CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 6

**WHY CIRCUMCISION MAY NOT BE THE ULTIMATE SMOKING GUN ON HIV/AIDS-GIVEN IT'S HISTORY? CONTINUED**


NO.CIRCUMCISION IS NOT THE ANSWER OR CURE FOR HIV/AIDS.

Why? (1)-In most of the western countries-Circumcision has sometimes been described as a solution in search of a problem. In the mid-19th century the problem was masturbation. Towards the end of that century it was syphilis. In the 1930s it was penile cancer. In the 1950s it was cervical cancer. 1980s - Urinary tract infections. And don’t forget the phimosis, the balanitis, and the cleanliness part.

For example, outside the Jewish community, where it’s a religious rite, circumcision was practically unheard of in America until 1870, when Lewis Sayre, M.D., claimed to have cured a 5-year-old boy of paralysis by stretching out his foreskin and snipping it off. For the next two decades, Dr. Sayre and his associates crusaded for circumcision, claiming it could cure hip-joint disease, epilepsy, hernia, convulsions, elephantiasis, poor eyesight, tuberculosis, and rectal prolapse, among other things. This was all disproved, of course, and circumcision would probably have vanished from the American medical scene had its backers not found a compelling new way to sell it: as a cure for masturbation. To the publicly puritanical but privately lascivious Victorians, masturbation was the root of numerous social maladies and physical illnesses, including blindness and even insanity. Naturally, they believed, if circumcision could prevent masturbation, it would prevent other diseases as well.

Doctors of the time reported that “removal of the protective covering of the glans tends to dull the sensibility” of the penis and “thereby diminishes sexual appetite.” In 1888, John Harvey Kellogg, M.D., of cereal fame, summed up the medical profession’s opinion and gave justification for the next 60 years of foreskin removal. “A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind since the infant wouldn’t be able to remember anything at this stage in his life-meaning-infants don’t feel pain.” By the end of World War II it was clear that circumcision was not stopping men from masturbating; but, by then, the procedure was institutionalized in America’s medical system. It had become the norm for white, middle-class American men. The uncircumcised were often recent immigrants or “African-Americans”. Probably as a result of racial prejudice, the uncircumcised penis was viewed as unhygienic and unclean. But this, too, turns out to be false.

It seemed that with the passing of time, the purported problems had gotten more trivial. It’s no Small wonder then that circumcision’s on the wane. But suddenly, there comes another big one–HIV/AIDS! Several eminent scientists and medical researchers have determined that a link exists between circumcision status and the rate of HIV transmission and they are urging universal adults/infants circumcision to help combat the disease. Circumcision promoters appear to have suddenly and finally found the mother of all problems’ solution. Regrettably, Smoke-screens, half truths and flat out lies have ensured. The issue is so enmeshed in emotion and advocacy that it's hard to know/tell where the truth is.
“The uncircumcised penis is self-cleaning,” explained Robert Van Howe, M.D., a pediatrician from Wisconsin who had been studying the causes of circumcision for 20 Years. “Every time you urinate, you flush out the preputial cavity. The hygiene issue was just another excuse. Since its inception, circumcision has been a surgery looking for a rationale. First it was disease, then masturbation, then hygiene; now it’s back to disease.” In 1971 the American Academy of Pediatrics (AAP) stated that circumcision was medically unnecessary. At the time more than 80 percent of American baby boys were circumcised. Then in 1989, the AAP released a new position paper that equivocated: “Newborn circumcision has potential medical benefits, as well as disadvantages and risks.” Still, by the following year, the rate was down to 59 percent.

Dr. Schoen chaired the AAP task force that made that reversal. He still stands by the position, claiming that the foreskin is the genital equivalent of the appendix, and that newborn circumcision is “a preventive health measure analogous to immunization.”

