Tuesday, July 7, 2009

Failure to Circumcise Cost Millions of Deaths

Sometimes it takes awhile for medical scientists to understand the importance of the discoveries made by fellow researchers. Such was the case of the link between the foreskin and HIV/AIDs, a discovery first made nearly 25 years ago.

Alex Renton, a reporter for The Observer, wrote this over the weekend:

"In 1985 researchers discovered that circumcised men who visited prostitutes in Kenya were much less likely to contract HIV. Some 30 studies on the issue were done during the 1990s, but it was not until 2004 that formal double-blind trials were commissioned by international Aids agencies. As a result of "overwhelming results" from these, pilot programmes for mass circumcision of men began in a number of African countries late last year. "

"It is now accepted by the World Health Organisation and other bodies that circumcision reduces chances of HIV infection by about 60%, and that up to 3 million deaths and 5.7 million infections could be prevented over the next 20 years. About 30 million people are thought to have died from Aids-related illnesses since 1981."

Dr Catherine Hankins, the chief scientific adviser to UNAids, the United Nations special agency for the epidemic, said that the failure to test the findings in the 1990s was "hard to explain".

"There's a good question to be asked of the research agencies: why they did not start the trials earlier," said Hankins. "We had 20 years of observational data on circumcision. I can't think of another product, or a technique, that waited for so long before trials." Circumcision has now been proved a very cost-effective way of reducing the rate of HIV infection, she said.

"Professor Francis Plummer, who led the University of Nairobi research team that first discovered the circumcision-HIV link in Kenya in the 1980s, said millions of lives might have been saved if his research had been acted upon sooner.

"There's been a failure of global public health institutions. We haven't done it very well. It's a frustration I've lived with for a very long time," Plummer said.

The failure of public health organizations to act has been deadly, not just in Africa but all over the world. In 2009, there is absolutely no reason for any male to have a disease-causing filthy foreskin. How long must we wait until the American Academy of Pediatrics and the U.S. Centers for Disease Control, to say nothing of their counterparts in other countries, wake up? It's time for the AAP and CDC to state clearly: the circumcision of every boy is a must to protect not only their own health, but also the health of their partners and society as a whole.

23 comments:

  1. That's why Muslims and Americans have much less HIV than, say, Scandinavians.
    Oh right. They don't.

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  2. Anon, this is such a spurious argument that you foreskin lovers use all the time. Nobody says that circumcision is the ONLY way to avoid HIV. But it is a beneficial procedure. The studies prove that a circumcised male is 60 percent LESS LIKELY to contract HIV. That doesn't mean that every single foreskin-afflicted male will get HIV. You take quite a leap. Uncut Scandinavians can avoid HIV, and most do. That doesn't undermine the studies at all. Take a course in logic, please.

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  3. And how do the intact men of Cameroon, Ghana, Lesotho, Malawi, Rwanda and Swaziland manange to have less HIV than the circumcised men of those same countries?

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  4. I don't think the US does enough to inform and encourage parents and also to make sure that all boys be circumcised. It's good for boys and good for society.

    Pediatrics organizations and the CDC needs to a universal routine circumcision policy for every boy to be circumcised before they leave the hospital or by a certain age.

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  5. Thanks, Anon #2. You are exactly right. I have blogged about this before. The US Govt spends millions to circumcise Africans overseas, but does little here in America. If it's good for African boys, then certainly it's good for American boys. All boys should be circumcised for their own health, the health of their partners, and society as a whole.

    The good news is that all signs suggest that the Centers for Disease Control, perhaps in sync with the American Academy of Pediatrics, seems about to endorse "routine neonatal circumcision" once again, thus abandoning their life-threatening "neutral" stance of the last decade or so. Every boy should be circumcised before they leave the hospital, as you say, and certainly before they enter school.

