BBC: Circumcision 'cuts' HIV infection

[jaybeat]

Circumcision can cut the rate of HIV infection in heterosexual men by 50%, results from two African trials show.

The findings are so striking, the US National Institutes of Health decided it would be unethical to continue and stopped the trials early.

It supports a previous South African study which reported similar results.

Experts said it was a significant breakthrough but could not replace standard methods of preventing infection such as condoms.

The two trials of around 8,000 men took place in Uganda and Kenya were due to finish in July and September 2007 respectively.

But after an interim review of the data by the NIH Data and Safety Monitoring Board decided to halt the trials as it was unethical not to offer circumcision in the men who were acting as controls.

Full article here.

Boy, it sure sucks when a ritualized mutilation without any rational justification turns out to, in fact, make us healthier than the way we are made to start with. But...

A modelling study done by international Aids experts earlier this year showed that male circumcision could avert about six million HIV infections and three million deaths in sub-Saharan Africa.

Obviously, with numbers like that, any disappointment is, to say the least, misplaced.

[Bunny]

1. Okay, I know this is LBN and I should be serious, but too bad...

:popcorn:

[grasswire]

2. the director of the WHO's AIDs program is named...

...Dr. de Cock?

[muriel_volestrangler]

3. And what more appropriate name for the UN doctor than

"Dr Kevin De Cock" :rofl:

Damn - I should type faster ...

[originalpckelly]

52. In french de is equal to "of" So he's Kevin of Cock!

:rofl:

[William769]

4. Who would have thought that Circumcision can prevents AIDS.

:eyes:

[jaybeat]

11. There's reducing your chances and then there's prevention

Apparently the studies show that if a man is circ'd, he has about half the chance of getting HIV as someone else who is intact. But there's still a chance, all things being equal. So, if you already are using currently accepted strategies to prevent infection (condoms, 100% fidelity between tested partners--don't laugh!), this reduces your chances even more.

I wonder by what % does rigorous condom use reduce the chance HIV infection? (In heterosexual sex only; the study did not look at homosexual transmission.) My guess would be that it is a lot more than by 50%, but it is also not 100%.

And 6 million fewer cases and 3 million fewer deaths (in Africa alone--is that per year??) means that there is not much point in quibbling over statistics.

Snip! Snip!

(Sorry, the procedure disgusts me and I'm using humor to compensate.)

[endarkenment]

20. You asked:

"The protection that proper use of latex condoms provides against HIV transmission is most evident from studies of couples in which one member is infected with HIV and the other is not, i.e., "discordant couples." In a study of discordant couples in Europe, among 123 couples who reported consistent condom use, none of the uninfected partners became infected. In contrast, among the 122 couples who used condoms inconsistently, 12 of the uninfected partners became infected."

ooops link added: http://www.thebody.com/cdc/factcond.html

consistent use: 100% effective. inconsistent: 90% effective.

Hmmmmm.... ritual mutilation or effective barrier techniques.

[bluerum]

5. Hells bells - cut the whole damn thing off while you're at it. I bet that

will slow down the spread of aids too.

[Hugin]

7. To prevent colds and flu... Cut off people's noses.

Same logic.

[bluerum]

8. Hand to face contact is the biggest transmitter of colds and flu.

The hands must go as well.

[Javaman]

80. And the face.

:rofl:

[last1standing]

You're comparing HIV to a head cold?

I don't like circumcision as it really is, as the O/P pointed out, ritualized mutilation, but let's try to keep some sense of proportion about this. HIV is a deadly disease that has no cure and ultimately leads to the deaths of many, if not most of its victims. A head cold generally goes away within a week, even without medical support.

If circumcision can be used a a tool in combating the spread of HIV then it's something that needs to be considered, just like sex education and the dispensing of condoms. And before the extremists jump in screaming about forced mutilation of children, I'm suggesting it ONLY for adults who can make up their own minds and decide to have the procedure performed on themselves. Children should be left intact.

And to be honest, if colds and the flu were generally deadly and it was found that nasal amputation was an effective means of preventing six million deaths, then I'd suggest we consider that as well. Other than that, the logic was impeccable.

