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.
Showing posts with label World Health Organization. Show all posts
Showing posts with label World Health Organization. Show all posts
Friday, September 11, 2009
Saturday, June 13, 2009
Americans Lead Way for Africa on Circumcision, But Don't Forget the Homefront
I have blogged about this before, but it's worth repeating. The United States is showing amazing leadership in circumcising African males, as the latest story below reports, and who can quarrel with doing that on that disease-infected, foreskin-afflicted continent. But I worry that the strong campaign to circumcise African males may blind the eye to what is happening here at home. Sadly, even if the anti-circs exaggerate the numbers, more American boys, especially Latinos and blacks, are going uncircumcised. In part, that's because the government Medicaid program no longer pays for this important procedure in about a dozen states. Poor blacks and Latinos are the first to suffer.
So while we can all applaud the Bill & Melinda Gates Foundation, the U.S. government through PEPFAR, and PSI -- let's not forget the boys at home who need to be circumcised, too.
Here's a June 11 press release from PSI:
"The Male Circumcision Partnership is launching a massive scale-up of voluntary male circumcision services in Swaziland and Zambia. The Partnership is supported by a five-year, US$50 million grant from the Bill & Melinda Gates Foundation to Population Services International (PSI). PSI and partners Marie Stopes International, Jhpiego, The Population Council and the governments of Swaziland and Zambia estimate that the project will provide voluntary male circumcision services to nearly 650,000 men."
"The Male Circumcision Partnership program in Swaziland and Zambia also builds upon the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported medical male circumcision activities in each country. This partnership is evidence of a strong and growing coordination among the Gates Foundation, PEPFAR and other partners under the leadership of host country governments to support evidence-based medical male circumcision for the purpose of HIV prevention."
"Cited by both the World Health Organization and UNAIDS as an "important intervention," male circumcision reduces HIV infections among men by 60%,according to scientific research -- more effective than any vaccine currently in development."
So while we can all applaud the Bill & Melinda Gates Foundation, the U.S. government through PEPFAR, and PSI -- let's not forget the boys at home who need to be circumcised, too.
Here's a June 11 press release from PSI:
"The Male Circumcision Partnership is launching a massive scale-up of voluntary male circumcision services in Swaziland and Zambia. The Partnership is supported by a five-year, US$50 million grant from the Bill & Melinda Gates Foundation to Population Services International (PSI). PSI and partners Marie Stopes International, Jhpiego, The Population Council and the governments of Swaziland and Zambia estimate that the project will provide voluntary male circumcision services to nearly 650,000 men."
"The Male Circumcision Partnership program in Swaziland and Zambia also builds upon the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported medical male circumcision activities in each country. This partnership is evidence of a strong and growing coordination among the Gates Foundation, PEPFAR and other partners under the leadership of host country governments to support evidence-based medical male circumcision for the purpose of HIV prevention."
"Cited by both the World Health Organization and UNAIDS as an "important intervention," male circumcision reduces HIV infections among men by 60%,according to scientific research -- more effective than any vaccine currently in development."
Monday, May 4, 2009
Circumcision Reduces Chance of Swine Flu, H1N1
Could male circumcision reduce the chance of getting H1N1, better known as the swine flu? It's not as far-fetched as some anti-circumcision fanatics might wish. Consider the countries where swine flu has been most devastating. Mexico is an uncircumcised country. They have 590 cases, so far, with 25 deaths. The much larger USA, which is mostly circumcised, has had only 1 death and 225 milder cases.
Now obviously other factors could contribute to the ability of circumcised Americans to withstand the ravages of this flu disease. But the link between the foreskin and swine flu should be examined by the World Health Organization, which already recommends male circumcision to reduce HIV, HPV, and STDs. The FLs ("foreskin lovers") will no doubt jump all over any suggestion of a link betwen swine flu and uncircumcised males -- and this might be a case where there is no link -- but the fact that the country with the most cases of H1N1 and deaths from this is largely uncircumcised should at least give people pause.
