Friday, September 11, 2009

UN Reaffirms Value of Universal Circumcision

Maybe, just maybe, we are beginning to see government agencies (outside of Africa) embrace the goal of universal circumcision, a society where the foreskin can no longer pose a threat to a male and his partners. Experts from the World Health Organization, UNAIDS, and the South African Centre for Epidemiological Modeling applied mathematical modeling to a number of studies showing the benefits of circumcision.

Here are some of their conclusions:

* "Using a 10-y time horizon, one new HIV infection would be averted for every five to 15 men newly circumcised. For the most successful interventions, where almost all men are circumcised, HIV incidence could be reduced by ~30%–50% over the same period."

* "Women, even if not directly protected, would benefit indirectly from the introduction or expansion of male circumcision services because their probability of encountering an HIV-infected male sexual partner gradually declines with programme scale-up."

* "Circumcising men who have not started sexual activity leads to the greatest population-level benefit in the long term. . . . Of course, circumcising both adult males and neonates would maximise the short- and long-term impact of circumcision on HIV incidence."

* "The estimated costs per adult male circumcision are between $30 and $60 depending on the programme setting, with neonatal circumcision costing about one-third this amount. . . . By comparison, estimates of discounted lifetime treatment costs typically exceed $7,000 per HIV infection if only first-line treatment is provided, and twice as much if second-line treatment is available."

Put simply, universal circumcision at birth provides the best health protection at the lowest cost. Circumcising before sexual activity is best, and one HIV case can be prevented for every five males circumcised. Isn't that worth it?

Now let's hope our friends at the Centers for Disease Control (CDC) are able to read this report through the fog of crap being tossed up by the anti-circ fanatics.

22 comments:

  1. "Circumcising before sexual activity is best, and one HIV case can be prevented for every five males circumcised. Isn't that worth it?" Er... the numbers don't add up. In 2006 there were 54,000 new cases of HIV reported. More than half were with men having sex with men, another 20% were intravenous drug users and if you add in the infants born to HIV positive mothers and all women contracting HIV, you are left with less than a quarter of the reported cases. I bet that those men reflect the general percentage of circumcised men in this country which is 80%. Universal circumcision would perhaps, and only perhaps, affect 20% of the remainder i.e. some 2 or 3 thousand men. Since the reported effective prevention is 60%, your cockeyed theory would have a target cohort of 800 to 1200 men at a cost of circumcising some 800,000 infants a year.

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  2. You lost me somewhere, Anonymous. This is a report from respected scientists, not me. If you want to dispute their mathematical modeling, fine. Direct it to them. But I would be surprised if the United Nations would endorse a "cockeyed theory" (no pun), as you put it. The bottom line is that circumcising males reduces the chance of HIV. Unless you think the foreskin outweighs the horrendous challenges of HIV, the conclusion is obvious: universal circumcision.

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  3. The UN report is clear - it is both costly and unethical to delay worldwide free and universal circumcision any more.

    Would the anti-circers please move out of the way and let us help the world be healthier.

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  4. In the name of public health and aesthetics, I propose that all girls undergo a preventative double mastectomy and have DD implants installed. That would eliminate breast cancer and make all women equally stacked with a giant set of bazongas! Lets face it, what guy wouldn't love that? While we're at it, lets make all 12 year old giirls undergo laser pubic hair removal because most guys love a bald beaver and it would eliminate pubic lice!

    Y'all pro-circers are a bunch of f*ing idiots. Unfortunately, you now have the support of the global public health industry which loves to impose heavy handed mandates on everyone and eliminate personal choice through junk science.

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  5. Comments like the one from this most recent Anonymous poster is why nobody takes the anti-circumcision whackos very seriously. C'mon, dude. Double mastectomies, DD implants, laser pubic hair removal -- WTF does this have do with medical studies that demonstrate the value of male circumcision?

    It's a common debate tactic to toss up strawmen, knock 'em down, and create stupid analogies to destroy the winning side. But, in this case, the anti-circ argument fails because medical science (not "junk" science) has concluded that males and their partners (male & female) are better off without a foreskin than with one.

    Dude, this is not some giant "global" conspiracy. It's just the reasonable result of countless studies and common sense. Your irrational argument undermines your credibility.

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  6. Is it not better not to have free sex? Circumcision will never help unless people stop sleeping around!! Froget about circumcision rather make a law against free sex!

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  7. I disagree with all the good stories about Circumcision that it will prevent people from contracting HIV. I think this is the most ridiculous situation in the world after Hitler.
    Routine Circumcision a dangerous message sent to many people in South Africa. What worries me the most is an article in a Johannesburg News Paper, about a boy of 18 who went for a circumcision. “I’ve heard we must come and circumcise so that we cannot get sick,” he said. “My parents think it’s a good thing.” Maiko is one of about 100 men aged 15 and up who come to the center every day and briefly occupy one of seven curtained-off beds in a one-room surgery”(see article http://www.irinnews.org/report.aspx?ReportID=85726) The whole aspect about circumcision is scary. If the message is understood that HIV cannot be contracted if you are circumcised the HIV rate in South Africa will increase considerably in the next few years.
    The USA is setting the example to the rest of the world. If the US is setting the wrong example the whole world will suffer!

