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Circumcision to cut AIDS rate in half

NY Times, H.I.V. Risk Halved by Circumcision, U.S. Agency Finds:
Circumcision appears to reduce a man’s risk of contracting AIDS from heterosexual sex by half, United States government health officials said yesterday, and the directors of the two largest funds for fighting the disease said they would consider paying for circumcisions in high-risk countries.

The announcement was made by officials of the National Institutes of Health as they halted two clinical trials, in Kenya and Uganda, on the ground that not offering circumcision to all the men taking part would be unethical. The success of the trials confirmed a study done last year in South Africa.

AIDS experts immediately hailed the finding. “This is very exciting news,” said Daniel Halperin, an H.I.V. specialist at the Harvard Center for Population and Development, who has argued that circumcision slows the spread of AIDS in the parts of Africa where it is common.

In an interview from Zimbabwe, he added, “I have no doubt that as word of this gets around, millions of African men will want to get circumcised, and that will save many lives.”

Uncircumcised men are thought to be more susceptible because the underside of the foreskin is rich in Langerhans cells, sentinel cells of the immune system, which attach easily to the human immunodeficiency virus, which causes AIDS. The foreskin also often suffers small tears during intercourse.
Yet another shred of evidence that highlights the medical benefits of a practice given to Western society by Judaism. Circumcision nay-sayers don't have a leg to stand on. It's a practice that has been repeatedly proven to have numerous health benefits.

Related: WHO: Circumcision to reduce AIDS rates

Circumcision nay-sayers don't have a leg to stand on.


The studies stopped by the NIH researched the effect on men voluntarily circumcised as adults. This is reasonable, as each man can choose for himself what he thinks is the best strategy for preventing HIV. If intact men think that circumcision would help, they should have it done. Unfortunately, I didn't get the choice. Yet, I still choose personal responsibility. What should not be overlooked is that this is no different than what newly circumcised adult men should do. We haven't really learned anything beyond the narrow confines of the study, leaving aside the reckless reporting.

To my stance, I'm anti-circumcision; his body, his rights. Adults should be free to choose. This information might help, if they feel they're at risk. My issue is not with the science behind this, and it doesn't change the validity of my opinion. Applying this to justify medically-unnecessary circumcision on non-consenting infants is the flaw, which is where I've stood all along. Circumcision is neutral. How it's wielded is not. Science and ethics are connected, but not interchangeable.

The news: hmm, interesting. The application of the news: just as wrong today as it was before the announcement.

The problem with voluntary adult circumcision is that many diseases prevented by circumcision occur before adulthood, such as chronic urinary tract infections and penile cancer. In addition, HIV is often contracted in pre-teen years from sexual contact. Therefore, it isn't an issue of adults choosing for themselves what the best method to prevent HIV is. Just like all medical issues, it’s an issue of adults choosing for their children what the best medical treatment is. Asking parents to withhold medical treatments, such as circumcision, until the children are adults who can choose for themselves is like asking parents to withhold the polio vaccine from children until they are adult enough to choose if they want to be vaccinated or not.

In addition, HIV isn't a hereditary disease that affects individuals. It's contagious and passed on. Therefore, precautions should be taken to prevent and contain it. If circumcision helps to reduce the risk of HIV, as it has been proven to do repeatedly (not just in the study mentioned), it should be recommended and perhaps even obligatory. We quarantine people who have infectious diseases in the medical community and should take similar measures to prevent the spread of HIV. Circumcision is one of those measures.

This is especially true in places like Africa, where the population has consistently refused methods such as condom use to prevent HIV. Where they, furthermore, believe sex with virgins will cure them of HIV. These places have a culture of HIV; the victims are not only the people who have the disease, but those who will end up getting it. If circumcision would help to save innocent lives, as it would, then it isn't a voluntary adult issue. It's something that should be required. Again, like getting your polio vaccine.

Circumcision isn't medical treatment in the overwhelming majority of procedures. Treatment requires the existence of a disease, not the threat of a disease. That's the flaw in circumcision for children as prevention. I have no problem with parents choosing circumcision, if it's medically indicated, or adults choosing circumcision for themselves for any reason. But forcing it on children for a scenario that is unlikely to occur violates the child's rights. Parents do not own their children. With medical decisions, they are guardians. Circumcision is surgery. Children are the patient, not the parents. The child's need for the surgery is, or should be, the crucial requirement. The parents' wishes are irrelevant to medically-unnecessary surgery.

Looking at your examples, girls suffer more UTIs than even intact boys. We treat girls with antibiotics, not a scalpel. What's different with male biology that antibiotics aren't sufficient? Just because we can do something does not mean it's justified. The purpose of medicine is to use the least invasive method to cure disease. There is no disease and circumcision is hardly the least invasive solution.

The incidence of penile cancer is so low as to be a laughable justification. Denmark has virtually the same incidence of penile cancer as the United States (%/100,000), except the majority of Danish males are intact. The rate is between .9 and 1.0 per 100,000 in the U.S. and .82 per 100,000 in Denmark. (link) What's going on, unless circumcision isn't the driving factor?

Looking a the numbers, though, reveals an interesting truth about statistics and incidence. One per 100,000 means that approximately 1,500 men will get penile cancer each year in America. The reduction in penile cancer from circumcision is often cited as a threefold decrease, I think. But that means that we expect 3 men in 100,000 will get penile cancer if all men are left intact. We must look at absolute numbers rather than deciding based only on statistical decreases. Of course, penile cancer is associated with older men, not minors. Inconvenient, but true. Should we circumcise more than 1,000,000 male infants this year to save 3,000 of them from a disease in the year 2066? A disease with behavioral risk factors? Sound anything like HIV? Might the other 995,500 men want their foreskin for the next 60 years? Might those 4,500 who will get penile cancer want their foreskin for the next 60 years? That's a different analysis than the specific decrease in the rate of penile cancer.

HIV isn't hereditary, but it isn't contagious, either. It's infectious. In this case, it requires a specific physical action for someone to become infected, not simply being in its presence. I agree that it should be contained, but in the case of these studies, condoms will still be necessary, as well as remembering that becoming infected requires sleeping with someone who is infected.

To equate HIV with tuberculosis or smallpox, and to suggest obligatory circumcision in response, is absurd. And the comparison to vaccination is wrong. Those diseases are contagious, and parents have a reasonable justification for considering vaccination. Public health crisis versus private health crisis. The latter is not irrelevant, but it requires a different response.

If the population of Africa refuses prevention methods such as condoms, do you really believe that providing them the appearance of extra protection will contribute to better behavioral choices? Circumcised men will still become infected, but if they embrace such ignorance that says a condom isn't necessary, the long-term outcome will be predictably more of the same. Does it make sense that circumcision is a viable answer as widespread policy, given that the a huge percentage of the U.S. adult male population is circumcised, yet we also have the highest HIV infection rate in the industrial world? Something else is at work. Poverty, for example. People who have little reason to believe the future will be better have little incentive to act responsibly today. Perhaps we should attack the political circumstances that result in poverty for large portions of Africa.

At least in the United States, individual rights are protected by the Constitution. Children have rights, just like adults, including being free from harm. Non-medical, preventive circumcision constitutes harm, as we'd define any other surgery that removes healthy tissue from a child. The science behind circumcision's ability to prevent HIV is fascinating, but that does not give it an exemption from logic and ethics. Parents have a responsibility to educate their children. Surgery is not education for children, that's obvious. But it isn't a reasonable complement to educating them, either.

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