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  6. I'll go aong with the idea that circumcision should be encouraged more in parts of the world where it is not at present common, but I'd like to put a word in for a couple of groups of boys who shouldn't be cut at birth. First, boys who are born with hypospadias, when the penis is bent down and opens at the bottom instead of at the end, which is common (about 1% of all boys). I have known three friends with this. Two were uncircumcised, and though not a disaster if they had been, life would have been more difficult for them if they had been. My other friend was circumcised as a baby even though it must have been obvious he had the condition, and it was a nuisance for him. I have heard that Jews get round the religious problem by just doing a sort of token cut on hypo boys, but leaving intact the sort of hooded foreskin that they have.

    Second, there are boys with buried penis, which was my own case as a baby. I was not circumcised then essentially because there was nothing there to circumise, but it was done when I was older, when my penis had grown to a reasonable size and the surgeon could see what he was doing.

    I've always thought that the Moslems have it about right - circumcise between about 5 or 6 and puberty.

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  7. I agree. Circumcision should be more promoted in regions of the world where it's not common such as Asia, Europe, and South America. Opponents often bring up that only about 20-30% of men in the world are circumcised, but I see it as just circumcision isn't widely promoted enough.

    Along with a universal circumcision policy to have every boy circumcised before they leave the hospital, I think having boys circumcised before they enter school is a great idea too.

    Some people say it's best at birth, but I say that having circumcisions at early childhood and before puberty is good too where the boy will be know and appreciate the expeirence as long as parents sit down with him to talk about any fears and explain all the benefits of circumcision and why it has to be done.

    If some cultures circumcise at childhood or before puberty as a rite of passage, why not us?

    I like this blog, keep it up!

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  8. I come from the UK where up until about 1950, infant boys were routinely circumcised. However, since then, the operation has fallen out of fashion. There are signs that the debate is beginning to revive. The Alex Renton article from the Observer was accompanied by another article elsewhere in the paper where the author was circumcised himself, was very pro-circ and was in the process of helping a friend to have his infant son circumcised. Perhaps if there were more pro-circ articles like this in the UK press, we would start to get back to the position where more UK boys were given a healthy start to life by having their foreskins removed soon after birth.

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  9. Thanks for some great comments from so many of you. Jamie, I agree with you that there must always be a medical exception for a delayed circumcision. You cite two good examples. In your own case, your circumcision was postponed for obvious reasons but at least you enter adulthood clean-cut.

    Anonymous 3, you're right that some cultures delay circumcision until the boy is a little older. I think it's easier, cheaper, and better to be circumcised at birth, but as long as it's done before school begins, I can live with the delay.

    Ivancirc, I share your hope for the UK. It's ironic that the nation that introduced circumcision to the English-speaking world a century or so ago is now a haven of foreskins. I think the pro-circ movement is growing there, but until the NHS recognizes that a few pounds spent at birth to circumcise save millions later on in HIV, STD, HPV treatment, Britons are on their own.

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  10. While circumcision delayed (say, into later childhood) is far better than no circumcision at all, it is specifically the routine circumcision of infant boys that I believe would best achieve the ultimate goal of universal circumcision, that is, having a population in which no fewer than 100% of males are circumcised.

    I have heard that, in decades past, circumcision often used to take place only minutes or even mere second after birth, right in the delivery room. Does anyone know if this is fact or fiction? (My wife, who used to work with children, is in fact the one who tells me this.) Circumcision immediately following birth certainly has the appeal of not letting the mother "change her mind" by anti-circ crusaders who are always trying to tell other people what's best for their children. Besides, the luckly kid gets to start living with a nicely circumcised penis basically upon his birth rather than having to wait days or longer for the procedure.

    Whether an infant boy is circumcised at birth or a day to two later, it's still better than waiting till he's 8 or 10 years old when the operation is much more painful and he has full memory of the pain. While infant boys being circumcised appear sometimes to be in discomfort, many barely cry and others fall asleep halfway way through. And that's without even any anesthetic being used. Doesn't seem that "traumatic" to me - nor to my wife who has personally attended to several infant circumcisions herself. She says, given the problems forskins can cause and the many benefits of circumcision, she (and I) are strong believers in "getting it over with" as soon as possible following the boy's birth.