“The most important health benefit of circumcision is the decreased risk of urinary-tract infections,” explains Dr. Schoen, citing a well-known 1985 study, which he said has since been “overwhelmingly confirmed” by other studies. But Martin Altschul, M.D., a pediatrician and M.I.T.-trained mathematician, has reexamined the evidence and finds it fraught with problems “The whole body of research on this issue is a how-to-lie-with-statistics classic,” argues Dr. Altschul. “Depending on how you collect the data, you can get almost any result you want.” Dr. Altschul’s own research also found that many of the urinary-tract infections in uncircumcised boys were “attributable to congenital anomalies.” Recently, several studies have suggested that neonatal circumcision may actually increase the infection rate.
Dr. Schoen cited two other medical benefits of circumcision, namely decreased risks of developing penile cancer and contracting sexually transmitted diseases, such as HIV and syphilis.

“You’re more likely to be struck by lightning than to suffer from penile cancer,” counters Dr. Van Howe. “Japan, Norway, Finland, and Denmark all have lower rates than the United States, and they don’t circumcise their boys.”
In fact, in 1996, representatives of the American Cancer Society wrote a letter to the AAP in which they pointed out that “fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.” The letter also stated that “perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.” Altschul. “It’s preposterous to even suggest that because we have some minuscule risk of disease, we should cut off the foreskin of every little boy.”

“Breast cancer in women is common,” says Dr. Denniston, “more common than all the purported health risks of the foreskin combined. Does that justify cutting off all breasts at puberty?”

What about circumcised men and STDs? A study published in the Journal of the American Medical Association around that time found that circumcised men did have a lower incidence of syphilis and HIV. But they had a higher rate of infection with herpes, hepatitis, and Chlamydia. Overall, the study authors wrote, “We found no evidence of a prophylactic role for circumcision, and a slight tendency in the opposite direction.”

“The bottom line,” says Dr. Denniston “is that the alleged benefits of circumcision don’t approach the risks.”

“Penile cancer is extremely rare-less than one case for every 100,000 men,” adds the Dr.
“Why is this procedure still covered by HMOs and health-insurance companies in America? The simple answer is, because parents want it,” says Patricia Wald, M.D., regional coordinating chief of pediatrics for Kaiser Permanente Medical Center in southern California. The doctors counsel parents so they’re making an informed decision, and don’t perform the operation unless asked. “We cover it as a courtesy. But to me it’s cosmetic surgery, like ear piercing.”

“After you counsel the parents appropriately and do the procedure,” Dr. Shoemaker explained, “it’s not a profitable use of time.”
Circumcision is the only surgery in America routinely performed without anesthesia. Sixty-four to 96 percent of circumcised infants endure the procedure with nothing to deaden the pain. Until recently, doctors often told parents they didn’t feel the same pain as adults.

“I didn’t know what circumcision really was when I consented to have my three sons circumcised,” says Marilyn Milos, founder and executive director of the National Organization of Circumcision Information Resource Centers (NOCIRC). “My doctor told me it was necessary, that it didn’t hurt, and that it took only a moment to perform-like cutting the umbilical cord, I thought.”
Ten years after her last son was born, Milos went back to school to become a registered nurse. As a student, she was asked to assist at a circumcision. “To see a part of a baby’s penis being cut off – without an anesthetic – was devastating.” Later, while working as a nurse, she made a videotape of the procedure and called it Informed Consent.

“Parents had no idea what was happening to their baby boys,” she explains. “The point was to show them what circumcision really entailed.” The hospital, Marin General in California, refused to allow expectant parents to view the tape. “They said it was too much for parents to see. I said, ‘then perhaps it’s too much for babies to experience.’”

In 1985, Milos founded NOCIRC. “It’s all such an unspeakable cover-up. The doctors are in denial, so the hospitals are in denial, so the parents are intentionally, illegally uninformed. Circumcision is the worst fraud in American medical history.” Recent studies support Milos’ gut reaction to unanesthetized circumcision. A issue of the Journal of the American Medical Association reported that “newborns...who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea).” The report goes on to say that the skill of the surgeon did not reduce the pain, and that infantile amnesia (the “he-won’t-remember-it-anyway” argument) can’t justify it.
But even if doctors did use anesthesia, the reduction in pain would have to be measured against other concerns, such as the danger of using potent painkillers on day-old babies.