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  8. Willie, thanks for posting but let's be clear. Nobody ever asserted that circumcision PREVENTS all cases of HIV. That's not what the evidence shows. The studies prove that it reduces the risk of female-to-male transmission by 60%. That's significant, but clearly not 100%. Circumcision also reduces the male's chance of HPV, STDs, and cancer. In other words, a man and his partner(s) are better off if the male is circumcised.

    This does not, however, preclude the use of condoms or other disease-preventive techniques. That African you quoted was obviously misinformed, but that is hardly a reason to abandon a perfectly good prophylactic policy -- the circumcision of all males.

    My hope is that the USA will set an excellent example to your country and many others by removing the risky foreskin from our population at birth. If we do that, the whole world benefits!

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  9. This is why *educating* everyone about the benefits is the most important, in addition to rigorous circumcision promotion campaigns. Of course the risk is never eliminated and it's not a free pass to engage in unsafe sex, but what it does is substantially lower the risk. Some things like phimosis and penile cancer will be virtually eliminated. And speaking of phimosis, many parents who decided against circumcision for their son at birth later had to have their son circumcised at a later age because of this or infections, or the son later has to have it done anyway later in life because of health problems. Why not

    You see ads on TV, in magazines, and on billboards everywhere when you're driving down the street stressing healthy choices like eating well, less TV more playtime, safe sex, exercising. I think there should be one that endorses and promotes circumcision for newborn boys. With the tagline having the statistics of how circumcision will lessen the risk of HIV, HPV, UTIs (which can also lead to kidney infections), etc.

    Lastly, health organizations need to reinstate universal routine infant circumcision.

    And there should also be greater awareness for parents, and something this important should definately be a major topic in parenting classes, needs to be on pamphlets, and just more widely raised for awareness.

    And to what Anoymous said above, that's just ridiculous. You're comparing circumcision to masectomies/implants for girls' cosmetic purposes. I really don't care about breast size or whether a woman has hair down there or not. As long as her bust isn't so big I could get lost in it or she's a werewolf down there-at least some maintenance and hygiene. That's just the media's definition of beauty. Circumcision is different because it has dozens of health benefits, hygiene reasons. Cosmetically looking better is just a great plus.

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  10. Totally agree - an awareness campaign is key. Parents are taught and encouraged to immunise in the West, why not circumcise as well?

    Present parents with all the facts and let them decide. The anti-circers want to prevent this at all costs, because they know they cannot win on the facts - just fears, much like the far right loonies in the current American healthcare debate, who are paranoid by their own ignorance.

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  11. I appreciate all the good comments, especially the last two Anonymous posters who pushed AWARENESS. When parents know the facts and doctors confirm the value of circumcision, then almost everyone does the right thing and circumcises their baby boy.

    Regular readers here know that I'm a bit of a radical here. Like childhood immunizations which are mandatory (with limited exceptions) for school, the positive benefits of circumcision so outweigh any risks that I favor mandatory circumcision at birth for all boys. This is not as extreme as it sounds because, of course, I would allow for exceptions, medically or religiously based or even if the occasional parent wanted to opt out of the health-confering procedure. The point is that circumcision at birth should be normal and routine UNLESS the parent specifically requests NOT to circumcise and can justify that request appropriately.

    We may never see the day when circumcision, like vaccinations, are required and 99.9% accepted. But I'm hopeful we can reach that result. As we move to greater AWARENESS of the health risks of the foreskin to both males and females, more and more parents will do the right thing. The tide has turned -- which makes the anti-circs even more fanatic in their silly cries of mutilation -- but all the studies about the health benefits of circumcision are beginning to sink in. And, finally, I think the news media is on our side because the facts support us!

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  12. "The bottom line is that circumcising males reduces the chance of HIV. Unless you think the foreskin outweighs the horrendous challenges of HIV, the conclusion is obvious: universal circumcision."

    You are confusing danger with risk, PD (as Chicken Little did).

    The danger of HIV/AIDS (death) is total, but the risk (likelihood of contracting HIV) is actually quite small, especially if you avoid the most risky practices, get tested (both of you) use condoms, and ideally confine yourself to one partner.

    No matter how great the danger, you still have to do a sober risk/benefit analysis, counting all the real risks of circumcision up to and including death, (and the inevitable loss and harm) and compare it with the real risk of HIV by female-male transmission in the developed world (very low indeed). And that's still assuming that the three African trials in which 5,400 men were circumcised, possibly protecting 73 men for less than two years, were faultlessly conducted.

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  13. Hugh7 wrote:

    No matter how great the danger, you still have to do a sober risk/benefit analysis,

    Absolutely.

    counting all the real risks of circumcision up to and including death,

    Quite.

    (and the inevitable loss and harm)

    What "inevitable" loss and harm is this?

    and compare it with the real risk of HIV by female-male transmission in the developed world (very low indeed).

