Sunday, April 11, 2010

South Africa to Circumcise Two Million Men

This amazing headline -- "South Africa to Circumcise Two Million Men" -- must drive the anti-circumcision fanatics crazy. After all, their goal is to keep the foreskin just where it is, thank you, free to infect the sad guy (or his partner) unfortunate to have one with STDs, HIV, and other diseases, to say nothing of his bad genital odor.

But this headline was prominent this past week as the South African government in one of its provinces committed to increase the health of its nation through the removal of that useless piece of ugly skin that has caused so much harm over the years.

Circumcising two million men sounds daunting, and would have never been necessary had routine neonatal circumcision been practiced throughout South Africa. It is so much better to snip a baby than to subject an adult male to a healthy circumcision. But it may take a generation or two before South Africa joins America in leaving the foreskin behind at the maternity hospital.

In the meantime, congrats to South Africa for setting an ambitious goal. You have a lot of fans in the USA rooting you on.

Here's the whole newspaper article:

"South Africa to circumcise two million men

Durban: In an effort to combat the scourge of HIV and Aids, over two million men will be circumcised in South Africa's eastern KwaZulu-Natal province, BuaNews reported on Friday.
The premier of KwaZulu-Natal province, Zweli Mkhize, said on Thursday this initiative had received overwhelming support from HIV activists and the medical fraternity.

The process will begin on April 11.

In late 2006, two randomised controlled trials on whether male circumcision reduces HIV transmission were halted because interim results showed an overwhelming protective effect, validating the results from an earlier South African trial conducted in Orange Farm.

Based on the weight of the evidence from both observational studies and randomised trials, public health leaders have concluded that male circumcision when performed by well-trained and well-equipped health professionals can significantly reduce the risk of HIV infection among adult men.

"We now have our task cut out for us to circumcise over two million males using the safety of professional techniques and encourage HIV pre-testing," he said.

16 comments:

  1. "This amazing headline -- "South Africa to Circumcise Two Million Men" -- must drive the anti-circumcision fanatics crazy."

    Not really. What a grown man does with his foreskin is of no concern to me. This new headline must drive the circumcision advocates insane "Circumcision benefits not seen in Australia" published today in the Australia Journal of Public Health.

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  2. Presumably Anonymous is referring to this study.

    I'm afraid it is unclear to me, though, why it should "drive the circumcision advocates insane". Indeed, it is unclear why the results of any single study (especially an observational study) should do more than raise an eyebrow, let alone drive anyone insane.

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  3. You mean like your observational study that you say proves over 50 percent of men want to get circumcised? The one at the gay parade? Where men were answering in part because of the false belief that adult circumcision reduces their risk of penile cancer? Like that one?

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  4. Do you mean Begley et al? If so, yes, that was an observational study, too.

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  5. How about the story from Johannesburg about a clinic that offers lunchtime circumcisions (it says only Chuck Norris types should go back to work afterwards)?

    "The clinic started offering circumcision in mid-February. It has received calls from all over the country, but it has circumcised only about 12 men."

    It's going to take a long time to reach 2,000,000 circumcisions at that rate.

    "In late 2006, two randomised controlled trials on whether male circumcision reduces HIV transmission were halted because interim results showed an overwhelming protective effect, validating the results from an earlier South African trial conducted in Orange Farm."

    Yes, and now we know that trials stopped early are more likely to show a positive effect even when there is none.

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  6. Yes, and now we know that trials stopped early are more likely to show a positive effect even when there is none.

    As I pointed out in our discussion, we don't actually know that at all. But we seem to get rather a lot of overinflated claims about what is "known" here. ;-)

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  7. With almost 49 million people, and one of the highest rates of HIV infection in the world, it's gonna take more than 2 million circumcisions. Even if every many woman and child in SA were circumcised, they would still have one of the highest rates of HIV. What a great experiment!

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  8. whoops, that should have been man woman and child. But "many woman" would probably do just about as much good. HIV will always be an epidemic in this country, and the life expectancy will just keep sliding.

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  9. Why on earth does anybody think that circumcision is going to have a significant impact on HIV rates in South Africa?

    "South Africa has the highest number of HIV-positive citizens in the world."

    "More than 67,000 cases of rape and sexual assaults against children were reported in 2000 in South Africa."

    "South Africa has some of the highest incidences of child and baby rape in the world."

    "A belief common to South Africa holds that sexual intercourse with a virgin will cure a man of HIV or AIDS."

    "It is estimated that a woman born in South Africa has a greater chance of being raped than learning how to read."

    "It is estimated that 500,000 rapes are committed annually in South Africa.[7]"

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  10. Right Jake. Lets discard it as it is only an observational study. Yet you do not discard a study that was done in Africa when arguing your case for circumcision in a developed country.