Then there is the question about how long the hurt lasts. “Circumcision causes such traumatic pain in newborns that it may have damaging effects upon the developing brain,” says James Prescott, Ph.D., director of the Institute of Humanistic Science in Long Beach, California. A psychologist who has written extensively on childhood trauma and its long-term effects, Prescott says the stress of circumcision damages the neural systems that mediate genital pleasure. In effect, he says, the baby’s brain is encoded to associate pain with pleasure. In fact, the pain is so severe that it’s not unusual for babies to go into a kind of shock, suddenly becoming silent and ceasing to struggle.

Most of the world’s leading medical establishments have come out against this surgery. “Circumcision of newborns should not be routinely performed,” says the Canadian Pediatric Society. “To circumcise...would be unethical and inappropriate,” says the British Medical Association. The Australasian [Australia and New Zealand] Association of Pediatric Surgeons states: “Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anesthesia to remove a normal, functional and protective prepuce.”

Kent Kleppinger, M.D., a pediatrician who performs circumcisions, says, “I tell parents circumcision is cosmetic surgery. It isn’t difficult to dissuade the mothers, but the fathers generally override their decisions. They want their boys to look like other boys in the locker room. They want their boys to look like them.”
Like father, like son. This may be one of the hidden reasons why infant boys are still being circumcised in America and may be a round the globe!

It may all come down to the basic human rights of the child. In 1996, the Canadian Medical Association approved a code of ethics that instructs doctors to “refuse to participate in or support practices that violate basic human rights.” This suggests that, in the case of circumcision, parental preference should not override the child’s physical rights to his body.

Margaret Somerville, professor of law and medicine at McGill University in Montreal –Canada and founding director of the Centre for Medicine, Ethics and Law, raised eyebrows at all North American pediatricians by declaring circumcision “technically criminal assault.”
“Once you decide that circumcision is not medically necessary, you take away the therapeutic intent. Take away therapeutic intent, and circumcision becomes an unjustified wounding,” she said.

Leo Sorger, M.D., writing in ObGYN News, is even more explicit: “Circumcision causes pain, trauma, and a permanent loss of protective and erogenous tissue. Removing normal, healthy, functioning tissue [for no medical reason]... violates the United Nations Universal Declaration of Human Rights (Article 5) and the United Nations Convention on the Rights of the Child (Article 13).”
In September 1996, the United States Congress passed a law banning the mutilation of female genitalia. “Americans are horrified by female genital mutilation,” said attorney Svoboda, “but they somehow don’t/didn’t recognize the routine torture going on in their own culture.” He acknowledged that a clitoridectomy is a more serious and detrimental surgery than circumcision, but he argued that “human-rights law doesn’t say if you cut off four toes, it’s a human rights violation, but if you cut off only three, it’s okay. That’s not how human-rights law works. If it’s wrong, it’s wrong. Involuntary circumcision is wrong.”


Why?-(2) Research studies-the most cited studies and probably the most referenced to date. As proving to have broken the camel’s back on circumcision - HIV/AIDS correlation are the two “researches” done in East Africa (Kenya and Uganda). The reports go like this: Adult Male Circumcision Studies-One study included nearly 5,000 men in Rakai, Uganda; the other almost 2,800 men in Kisumu, Kenya. Both were funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID). The NIAID should ring a loud bell here for those who are interested in looking at its affiliations/intentions and the facts thoroughly!

None of the study participants had been circumcised before the studies started. The report notes. The Ugandan men were 15 to 49 years old; the Kenyan men 18 to 24. They were randomly assigned to get circumcision (surgical removal of the foreskin) right away or after a two-year delay. Both studies enrolled participants by September 2005 and were scheduled to last until the middle of 2007.
That plan changed on Dec. 12, 2006, when researchers reviewed the studies' interim results, which showed that the men who had gotten circumcised were about half as likely to contract HIV. In the Ugandan study, the circumcised men were 48% less likely to acquire HIV. In the Kenyan study, they were 53% less likely.
Based on those results, the trials were stopped early so any participant who wanted to could get circumcised.