[Hugin]

22. Condoms are a better tool.

[last1standing]

54. And they should be used.

But if voluntary, adult circumcision could also help, then its something to look at.

[nodehopper]

97. unfortunately, they are vastly underused in Africa

because of a cultural stigma associated with them, despite the best efforts of whatever NGOs that haven't been disenfrenchised for promoting safer sex.

[endarkenment]

100. Research Uganda regarding that myth. nt.

[endarkenment]

24. Ok how about mastectomy at birth?

After all breast cancer is a hugely awful disease, worse than HIV.

[last1standing]

53. Yes. I'm in favor of forced mastactomies at birth.

If you had bothered to even read my post, you would have seen that I was saying the exact opposite of what your *very intelligent* rebuttal was meant to argue against. But that's the way it is with extemists of any ilk. Jump in fighting regardless of the facts. :eyes:

[endarkenment]

56. prophylactic mastectomies are actually done.

I didn't intend to attack you. I really was wondering in general why, if it is rational to mutilate men for a 50% reduction in risk, shouldn't women be mutilated for the risk avoidance with respect to breast cancer? It seems a fair question to me.

[last1standing]

60. Because I didn't say it SHOULD be done, I said it was something to look at.

I also stressed that it should only be done on adults who volunteer for it, not children at birth. You were arguing points that I had specifically not made. It also showed that you didn't read my entire post so it irked me when I knew you were debating me without even bothering to consider what I was saying.

Please read the post, then tell me what's wrong with my opinion. I'm happy to consider well thought out rebuttals as I did in another post in this thread.

[XemaSab]

112. Babies don't have boobs

:eyes:

[Hugin]

28. I beg to differ... Influenza is in the top 10 killers world wide.

I wasn't referring to a 'mere head cold'.

[last1standing]

51. And cutting off your nose can prevent it? WOW!

Unless it can, you're not comparing apples to apples.

[endarkenment]

59. Well without meaning to be offensive, cutting off your hands might.

I could be wrong but I think it is hand contact that is the more effective transmission agent.


The whole discussion drives me nuts, as you have noticed. Everytime there is any evidence that men ought to have their penises chopped up, the clipping fan club has a party.

[last1standing]

63. We also have to look at cost versus benefit.

Hands are a little more important than foreskin, I think. I believe its wrong to circumcise children without a solid medical reason, but you'll never convince a single parent who does it for either religious or social reasons so I don't get involved in that debate. It's like trying to debate a fundie with logic. You can't argue with people who place their entire lives in the hands of faith and you can't tell a parent that they can't clip their kid. It's a shame but that's just the way it is.

[closeupready]

35. I agree that if an adult decides they want to, that is better

In fact I know men who did decide to have it done and were glad they did. in contrast, i know men who were mutilated as they were being circumcised (as infants).

[last1standing]

57. I was circumcized and wish I hadn't been.

But I know guys who have had the surgury as adults as well. To each his own. :)

[endarkenment]

61. Yes it would have been nice to have been asked.

I've fought this battle at home and my kids are all intact and free to choose what they would like to do if and when they want or need to do anything. The lack of sensitivity (pun intended) on this subject displayed by some posters is amazing.

[customerserviceguy]

82. Count me

as one of the adults who did, and I made sure my boys were done shortly after birth, so they have no conscious memory of having had it done. I didn't want them having to deal with inheriting my circumstances.

[colorado_ufo]

40. Well meant sentiments, but the operation is much harder on adults.

Having worked in surgery, I know this to be true. However, it is inexcusable to perform this procedure on infants without at least topical anesthesia, as was done in the past. This was truly ignorant.

[jaybeat]

43. Not so very long in the past

Happened in the NICU when my son was born in 1997. Only one practitioner used anesthesia out of half a dozen procedures we witnessed. It was sickening.

[AtomicKitten]

62. I have never understood that claim.

I transcribe surgery reports and NEVER in my 30+ years of doing so have I EVER transcribed a circumcision without anesthesia, for infants or adults. I have always thought that claim was propaganda used by the anti-circumcision folks.

[endarkenment]

64. You've never been to a bris?

I have. Yikes.

[AtomicKitten]

67. wow - glad I missed that experience too

A mohel doesn't use anesthesia? Yikes indeed.