    Observational study after observational study in developed countries show that it has no effect.
    Hence it is silly to engage further with a circumcision experiment in the USA (which so far, has failed spectacularly).
    And I mean that. I hear the pro-circ crying - "but the HIV rate would have been higher". Really? I doubt it. The USA is not spectacularly different to the UK. And I think I am right in saying that the UK has lower rates of HIV. The USA is also much more religious than the UK so you would expect that to reduce promiscuity. So: less promiscuity together with circumcision and still, higher rates of HIV. Now you might bring up that "the fact they are religious would also mean that they oppose condoms". But is that true? I thought that was just Catholics. I am English so I don't know for sure, but isn't planned parenthood an organisation that promotes condoms and isn't that organisation quite prominent? Also, wouldn't anti-abortion groups, which I gather are also quite prominent, endorse condoms too?
    To me it is quite easy to see the reality of what is going on here, and science has nothing to do with it. What it really boils down to is a bunch of academics who are in the field of HIV trying to get more grant money. People like Halperin, Moses, Schoen, Morris et al have spent their whole careers promoting circumcision. To accept the fact that they were wrong all along would be a major ego blow. There is also probably some pyscho-sexual fascination here with most of them. Jake being a gay man probably prefers the circumcised look. He also probably thinks that with anal sex it is more hygienic and practical for the inserter to be circumcised. Correct me if I am wrong Jake. Sorry to get personal but lets not pretend that pro-circers are so passionate for purely altruistic reasons.

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  11. Circumcision in SA? That's not the problem or the cure. HIV reflects sexual practice, not circumcision status.

    From Time Magazine, 2009:

    South Africans received a horrifying measure of just how bad their country's rape crisis is with the release this week of a study in which more than a quarter of men admitted to having raped, and 46% of those said that they had raped more than once.

    The study, conducted by South Africa's Medical Research Council, reveals a deeply rooted culture of violence against women, in which men rape in order to feel powerful, and do so with impunity, believing that their superiority entitles them to vent their frustrations on women and children. The men most likely to rape, the researchers found, were not the poorest, but those who had attained some level of education and income. (See pictures of South Africa, Fifteen Years On.)

    Researchers interviewed 1,738 men of all race groups, in both urban and rural settings in the Eastern Cape and KwaZulu-Natal, provinces marked by high rates of AIDS and poverty, and the men answered questions about rape and HIV using small handheld computers in order to guarantee anonymity. Of those admitting rape, 73% said that they had committed their first assault before the age of 20. According to the researchers, many of the study's participants appeared to see no problem with what they had done. These findings, says Mbuyiselo Botha, a senior program advisor at Sonke Gender Justice, an advocacy group for abused women, "highlight the lack of remorse among men in our country, and also the attitude that women remain fair game for us." Men, says Botha, "continue to abuse even to the point of getting away with murder."

    South Africa has one of the highest incidents of reported rape in the world. The most recent statistics show that 36,190 cases of rape were reported to the police between April and December 2007, though experts believe that number only accounts for one out of nine cases. But the number of rape cases that make it to court — let alone result in a conviction — are far fewer.

    Researchers said that many of the perpetrators reported having bullied or been bullied. The study also underscores the huge divide between South Africa's liberal constitution, which enshrines the rights of women and children, and "the realities of a society where poverty, inequality and violence are rife."

    Gender advocates say that the 2006 rape trial of prominent politician Jacob Zuma was incredibly damaging to their cause. Zuma, who was elected President this year, was tried and acquitted of raping an HIV-positive family friend. He told the court that the woman had dressed provocatively, in a traditional wrap-around kanga, and that it was against Zulu culture for a man to leave a sexually aroused woman unsatisfied. (See a profile of South African president Jacob Zuma.)

    Zuma's plainspoken views as a polygamist and a traditionalist appeal to many men who feel adrift in a society that defines men by the material trappings they attain, says Aernout Zevenbergen, author of Spots of a Leopard, a book on masculinity in Africa that is soon to be released in English. "Rape is a signal of a society that is sick to the core," Zevenbergen says. He points to South Africa's long history of migrant labor, in which men left home to work in the mines, as having broken apart generations of families. This system set the stage, he says, "for an epidemic of young men who, in the absence of positive male role models, are now consumed by a sense of anger and entitlement."

    "What we have are the wounds of men creating wounds in women, creating wounds in children," says Zevenbergen. "Who is going to stop the vicious circle?"

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  12. Right Jake. Lets discard it as it is only an observational study.

    May I propose a more moderate approach? Why not treat it as one piece of appropriately weighted evidence among many? Compared with RCTs, the appropriate weight is relatively small, but discarding it altogether would be a mistake.