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  11. I've heard of some circumcisions being done immediately after birth instead of a few days later.

    It's a good idea. But the main idea is to make sure every boy is circumcised and one of the best way to ensure that would be to do it right away after birth and before leaving the hospital with no questions asked as if it's a regular procedure.

    Sometimes anesthetics may be used (like lidocaine or Sweetease pacifiers) in routine infant circumcisions but it doesn't matter. For parents to have their son circumcised is an act of love, even if love can be painful.

    I don't think it's at all traumatic for infants because they won't remember anything. And like you said, many don't even appear to be in any discomfort.

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  12. "Alex Renton ... was in the process of helping a friend to have his infant son circumcised." They couldn't find a doctor in Scotland who would do it. Doesn't that tell you something? So Renton was talking about doing it themselves the way Nelson Mandela was done, with one blow (of an assegai?). No mention of the agony Mandela described.

    Women who've been drug-raped "won't remember anything" either, so I guess that's not traumatic for them either. Not.

    Interesting how your correspondents are starting to talk about tricking the parents out of any choice. So much for "parental choice" then, let alone the penis OWNER's choice. Seems like it has to be YOUR choice.

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  13. The goal is certainly 100% universal circumcision, although I recognize that this cannot always be achieved at birth for some of the reasons cited in the comments.

    My own view is that RIC at birth is the norm, just like they cut off the umbilical cord, so all males must be circumcised UNLESS the parent has signed a "conscientious objection" form of some sort. In other words, permission is assumed and circumcision is routinely done on all baby boys, unless the parent has raised a specific objection, citing some valid reason not to circumcise. [Jews & Muslims, for example, may prefer to circumcise later in a religious ceremony].

    I think once the CDC and AAP revise their positions to make it clear that circumcision is a valid health measure to reduce the chances of HIV, STDs, HPV, etc., this is exactly what will happen in America. All boys will be circumcised, unless the parent intervenes with a good reason to keep the filthy foreskin.

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  14. Provoking debate said: "Ivancirc, I share your hope for the UK. It's ironic that the nation that introduced circumcision to the English-speaking world a century or so ago is now a haven of foreskins. I think the pro-circ movement is growing there, but until the NHS recognizes that a few pounds spent at birth to circumcise save millions later on in HIV, STD, HPV treatment, Britons are on their own."

    The economics certainly favour universal infant circ. Not only is money saved on HIV, STD etc treatments for men and their partners, it is also the case that about 10% of men will need circumcising for diseases of the foreskin (phimosis, balanitis etc). Adult circumcision is way more expensive than RIC - initial consultations with doctors and surgeons, the op itself, greater recovery time, time off work, time off sex(!). The emphasis on healthcare in the UK is supposed to be looking at prevention of disease rather than treatement of disease; circumcision is certainly way up there in the prevention stakes.

    But compelling as the health benefits of circumcision are, they are incidental to the main benefit of circumcision which is the complete and permanent exposure of the glans. Every male has the right to enjoy this benefit which is why I favour compulsory male infant circumcision

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  15. Ivancirc: "But compelling as the health benefits of circumcision are, they are incidental to the main benefit of circumcision which is the complete and permanent exposure of the glans."

    Before the anti-circ crusaders go on the attack, here are some very real benefits of a circumcised penis:

    1. Better appearance. The denuded glans looks manly yet at the same time intruigingly vulnerable and helpless.

    2. Drier and cleaner. No place for bacteria to breed in the moist folds of a foreskin. Instead, the penis is always dry and clean.

    3. Rubbing against clothing. Without the redundant foreskin covering, the glans is free to rub agains underwear, bedding, etc. all the time. While some men may find this distracting, others take pleasure in it.

    4. Less sensitivity. Men can last longer with decreased sensitivity of the glans resulting from permanent exposure to the air and clothing.