I found this http://www.ebris.com/questions.html#3

Anesthesia, if recommended, what types are used?

Yes. I recommend the use of pain reducing medications such as elamax cream non prescription anesthetic cream, infant Tylenol, sucrose water, Kosher sweet wine or sweet grape juice and a lidocaine based ointment for aftercare.

I believe that this recipe of helpful ingredients diminish the baby's discomfort in a rational and reasonable way. I feel the use of injection anesthetics is overly aggressive and exposes the baby to potentially serious complication without significant beneficial effect. Injection anesthetic is not considered acceptable under Jewish law in certain Jewish religious circles. I will however, agree to use an injection anesthetic (dorsal block) if a family requests its use.

[Javaman]

81. My question is: how do they train for that? On bananas?

or better yet...wait for it...baby dills.

Ba dum bum! I'll be here all week folks remember to tip your waiters!

[jaybeat]

69. Well, we didn't look at the charts, but

For one kid, the practitioner used a spray on the, er, area, a few minutes before beginning, and the baby fussed a bit, but didn't really cry the whole time. (Though I'm sure he did after the local wore off! :scared: )

All the rest, I can't say for sure that a spray *wasn't* used (for some I know it wasn't, but I didn't watch them all closely), but the babies all screamed like holy hell. Not a hunger cry or an "I don't like being held down" cry, but a huge, whoppin', giant pain cry.

That one practitioner later confirmed to us that she used the local but that most didn't. (That is, she always offered it to the parents, while the others didn't even mention that it was an option.)

[AtomicKitten]

70. yikes

That was a local anesthetic that freezes; I had a skin tag removed with it and had no pain. It's really peculiar that every single circumcision I've transcribed over the years, and there have been many, ALL indicated anesthetic was used, almost always injectable.

Somehow I feel I owe my son an apology now ...

[Ms. Toad]

104. do you regularly transcribe for the same practice?

My guess is that individual doctors (and likely practices) regularly follow the same practice - so you may have been seeing the reports from same doctor and/or practice group over and over.

The doctor involved in my child's birth did not use anesthesia - and we had decided against circumcision if she had been a he - but would have insisted on anesthesia if we had made the opposite choice (and she had been a he).

Always talk to the doctors treating your child - they often believe children do not really feel have a developed sense of pain (no kidding - there have been studies about this).

[AtomicKitten]

106. **

work for several acute care institutions (hospitals) in California, mostly surgeries. Seriously, ZERO of the thousands of this particular procedure I've transcribed over the years at many different institutions by many different MD's have done circumcision without anesthesia. The thought of doing so without anesthesia is barbaric.

[Midlodemocrat]

79. I used to transcribe surgery reports as well and my experience is the

same as yours. I never ran across one OB who didn't use some type of numbing agent, even a topical one like lidocaine.

I insisted on anesthesia for my son and he seemed to be okay. Not a ton of screaming or anything like that, Thank God.

[colorado_ufo]

88. It may depend on the area of the country where you work.

My son was a very quiet baby from birth, but the day of the circumcision, he screamed for hours afterward. I was incredibly stressed by this.

[Midlodemocrat]

90. I definitely believe you about your baby, it's just that I have no first

hand knowledge of it.

[last1standing]

55. Very good points.

I don't know how difficult it is or the risks involved. I'm just saying it's something that should be looked into, but that could be a good reason to look elsewhere.

[Viva_La_Revolution]

75. aside from the fact that in Africa

1. there is not enough water to drink, let alone bathe properly.
2. they practice "dry sex" which greatly increases the chances of AIDS spreading.


I would be willing to consider this true if the study was held in another country without those two issues messing with the numbers.

[last1standing]

76. There are two flaws there, I think.

One, you've made a very common mistake in lumping all of Africa together as a homogeneous entity. There's a tremendous amount of diversity in the makeup of Africa's geography depending on location and while there are some places that do not have sufficient access to water there are many more that do. Two, while practicing dry sex could definitely be a factor in HIV transmission, I'd have to think that it would evenly affect both circumcised and uncircumcised men equally so it would be a non-factor for the purposes of the study.