Now obviously other factors could contribute to the ability of circumcised Americans to withstand the ravages of this flu disease. But the link between the foreskin and swine flu should be examined by the World Health Organization, which already recommends male circumcision to reduce HIV, HPV, and STDs. The FLs ("foreskin lovers") will no doubt jump all over any suggestion of a link betwen swine flu and uncircumcised males -- and this might be a case where there is no link -- but the fact that the country with the most cases of H1N1 and deaths from this is largely uncircumcised should at least give people pause.
Saturday, April 25, 2009
American Academy of Pediatrics Statement on Circumcision We Hope to See
Somewhere circulating within the emails of the American Academy of Pediatrics' Task Force on Circumcision, there is a draft proposal updating the AAP's 1999 "neutral" stance on circumcision in light of the growing medical evidence in favor of male circumcision. You can call this a fictional wish-list, but we hope the AAP has the guts to issue a report something like this:
After a comprehensive review of the latest medical and scientific evidence, the American Academy of Pediatrics concludes that all males should be circumcised, preferably at birth, as a matter of both personal medical well-being and general public health to protect themselves, their future sexual partners, and society as a whole from a number of debilitating, life-threatening, and costly diseases.
In 1999, the AAP declared that “scientific evidence demonstrates potential medical benefits of newborn male circumcision,” but we cautioned that “these data are not sufficient to recommend routine neonatal circumcision.” This position, reaffirmed in 2005, understandably left parents of newborn males in a quandary. While the medical benefits of circumcision were established, such as a substantial reduction in urinary tract infection, the evidence was not then compelling to recommend that every male be circumcised. Parents were left to draw their own conclusions, which meant that social, familial, and other non-medical concerns often took priority over health care in the decision-making process.
With substantial new scientific evidence over the last four years, the AAP now recommends that all newborn males be circumcised, and we encourage all public and private health insurers and medical providers to cover, promote, and establish efficacious ways to achieve universal male circumcision. We endorse routine neonatal circumcision, with all the appropriate analgesics to alleviate pain, and we recommend that all males, regardless of age, be circumcised. Circumcision not only confers life-long benefits on the male, but it also protects his female partners and society as a whole.
Among its other benefits, circumcision reduces a male’s chance of acquiring HIV by at least 50 percent, reduces his risk of acquiring HPV by 35 percent and spreading HPV to his female partners, reduces his chances of contracting Herpes Simplex Virus Type II by 28 percent, and reduces the likelihood of causing cervical cancer in his female partners. The AAP does not assert that circumcision eliminates these painful and costly medical scourges, but it will significantly reduce them. These health benefits to males and females far outweigh any risks posed by circumcision, and to suggest otherwise is to engage in a head-in-the-sand approach to science for political and non-medical reasons.
We recognize that the decision to circumcise children lies with the parent, so, consequently, just as with AAP-recommended vaccinations, an option not to circumcise must be made available. But the AAP concludes that sound science dictates the goal of universal male circumcision, regardless of the race, nationality, religion, age, or economic status of the male. A requirement by schools that all boys be circumcised before puberty is recommended, subject to exception for religious or deeply-held objection, or a rare medical necessity. But like the eradication of polio and measles through a policy of universal vaccination, the public health benefits of circumcision are best conferred when adopted by all.
This position in no way impugns the decision of many parents in recent years that left their sons uncircumcised. The decision not to circumcise was perfectly understandable, particularly in the context of the AAP’s former position. But medical science advances, and health care requirements must change with that evidence. Boys left uncircumcised, particularly as they become sexually active, increase their own risks and those with whom they are intimate. That is why the AAP encourages both public and private health insurers and health providers to establish cost-effective options to circumcise both young and older males. And we encourage parents of uncircumcised boys to take advantage of those options as quickly as possible.