    5. Better friction during intercourse. Thrusting is more precise and focused. Women can experience the pleasure of feeling the glans as it is pulled in and out (especially out) of the vagina or anus.

    6. Health benefits. These are well documented elsewhere (eg., protection against HIV, etc.)

    7. (fill in the blank)

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  16. Pete's reasons for circumcsion 1-5 set out precisely the advantage of the denuded glans which all males have the right to enjoy.

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  17. So circumcision makes a newborn baby's penis "manly"? Bizarre.

    If 10% of men will need circumcising, why is the lifetime rate in Finland less than one in 6000?

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  18. For the traumatic or not argument, I don't think you can compare an infant and an (adult) woman who was raped using date-rape drugs.

    Name one infant who remembers his circumcision, was later consciously aware of it (a woman will be aware she had been date-raped later even if she didn't remember anything on that day), and comes down with problems or other grievances later in life. The "anti-circ" movement is just a social construct.

    Parents have the right to make medical decisions for their children (which circumcision is). So it's an invalid argument of arguing for both parental rights and the owner of the penis's rights. Bottom line, since parents have the ultimate say in medical decisions, parents have every right to have their son circumcised whether he wants to or not.

    With a universal circumcision policy (campaigns to encourage circumcision and/or do it as a routine procedure before leaving the hospital) it's just meaning permission is automatically implied unless there's an specific exemption reason procedure to go through. No one's suggesting that either have your son circumcised or go to jail.

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  19. Great discussion. "Parents have every right to have their son circumcised whether he wants to or not." This is true because circumcision is medically beneficial, and, of course, infants and young children are incapable of knowing what is in their best interests. That's the parent's responsibility and obligation. I think once a kid is 14 or older, then it's harder for a parent to insist on circumcision if the son is adamantly opposed. But most American boys want to be circumcised, so this issue never comes up.

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  20. The discussion about a parent's right to have his son circumcised is interesting. A few years ago now I wrote an article "Parental Rights, Parental Duties" which can be accessed at http://www.circinfo.com/parental_rights/parental.html

    I still believe that leaving a boy uncircumcised to give him choice later is a myth. In the UK, how many fathers discuss the pros and cons of circumcision with their sons as they appraoch puberty? And suppose the boy said he wanted to be cut; just how difficult and expensive would that be to organise. Choice for the boy is promoted by the anti-circ lobby because they know there is no way that choice will ever be offered. The boy will be condemned to remaining uncut.

    If a father is persuaded by the merits of circumcision, he not only has the right, he has the duty to have his son circumised at birth.

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  21. Ivan, you nailed it on the head! The anti-circ "free choice for infants" argument is designed precisely because they know it is both costly and difficult, and probably more painful, for an adult to get circumcised -- so there is really no choice at all.

    "If a father is persuaded by the merits of circumcision, he not only has the right, he has the duty to have his son circumised at birth." That sums it up for me. And it is the obligation of medical societies and government to adopt a policy of universal circumcision so that parents have unbiased information about the advantages of circumcision -- and, I would argue, free and easy access to infant circumcision at birth. Condemning a boy to remain uncut, as you put it, is not just medically and socially insane, it is contrary to good public health.

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  22. No, the reason we say the penis's owner should be the person to say what, if any of it, gets cut off is that it is HIS penis and nobody else's. He almost certainly WON'T want any of it cut off as an adult, and he may very well resent it very much if that is done without asking, and he has every right to do so. Public health? Seven out of ten men in the world enjoy a whole penis and it never gives them any trouble.

    Not only that, but circumcisng an adult is more EXACT. Circumcising a baby is like writing on a balloon. Countless men have uneven circumcisions for that reason. Wait till it's full sized.

    (And Ivancirc is wrong that boys were ever routinely circumcised in the UK. The maxium rate was less than 40% and mainly among the upper classes.)

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  23. All of you pro-circ people are severely fucked in the head...oh my gawd!!!

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