Circumcision and HIV

Some very positive news in favor of a practice too many ideologues have been eager to condemn as pointless.

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. (emphasis added)

That is about as strong an endorsement of a medical practice as they come! Circumcision may seem to be a waste of time to Westerners who feel certain* that their lifetime risk of exposure to HIV is insignificant, but it is the height of folly for anyone to continue campaigning against it in places like Africa, Russia or South Asia, in the name of some supposed foregone pleasure circumcised infants will never miss anyway; better to lose a foreskin than to lose one's whole life prematurely.

*All too often mistakenly so ...

[Via MeFi.]

PS: There's more on the study in this WSJ article. Amongst the details disclosed is that the study was a randomized, controlled clinical trial involving 3,000 HIV-negative men, meaning that the results obtained are highly robust.

Comments

[Jeff]

I agree with you that it's doesn't make much sense to campaign against circumcision because of the supposed lack of sensation if a causal relationship between it and SIDA has been established. Especially if started now, a lot of the participants would be adults - so the consent thing will not be a big deal.
However, there are reasons to be cautious about embarking on mass circumcision. The results reported in that article are based on nothing more than mere correlation. Though a couple of theories have been put forward, the causation is still very unclear.
So there is a real danger in embarking on a costly exercise when other factors could be behind the low prevalence of SIDA in other regions such as West Africa where circumcision is common.

[Jeff]

Sorry, I mean AIDS by SIDA.

[Abiola]

"The results reported in that article are based on nothing more than mere correlation."

No, they're not. This was a carefully designed longitudinal study, with participants selected for homogeneity on a number of criteria and then chosen for circumcision at random, and the conclusion it points to is inescapable - circumcision has a *drastic* effect in decreasing the risk of AIDS.

"Though a couple of theories have been put forward, the causation is still very unclear."

Again, no, the causal mechanism is *very, very* well known; the underside of the foreskin is a very inviting surface for HIV and other sexually transmitted viruses.

"So there is a real danger in embarking on a costly exercise when other factors could be behind the low prevalence of SIDA in other regions such as West Africa where circumcision is common."

This is a bogus statement. All the participants in the study were in the same region of South Africa, and yet the dramatic difference emerged; it's far from being the first such study either.

There's no wiggle room for debate here: if researchers had been able to come up with a vaccine half as effective at controlling HIV as circumcision has been shown to be, Bob Geldof and company would be lambasting George W. Bush for not rushing it out into the field, even without a tenth as much research showing its efficacy.

[eoin]

RIght then. Off to get the snip.

[Andrew]

Now to see if men will actually agree to get circumcised as a preventative measure. I mean, if you're not willing to use a condom, why would you be willing to amputate part of your, uh, special area? [Leaving aside cases where condoms are unavailable or too expensive, which admittedly is quite a lot of cases!]

Interesting to compare to vaccines: how do the ethics of mandatory circumcision compare to the ethics of mandatory vaccination?

[Abiola]

"I mean, if you're not willing to use a condom, why would you be willing to amputate part of your, uh, special area?"

1 - Circumcision is a one-off operation, condom wearing isn't.

2 - Circumcision is widespread in Africa, and even if men come from ethnic groups in which it isn't practiced, they're in contact with others in which it is, so they won't view it in the jaundiced terms suggested by the loaded word "amputated". Condom-wearing has no such cultural precedent in its favor.

3 - Infant circumcision would make this a moot issue anyway, at least for future generations. It also has the considerable benefit of occurring before *any* sexual activity whatsoever can have taken place.

"Interesting to compare to vaccines: how do the ethics of mandatory circumcision compare to the ethics of mandatory vaccination?"

Don't get the wrong idea here: I'm certainly not about to start advocating a campaign of *mandatory* circumcision for anyone, no matter how much at risk. All I'm asking for is that the anti-circumcision ideologues keep their yaps shut outside their home borders, so that those working to control the spread of AIDS can impart information to those at risk without being undermined all the time by axe-grinding ignoramuses.

If men still don't feel like getting circumcised after being given the objective facts about its benefits and (miniscule) risks, then at the end of the day, it's *their* choice to make, not any government's; suicide isn't a crime, nor should it be one even if it occurs through stupidity.

[Andrew]

Ah, good points! I wondered whether there might be some stigma attached to circumcision, but I guess not. Cool.

[razib_the_atheist]

this is a hot topic, people get charged up by it. in many parts of the world circumcision and islam are closely identified (south asia, the slavic world). nevertheless, the comparisons of thailand vs. philippines, luo vs. non-luo, xhosa vs. zulu are persuasive to me (and its not like you can't posit a plausible physiological model to slot into the correlation).

that being said, i am also skeptical about the utility of the procedure in the west. after all, japan and much of europe have lower HIV rates than the united states, so circumcision is not a necessary condition for low HIV seroposivity. i only bring this up because on my research on this topic i ran into a jewish site which used this data to argue for a massive circumcision program in the west, and was arguing the current decline in circumcision in much of the united states should be militated against. but later on, the author makes it quite clear that he connects non-circumcision to anti-semitism, and a society where jews and non-jews are distinct by foreskin or lack thereof is dangerous.

p.s. there has been data using tamil muslims vs. tamil hindus to show that circumcised males in a population reduces cervical cancer rates. classic correlation. the anti-circumcisers shoot back with the lower cervical cancer rates in uncircumcised sweden vs. circumcised USA. the key here i think is to advise caution against one-size-fits-all solutions and admit that there are various components to any given problem (well, duh, but the ideologues forget that sometimes).

[Jim]

"but it is the height of folly for anyone to continue campaigning against it in places like Africa, Russia or South Asia,.."

In Russia and India no one has to campaign against circumcision. There is a huge stigma attached to it, for Russians and Hindus. It marks you as either Jewish or Muslim.

[razib]

It marks you as either Jewish or Muslim.

a few years ago vladimir putin told a reporter who he perceived to be soft on islam to go 'get circumcized.' this elicited confusion in the USA, where most men are circumcized. there is simply lack of knowledge among many americans that 70% of the world's circumcized males are muslim, or that it is not typical in europe. in bangladeshi bengali the act of circumcision is cognate to 'to become a muslim.' (mussulman ~ muslim, mussulmani ~ circumcision).

[Phil Hunt]

It might have been randomised, but I bet it wasn't double-blind :-)