Finally, we believe that the evidence for universal male circumcision is so compelling that the United States Government, through the Surgeon General, the Public Health Service, the Centers for Disease Control, Centers for Medicare & Medicaid Services, and all other relevant agencies, needs to engage in a public information campaign and improve affordable access to circumcision for all American males of every age. Under the leadership of the World Health Organization, many other governments have taken such a pro-active lead. The American Academy of Pediatrics urges the U.S. Government to do the same. A country with the greatest medical scientists, practitioners, and institutions should once again take the lead on this critical public health mission.
"DRAFT DRAFT DRAFT"
Task Force on Circumcision
American Academy of Pediatrics
Benefits of Male Circumcision Outweigh Risks
A Call to Universal Circumcision
Executive Summary
After a comprehensive review of the latest medical and scientific evidence, the American Academy of Pediatrics concludes that all males should be circumcised, preferably at birth, as a matter of both personal medical well-being and general public health to protect themselves, their future sexual partners, and society as a whole from a number of debilitating, life-threatening, and costly diseases.
In 1999, the AAP declared that “scientific evidence demonstrates potential medical benefits of newborn male circumcision,” but we cautioned that “these data are not sufficient to recommend routine neonatal circumcision.” This position, reaffirmed in 2005, understandably left parents of newborn males in a quandary. While the medical benefits of circumcision were established, such as a substantial reduction in urinary tract infection, the evidence was not then compelling to recommend that every male be circumcised. Parents were left to draw their own conclusions, which meant that social, familial, and other non-medical concerns often took priority over health care in the decision-making process.
With substantial new scientific evidence over the last four years, the AAP now recommends that all newborn males be circumcised, and we encourage all public and private health insurers and medical providers to cover, promote, and establish efficacious ways to achieve universal male circumcision. We endorse routine neonatal circumcision, with all the appropriate analgesics to alleviate pain, and we recommend that all males, regardless of age, be circumcised. Circumcision not only confers life-long benefits on the male, but it also protects his female partners and society as a whole.
Among its other benefits, circumcision reduces a male’s chance of acquiring HIV by at least 50 percent, reduces his risk of acquiring HPV by 35 percent and spreading HPV to his female partners, reduces his chances of contracting Herpes Simplex Virus Type II by 28 percent, and reduces the likelihood of causing cervical cancer in his female partners. The AAP does not assert that circumcision eliminates these painful and costly medical scourges, but it will significantly reduce them. These health benefits to males and females far outweigh any risks posed by circumcision, and to suggest otherwise is to engage in a head-in-the-sand approach to science for political and non-medical reasons.
We recognize that the decision to circumcise children lies with the parent, so, consequently, just as with AAP-recommended vaccinations, an option not to circumcise must be made available. But the AAP concludes that sound science dictates the goal of universal male circumcision, regardless of the race, nationality, religion, age, or economic status of the male. A requirement by schools that all boys be circumcised before puberty is recommended, subject to exception for religious or deeply-held objection, or a rare medical necessity. But like the eradication of polio and measles through a policy of universal vaccination, the public health benefits of circumcision are best conferred when adopted by all.
This position in no way impugns the decision of many parents in recent years that left their sons uncircumcised. The decision not to circumcise was perfectly understandable, particularly in the context of the AAP’s former position. But medical science advances, and health care requirements must change with that evidence. Boys left uncircumcised, particularly as they become sexually active, increase their own risks and those with whom they are intimate. That is why the AAP encourages both public and private health insurers and health providers to establish cost-effective options to circumcise both young and older males. And we encourage parents of uncircumcised boys to take advantage of those options as quickly as possible.
Finally, we believe that the evidence for universal male circumcision is so compelling that the United States Government, through the Surgeon General, the Public Health Service, the Centers for Disease Control, Centers for Medicare & Medicaid Services, and all other relevant agencies, needs to engage in a public information campaign and improve affordable access to circumcision for all American males of every age. Under the leadership of the World Health Organization, many other governments have taken such a pro-active lead. The American Academy of Pediatrics urges the U.S. Government to do the same. A country with the greatest medical scientists, practitioners, and institutions should once again take the lead on this critical public health mission.
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