% of the participants were chosen (not randomly selected) which means degrades the standards of the study, as they could have chosen with a bias (e.g. selected healthier men to be circumcised).

- They failed to disclose that more than a third of the circumcised men were infected before the study started, and hence were not enrolled to continue in the study. The fact is that over one-third (29/79) of the circumcised men in this study were HIV-positive on entry demonstrates that transmission to circumcised men occurs in this population, and it seems extremely unlikely that heterosexual transmission did not contribute.

Reference: "HIV InSite Journal Club, April 14, 2000.Discussion of study by Quinn et al., in the New England Journal of Medicine, March 2000".

So based on this study, the real rate of HIV infection among circumcised men in Uganda is around 344 (322+22) men among 964 circumcised men.

The study (Gray R et al. Male circumcision and the risks of female HIV and sexually transmitted infections acquisition in Rakai, Uganda. Thirteenth Conference on Retroviruses and Opportunistic Infections, Denver, abstract 128, 2006.) was an attempt to find whether circumcised men were less likely to infect their female partners with HIV.

So 299 couples where the man was intact were compared with 44 where the man was circumcised. (Yes, note the extreme group differences). After 30 months, infection rates were 7 per 100 person-years for the wives of circumcised men and 10 for the wives of intact men. This may look like a protective effect, but in statistical terms, p=0.22, meaning no statistical significance. In real terms, it can be back-calculated that 8 of the wives of circumcised men were infected. If 11 had been, the rate would be the same for both, and that difference of three infections in 30 months is too few to be considered significant.

But the study was widely reported (by Reuters) as showing that all 299 wives of intact men were infected, compared with only 44 wives of circumcised men, as if these were just the small (infected) samples of two much larger and equal samples. This makes the supposed protective effect look much greater.

Why, one wonders, was the study ever published, and why in this very misleading form?

Finally here is the research recommendation from Annals and Family Medicine:

Although approximately 30% of the global male population is circumcised, there is a paucity of high-quality evidence. 24 Depending on the indication under investigation, prospective RCTs and case-control studies should be conducted to strengthen the evidence base and allow more informed conclusions on nontherapeutic male circumcision to be drawn. 

Although the evidence for the efficacy of adult nontherapeutic male circumcision in preventing HIV/AIDS acquisition in sub-Saharan African men is strong, it is unclear whether these findings can be extrapolated to male populations in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infection, urinary tract infection, and penile cancer is less clear, whereas the role of neonatal circumcision in preventing HIV/AIDS, sexually transmitted infection, urinary tract infection, and penile cancer is not presently supported by RCT evidence. 

Patients who request circumcision in the belief that it bestows clinical benefits must be made aware of the lack of consensus and robust evidence, as well as the potential medical and psychosocial harms of the procedure. As the efficacy of prophylactic nontherapeutic male circumcision has not been comprehensively studied in neonates, it would be inappropriate to recommend widespread neonatal circumcision for this purpose.

You can also see that the circumcision health benefit is virtually nil, study finds in Public Health Report: (http://www.theglobeandmail.com/life/health/circumcision-health-benefit-virtually-nil-study-finds/article1427972)
==========================================

When studying circumcision, cultural bias must be considered in order to prevent misleading results:

Circumcision practices are largely culturally determined and as a result there are strong beliefs and opinions surrounding its practice. It is important to acknowledge that researchers' personal biases and the dominant circumcision practices of their respective countries may influence their interpretation of findings. (Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, Weiss H, Walker S, Williamson P. Male circumcision for prevention of heterosexual acquisition of HIV in men (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.)

The fact is that pro-circumcision studies are based on cultural bias.The western researchers who support circumcision in their studies are based on Jewish and Puritan cultural biases and the eastern researchers who support circumcision in their studies are based on Islamic cultural biases. As a result, they only published the results of their studies that support circumcision, they created rushed studies with many flaws, and they avoided gold-standard, scientific studies on intact males to determine the health status of remaining intact.

Then why is HIV transmission lower in Islamic areas? First, updated findings are proving this to be untrue, or less than previously considered.


Secondly, we have to consider cultural and religious behaviors of that area:

- ritual washing before prayer
- abstinence from alcohol
- periodic abstinence from sex
- strict marital fidelity

These are all factors affecting HIV transmission.”


Additional resources on medical authority and circumcision:

A summary of worldwide Medical association position papers http://www.nocirc.org/position/

The Canadian Paediatric Society says that male neonatal circumcision should not routinely (i.e., in the absence of medical indication) be performed.33 The American Medical Association calls male neonatal circumcision a non-therapeutic procedure.34 The American Academy of Family Physicians equates male neonatal circumcision to a "cosmetic procedure."35 Male neonatal circumcision now is regarded as a non-therapeutic procedure that is totally unnecessary for a child's health and well-being. Furthermore, male neonatal non-therapeutic circumcision has significant risks and complications.36 Circumcision increases infant mortality because some babies die from complications of circumcision.37 Studies show that intact boys have better penile health during the first three years of life.39,40 Other drawbacks and disadvantages include psychological and sexual problems in adult life.40 http://www.drmomma.org/2009/12/effects-of-circumcision-on.html

The Finnish Medical Association feels that no law authorising circumcisions should be passed, and that public health care should not be obliged to perform the procedures. This view is echoed by Harry Lindahl, thinks that non-medical circumcisions for underage boys should be illegal. “I think that it would be fine to wait until a boy turns 18, when he can decide for himself”, Lindahl notes.http://www.hs.fi/english/article/Legislation%20on%20circumcision%20stalled/1135256085478

Here is the Genital Integrity Statement from doctors who oppose circumcision. It is an official, authoritative, 64 page document with an index for easy reading: http://www.doctorsopposingcircumcision.org/pdf/GenitalIntegrityStatement.pdf

A neutral medical website: http://www.caringforkids.cps.ca/babies/Circumcision.htm (Canadian Paediatric Society)

“What Your Doctor May Not Tell You About Circumcision: Untold Facts on America's Most Widely Performed-and Most Unnecessary-Surgery
by M.D. Paul M. Fleiss (Author), D.Phil Frederick M. Hodges (Author) http://www.amazon.com/gp/offer-listing/0446678805/ref=sr_1_olp_1?ie=UTF8&s=books&qid=1252896640&sr=1-1

Dr Sears advises about circumcision: http://www.askdrsears.com/html/1/T012000.asp

An intact American doctor questions cultural beliefs she was raised with:
By Dr Cat Saunders --  http://tinyurl.com/2k2t3q

Circumcision Causes Lifelong Harm, Concludes New Research U.S. attorney warns doctors, "The foundation is well laid for lawsuits."http://www.prweb.com/releases/2002/06/prweb41148.htm

© Guggie Daly

2 comments:

  1. This is a wonderful blog! Say no to circumcision.

    ReplyDelete
  2. Neurologically, the most specialized pressure-sensitive cells in the human body are Meissner’s corpuscles for localized light touch and fast touch, Merkel’s disc cells for light pressure and tactile form and texture, Ruffini’s corpuscles for slow sustained pressure, deep skin tension, stretch, flutter and slip, and Pacinian corpuscles for deep touch and detection of rapid external vibrations. They are found only in the tongue, lips, palms, fingertips, nipples, and the clitoris and the crests of the ridged band at the tip of the male foreskin. These remarkable cells process tens of thousands of information impulses per second and can sense texture, stretch, and vibration/movement at the micrometre level. These are the cells that allow blind people to “see” Braille with their fingertips. Cut them off and, male or female, it’s like trying to read Braille with your elbow. Gary Harryman

    ReplyDelete