Let's start with the evidence. Several other studies carried out in Africa including the above two examples are reported to have found a positive correlation between HIV infection and non-circumcised status. Of note is that there are also some studies that have found a negative (read circumcision to increasing the risks of contracting HIV/AIDS) correlation. None of these studies are flawless, however. In some cases the sample size are either too small to give meaningful conclusions, or in some, the methodology are suspect and in others the logical inferences are unsupported by the evidence. That doesn't mean these studies are without merit. In the best of situations it's very difficult to conduct a controlled experiment with living human beings. People lie, change/modify their behavior, move, quit, die and worst of all for experimenters – people have rights.

An "ideal" experiment would be to randomly select a large sample of uncircumcised, non-HIV positive participants, circumcise half of them, force them all to repeatedly have sex with HIV infected partners, then conduct tests to see which group (circumcised or uncircumcised) has the highest rate of infection. That would be definitive. This is the only way we could confidently assert that a correlation exists. Alas, any conclusions drawn from any study that falls short of this "ideal" will have to be taken with at least some degree of analytic skepticism i.e. a pinch of salt-maybe?

The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the often-reported 65%, and several of the subjects disappearing. The fact that one study described circumcision as “comparable to a vaccine of high efficacy” seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised. Daniel Halperin is the grandson of a mohel, and seems to think that “maybe in some small way (he’s) destined to help pass along (circumcision)” so his objectivity is questionable.
Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of “dry sex”.

The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circumcised men than the uncircumcised men, yet they’ve just started a nationwide circumcision campaign. Other countries where circumcised men are “more” likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. That’s six countries where men are more likely to be HIV+ if they’ve been circumcised.

Something isn’t right somewhere. Or could it be that these people aren’t interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them in the long run? Think about it. Given the fact that NIAID doesn’t think there are any implications for U.S. Thus the “African studies will likely not have a large impact on the incidence of HIV/AIDS in the United States or Europe, where heterosexual transmission is low compared with areas like sub-Saharan Africa and parts of Asia," Bailey one of the two groups who conducted the East Africa “researches” said.


**Below are some of the lists of those who conducted the much cited “African experiment-research”**

1) Weiss HA, Quigley M, Hayes R. [Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000; 14:2361-70.]

2) Bailey C, Moses S, Parker CB, et al. [Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet 2007; 369: 643-56.]

3) Gray H, Kigozi G, Serwadda D, et al. [Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial. Lancet 2007; 369:657-66.]

4)Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of [male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2005; 2(11):e298.]

**Remember the CDC clarifies that it hasn't made any recommendations on male circumcision to reduce HIV transmission and is studying risks and benefits of circumcision as an HIV prevention strategy.***

If you read those reports, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners to only trusted and with known HIV negative status protects against HIV/AIDS. There are people who haven’t even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn’t refuse to fund condom education, or work that involves talking to prostitutes. There are prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, they’d be focusing on education as a toll to teach about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behavior.

**Somebody needs to tell politicians to stick to what they know and do best and not misguide the citizens about health issues. It is not helping, especially Kenyan’s politicians hailing from around the Lake Region- when they promote something that they seem not to have knowledge about or careless to know without consideration of cultural/customs ramifications attached. It is reckless! Hon., the PM. Raila Odinga and others promoting circumcision as a cure/prevention of HIV/IDS. I have to say respectfully , here you are wrong! Citizens need proper and appropriate measures/programs-educational, cultural or otherwise and safe ways to prevent and contain this tragedy. Stop the gimmick already! ****

Some findings have suggested that circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.
ABC works against HIV. Circumcision appears not to. Remember that circumcision won’t make any difference unless someone isn't having unsafe sex with an HIV+ partner.

******Why? (3)- TO BE CONTINUED*********