On Circumcision Debate, Studies Cut Both Ways
A New Zealand study published in the Journal of Pediatrics adds yet another wrinkle to the acrimonious debate over circumcision. The study found that circumcision doesn't appear to protect men living in the developed world from certain sexually transmitted diseases, Reuters reports. Researchers at the University of Otago found that of 499 men they have followed since the 1970s, the same percentage of circumcised men and uncircumcised men—about 23 percent—developed bacterial and viral STDs such as chlamydia, genital warts, and herpes. The researchers didn't collect data on HIV, which is comparatively rare in New Zealand.
Most news in the last few years about circumcision has been dominated by the results of three randomized trials in African countries that found the procedure considerably reduces a man's risk of contracting HIV. In one of the studies, the risk was reduced by as much as 76 percent. Since then, public-health officials in some African countries have been scrambling to develop large-scale circumcision programs. The implications for Americans, however, remain murky. There are differences between the African and North American HIV epidemics, and the CDC has emphasized that benefits seen in the African trials don't necessarily translate to America.
U.S. News Health Editor Dr. Bernadine Healy, a former director of the NIH and the Red Cross, has written the procedure is nothing to fear, much to the chagrin of readers who argue that circumcision carries significant risk, as well as those who oppose circumcision on other grounds.
Future research may resolve the debate over circumcision, but, in the meantime, one thing remains crystal clear. For sexually active men—circumcised or not—it's plain stupid not to wear a condom. Yet even discussing condoms in sex ed classes has become a political football, as my colleague Deborah Kotz has reported.
Bottom line, fellows, is that party hats are still key, regardless of your circumcision status. Latex is best, but if you're allergic, plastic (polyurethane) condoms will do, according to the Mayo Clinic. Don't rely on lambskin, which doesn't protect against HIV. And when you're deciding whether to use a condom, don't forget there are plenty of people out there who don't realize they have an STD—or know they do but lie about it.
Tags: STDs | men's health
Tools: 
Share
|
| Comments (3)
Reader Comments
Condoms, not circumcision, prevented HIV in NZ
Yes, HIV is comparatively rare in New Zealand, largely because of heroic efforts in the 1980s by the gay community, somewhat reluctantly adopted by the government, to make protected sex a community norm.
Meanwhile, circumcision, near universal in the 1950s, fell out of favour through the rest of the century so that hardly any non-Polynesian babies are now circumcised, and most men under 35 - those most at risk of exposure to HIV - are intact.
"The benefits seen in the circumcision trials" not only don't necessarily translate to the US, they don't even translate to AFRICA. In Cameroon, Ghana, Lesotho, Malawi, Rwanda and Tanzania, a higher proportion of the CIRCUMCISED men have HIV than the non-circumcised.
not even close to 76%
I think your article has an error in saying In one of the studies, the risk was reduced by as much as 76 percent. The three main studies were in the low 50% range of lowering risk. The studies have no real information on who really wore a condom and how much sex the men had. Certainly the cut men had less time for sex as the circumcision kept the cut (mutilated) inactive for the first months or so of the studies. The cut men got different condom advice and may well have practiced safer sex. No one is mentioning that male circumcison has resulted in higher HIV transmission rates from men to women.
A study indicates that female circumcsion (FGM) can also cut HIV risk. If you are a man and have this sensitive part of the penis, you know it feels really good. Is the argument for MGM to reduce HIV risk that mens sexual pleasure is less important than womens? Or are men easier to manipulate and sell a barbaric procedure to as a cure?
Adam Voiland's reply:
The CDC explains why you’re picking up that discrepancy in the risk reduction percentages here. Some of the data was reanalyzed after it was first published. Here's how CDC explains it:
“In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a few men who had been assigned to be circumcised did not undergo the procedure, and vice versa. When the data were reanalyzed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised.”
Your point about female circumcision possibly lowering the risk of HIV is intriguing. I’ve seen one study on this so far. Hopefully, future research will reveal more.
A few men
Yes, "a few men" changing status made a big difference to the claimed outcomes, because though they started with a total of 10,908 men, only 201 (64 circumcised, 137 controls) got HIV in the curtailed time-span of the trials. When they claim "circumcision could protect millions" they just multiply those small numbers by whole populations, ignoring the enormous uncertainties individual behaviour differences cause.
There are many other problems with the trials, notably:
* the drop-out rate of 673 men (327 circumcised 376 control) which could easily overturn the findings if circumcised men who found they were HIV were more likely to drop out (as you would be).
* the role of non-sexual and same-sex transmission (the experimenters assigned ALL transmission to male-female sex). "Needle men" who inject with the same needle for any ailment are common in Africa. Same-sex activity is a big no-no and would go unreported. Researchers ignored men contracting HIV and reporting no sexual activity or no unprotected sexual activity in the relevant period.
Add your thoughts
All comments are moderated and generally will be posted if they are on-topic and not abusive. For more information, please see our Comments FAQ.advertisement
iTunes
RSS