    Yet you do not discard a study that was done in Africa when arguing your case for circumcision in a developed country.

    It wouldn't make sense to do so. Human anatomy is the same in Africa as it is in developed nations.

    Observational study after observational study in developed countries show that it has no effect.

    I haven't counted, but I would estimate that two thirds of observational studies conducted in developed nations find results consistent with a protective effect.

    Hence it is silly to engage further with a circumcision experiment in the USA (which so far, has failed spectacularly).

    Where's your evidence?

    And I mean that. I hear the pro-circ crying - "but the HIV rate would have been higher". Really? I doubt it. The USA is not spectacularly different to the UK. And I think I am right in saying that the UK has lower rates of HIV. The USA is also much more religious than the UK so you would expect that to reduce promiscuity. So: less promiscuity together with circumcision and still, higher rates of HIV. Now you might bring up that "the fact they are religious would also mean that they oppose condoms". But is that true? I thought that was just Catholics. I am English so I don't know for sure, but isn't planned parenthood an organisation that promotes condoms and isn't that organisation quite prominent? Also, wouldn't anti-abortion groups, which I gather are also quite prominent, endorse condoms too?

    I guess if you argue on the basis of assumption, rather than evidence, you can reach any conclusion you want.

    (continued.)

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  13. Here's some data on the differences in sexual practices:

    "More US (16%) than UK (4%) women reported additional
    acts (other than in the last 5 days) of unprotected sex
    during the cycle in which they sought EC." Blanchard K,
    et al. Differences between emergency contraception users in
    the United States and the United Kingdom. J Am Med Womens
    Assoc. 2002 Fall;57(4):200-3, 214.

    "In comparison with that of Britain, the US population has
    greater variability in sexual behavior, less tolerant opinions
    about sexual behavior, and a higher STD prevalence and lower
    condom usage among men." Michael RT, et al. Private sexual
    behavior, public opinion, and public health policy related to
    sexually transmitted diseases: a US-British comparison. Am J
    Public Health. 1998 May;88(5):749-54

    "Annual abortion rates (per 1000 women aged 15-44) are 5.6
    in the Netherlands, 13 in Britain and 28 in the USA" Drife
    JO. Contraceptive problems in the developed world. Br Med
    Bull. 1993 Jan;49(1):17-26

    "Of the 4 country/gender groups, US males were at the highest
    risk, while Swedish men had a low-risk behavior profile. Fewer
    differences were found between the women." -- Weinberg MS,
    et al. AIDS risk reduction strategies among United States and
    Swedish heterosexual university students. Arch Sex Behav. 1998
    Aug;27(4):385-401.

    "Among countries of the 'developed world', the teenage birth
    rate in the UK is second only to that in the USA. The UK rate
    is nearly five times that in the Netherlands, over three times
    that in France and over twice that in Germany" -- Contraception
    in teenagers. Drug Ther Bull. 2002 Dec;40(12):92-5

    "In 1998, 42 health professionals and graduate students from
    the US traveled to Europe to study successful approaches to
    adolescent sex behavior adopted by Germany, France, and the
    Netherlands. The main lesson learned was that the policies of
    these countries are based on research not ideology and accept
    adolescent sex behavior as normal and healthy. The countries
    fund sex education and reproductive health services for
    adolescents, including contraception and abortion services.
    Rather than leading to promiscuity, as compared to the US
    this policy has resulted in a higher average age at first
    intercourse, fewer sex partners, longer waits between partners,
    and reduced numbers of abortion." -- Brick P. How does Europe
    do it? Fam Life Matters. 1999 Winter;(36):3

    To me it is quite easy to see the reality of what is going on here, and science has nothing to do with it. What it really boils down to is a bunch of academics who are in the field of HIV trying to get more grant money. People like Halperin, Moses, Schoen, Morris et al have spent their whole careers promoting circumcision. To accept the fact that they were wrong all along would be a major ego blow. There is also probably some pyscho-sexual fascination here with most of them. Jake being a gay man probably prefers the circumcised look. He also probably thinks that with anal sex it is more hygienic and practical for the inserter to be circumcised. Correct me if I am wrong Jake. Sorry to get personal but lets not pretend that pro-circers are so passionate for purely altruistic reasons.

    I'm not going to discuss personal matters with you, Richard, nor am I going to bother to respond to a paranoid conspiracy theory about the motives of researchers. I'm very happy to have a mature discussion, grounded in evidence, about circumcision. It's your choice.

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  14. In Swaziland, More circumcised men are HIV positive. Here is the article to prove it. Circumcision is and has always been a surgery looking for a reason.

    http://www.times.co.sz/index.php?news=20909

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  15. Sex is so much better for oneself and ones lover after circumcision! Sirkumsised

    ReplyDelete