    What's strange here is the omission of the other benefits of circumcision. It doesn't make sense to count "all the real risks" on one hand and a single benefit on the other.

    What does make sense is to conduct a "sober risk/benefit analysis" when considering all aspects, including the risks of circumcision and the benefits.

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  14. ANON5 - New poster to this threas.

    Can you please provide a link to where you got the information presented in this post?

    "Nobody ever asserted that circumcision PREVENTS all cases of HIV. That's not what the evidence shows. The studies prove that it reduces the risk of female-to-male transmission by 60%. That's significant, but clearly not 100%. "


    Just because you have something that reduces numbers by 60% does not mean we can clasp our hands, and walk away thinking "problem solved"

    Hell we already have condoms and they are FAAAR more effective in preventing HIV infection then circumcision could ever be. But the HIV problem in Africa is hardly solved.

    I have spent a lot of time studying African culture, and history in education. (not to mention I have a few close friends from south africa) And the point they made to me is they see this as another horrible thing.

    There is a pattern in Africa, of foreigners coming in, seeing problems (real or imagined) and imposing their culture, and completely negating africans culture. Because they think they know whats best. We can all see what this pattern has done in the past.

    Now specifically with HIV. People there are so desperate for a solution, they will do anything. Believe anything, so they dont have to live in fear of AIDS. A few years back the idea was spread around that if you have sex with a virgin, it will cure your AIDS. So ever since there as been a all too common problem of babies being raped by men trying to cure their own AIDS.
    Now this where my friends have gotten worried. Articles, like the one a user posted above are starting to come out, and more and more people are believing that circumcision CURES AIDS, so men go get it done, so they can have sex with out care, or precaution, because they are now "protected".

    Because you can say, well they should know its only 60% effective. But most campaign Ads for adult circ are not saying "come get circumcised, but still wear a condom because it does not really protect you from getting AIDS" Many African men would respond with "so I am taking time off work, to get something that does not even fully protect me?"

    Instead of providing a complex % rate discussion with every man who comes in for circing, instead many doctors simply say "yes it will protect you." This could cause this disease to spread, not shrink.

    But this is the result to the typical formula of the West coming to Africa to apply their culture to solve Africas problems, only to result in a bigger mess. It happens over and over, and if you think,
    "Nobody ever asserted that circumcision PREVENTS all cases of HIV. That's not what the evidence shows. "

    and just trying to let people know thats not what the evidence shows, and thinking that enough, just shows we are going to repeat the cycle again. Because if people in the international health groups think about it in the same way you just exhibited, then Africa is in store for a whole new wave of problems...

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  15. A splendid example of the benefits of circumcision that we can bring to Africa is explained nicely in this article:

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7GX6-4WN1YGT-4&_user=108429&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1019136223&_rerunOrigin=google&_acct=C000059713&_version=1&_urlVersion=0&_userid=108429&md5=fd886d9cffdcc2feca5b61ac23cf3953

    Clearly it's worth doing.

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  16. You'll need a subscription to Science Direct, or purchase the article, to see the horrific genital mutilation that is occurring in Nigeria as a result of pastibell circumcision. These boys will become the next generation of anti-circ nuts.

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  17. "... the horrific genital mutilation that is occurring in Nigeria as a result of pastibell circumcision. These boys will become the next generation of anti-circ nuts."

    What's "nuts" about objecting to having become the next generation of circumcision VICTIMS?

    What's nuts is creating such a generation.

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  18. Hugh7,

    You might find it useful to try constructing an actual argument based on evidence and logical reasoning. Using emotive, inflammatory language like "victims" is all very well, and is perhaps convincing to those who already share your ideology, but to the rest of us - I'm sorry to say - it does tend to reinforce the impression that you good people are "nuts".

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  19. The photos of the destroyed penises - from just one hospital in Lagos - is enough to make a fair determination that these boys are victims. Jake, a gay man who decided as an adult to get circumcised, and a well known defender of circumcsion on the internet, demonstrates at every post that he is psychologically unable to see the damage. He breaks up, every time, the world into "the rest of us", meaning circumcised men, and those men whose forced circumcisions were so damaging that they fight against the practice. Jake's penchant for circumcision proves that it was damaging for him too.

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  20. It would be laughable how predictably naive you people are, if it was not for all the damage its going to most likely cause.

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  21. As the author of this Blog, may I suggest that all participants -- and I mean ALL -- on both sides of this debate REFRAIN from calling each other names or engaging in any form of character assassination. Keep focused on the issue -- the benefits of universal circumcision for all males and their partners (male & female). I welcome everyone to this Blog, but let's keep the personal attacks out of this, PLEASE.

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  22. PlastiBell was introduced in mid-1950's it differs from Gomco circumcisions in part by increased use of scissors to trim the excess skinnage. There's a video on You Tube showing a PlastiBell circ and there are many disrespectful comments against the doc who demonstrated it on an admittedly screaming male. But he won't remember it, and the pain is temporary. The lady MD I staff for is proficient in Gomco and PlastiBell foreskin removal. It does make for noisy patients! And it's nice that their absence of consent is irrelevant.

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