Circumcision Not a Cure-all for AIDS

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Circumcision may result in false belief that safe-sex practices are no longer necessary. The result could be a worsening of the incidence of HIV infection, especially for women.

Circumcision may result in false belief that safe-sex practices are no longer necessary. The result could be a worsening of the incidence of HIV infection, especially for women.

A paper, read at a conference in Brazil, claims that male circumcision has the potential to reduce female-to-male transmission of human immunodeficiency virus (HIV). The "Wall Street Journal" reported that the "Lancet," the pre-eminent medical journal in the world, refused to publish the paper for unknown reasons.

The researchers said circumcision might help in reducing HIV transmission women-to-men. What they don't say is that male circumcision doesn't protect women from HIV. An infected circumcised man having sex with a woman is just as likely to spread the disease as an intact man. The same goes for any male partner with whom he has sex. The problem is that men and women may erroneously believe that circumcision is like a condom, which then leads to unprotected sex and transmission of the virus.

Robert Bailey, the scientist who sponsored the study, has been promoting circumcision to prevent HIV transmission since 1989. The world medical community thus far has not accepted his published studies. The present study, which was conducted in South Africa, is his latest effort. In such cases, one must be aware of possible researcher bias.

UNAIDS has cautioned against circumcision.

If circumcision were promoted as a way of preventing HIV infection, people might abandon other safe sex practices, such as condom use. This risk is far from negligible - already, rumors abound in some communities that circumcision acts as a "natural condom. A sex worker interviewed in the city of Kisumu in Kenya summed up this misconception, saying, "I can sleep with circumcised men without a condom because they don't carry a lot of dirt on their penis." While circumcision may reduce the likelihood of HIV infection, it does not eliminate it. In one study in South Africa, for example, two out of five circumcised men were infected with HIV, compared with three out of five uncircumcised men. Relying on circumcision for protection is, in these circumstances, like playing Russian roulette with two bullets in a (five-shot) revolver rather than three.

The World Health Organization (WHO) said they were concerned that demand for circumcision, as a result of misinterpreting this study, may encourage healers and witch-doctors, which could boost the risk of HIV infection rather than prevent it due to using contaminated instruments. They also fear a false security from having been circumcised, and reduced sensitivity in the penis may cause an increase in risky, sexual behavior and a decline in condom use leading to increased transmission of the virus.

Circumcision itself is believed to be a vector for transmission of HIV in Africa due to the unsanitary condition of African hospitals, clinics, and traditional circumcisors.

Many South African tribes, such as the Xhosa, practice male circumcision as a cultural ritual, yet South Africa has an extremely high incidence of HIV-positive males. Male circumcision apparently has not worked in South Africa. Recently, authorities in Eastern Cape Province arrested a ritual circumciser who was circumcising numerous youths with the same non-sterile knife.

Circumcision is a radical operation that amputates significant erogenous tissue from the penis. Many people call forced or coerced circumcisions an assault and male genital mutilation.

Men must be warned of loss of sensation – resulting in decreased erectile power, difficulty in ejaculating, and decreased sexual satisfaction, before consent for the surgical amputation is obtained.

Two similar studies have not yet been published. Bailey's present study has not yet been peer-reviewed. The three studies must be carefully reviewed before a determination of the value of circumcision in preventing female-to-male HIV transmission, and even then, legal and ethical issues about self-determination must be addressed before advocating the procedure.

Even if the studies prove true and accurate, Africa cannot afford to circumcise all its males. A safe circumcision costs $15, compared to the already-proven methods for stopping the spread of HIV/AIDS, education and condom use, which cost $1.

Circumcision has many risks, including infection, penile loss, hemorrhage, hypovolemic shock, and death. The claimed benefit must be balanced against these very real risks.


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George Hill
Doctors Opposing Circumcision
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