At least that's my opinion of the situation. I'm definitely no expert on the subject and if you are I'd love to hear more about it in detail.

[SmokingJacket]

73. Do you have any sense of how devastating AIDS is in Africa?

It's worth offering to people, if they want to cut their risk in half.

[Hugin]

6. So... They'd rather hand out circumcisions than condoms?

:eyes:

[jaybeat]

15. In fairness, it looks like they went out of their way to *not* say that

Dr Kevin De Cock, director of the HIV/Aids department of the World Health Organization told the BBC the results were a "significant scientific advance" but were not a magic bullet and would never replace existing prevention strategies.

<snip>

"This is an intervention that must be embedded with all the other interventions and precautions we have. Men must not consider themselves protected. It's a very important intervention to add to our prevention armamentarium."

<snip>

But Tom Elkins, Senior Policy Officer at the National AIDS Trust warned: "There is a real danger in sending out a message that circumcision can protect against HIV. This is not the case and could lead to an increase in unprotected sex.

"There is still a long way to go in providing comprehensive prevention programmes in many countries, and resources should go into normalising the use of condoms, which are the most effective method currently available for preventing HIV."

[aquart]

9. You poor dears, clutching your tiny wee turtlenecks.

I say, don't circumcize. Your people will croak. Mine will live. oh, dear.

Sorry, but you're making me laugh.

[BreweryYardRat]

12. Foreskin adds extra length/girth when you're really horny.

That's worth taking risks for, thank you.

[aquart]

13. Still laughing.

Teeny weeny tiny turtlenecks.

[Megahurtz]

37. "Turtlenecks" not always as teeny as you think.......

:hide:

[Lilith Velkor]

84. Obviously he's never been to the Rez

I wouldn't suggest it. He seems insecure enough about size already.

[endarkenment]

16. A similar comment regarding female genitalia here would

be deleted.

And condoms cut infection rates by how much?

Ritual mutilation or condoms, hmmmmm....

[E-Z-B]

23. Do you expect the people of Africa to start using protection?

It's tough enough getting Americans to do that. You can't expect people in third world countries to "be prepared".

[endarkenment]

25. Do you realize what a racist statement that is?

And yes, there have been successful programs in third world countries to promote safe sex practices. Uganda and Thailand come to mind.

[E-Z-B]

26. How is that racist?

It doesn't matter what race the people are. They live under different conditions, different priorities. Food, land, procreation to continue the community, survival of the people are the primary concerns. It's not about carrying protection - that's the least of their concerns.

[endarkenment]

29. I'm sorry if you don't understand

"Do you expect the people of Africa to start using protection" yes, given access to condoms and good information about their use, people in africa will use condoms. See Uganda. That you do not expect african people to behave this way is racist.

[E-Z-B]

31. You could insert "africa" with "central america" or "rural china"

It doesn't matter. The same survival conditions apply anywhere.

You reading into something that isn't there.

[LeftyMom]

41. It makes more sense than expecting widescale sterile surgery. nt

[aquart]

27. You go with the condoms, sweetie.

The rest of us will carry on.

I have to stop laughing here.

[endarkenment]

33. So if I posted:

'go get a clitorectomy, after all it will reduce your sexual desire and thus your chances of getting or spreading sexual disease, and after all it is just a tiny little button, you would not be offended?

Female circumcision has been practiced for thousands of years, therefore there must be a good reason for it, or so it seems from the posts I've read here.

Still laughing?

[E-Z-B]

36. Do you have statistical numbers to back your claim?

[endarkenment]

50. No of course not.

And any scientist seriously proposing to evaluate the health benefits of ritual female genital mutilation would most properly be laughed out of a career. So why the fascination with ritual male genital mutilation?

[kutastha]

10. Interesting study

A similar one in last month's Pediatrics looked at a cohort over 25 years and found that uncirced males were 3.19 times more likely to be infected with an STD than circed males.

[mimitabby]

14. years ago

they noted that Jewish women had less cervical cancer and it was suggested it had
something to do with their husbands all being circumsized. There's a reason
for this "ritualistic" surgery

[jaybeat]

17. Could be, but if men are transmitting HPV...

It is because they can't keep their puppy in the house. If true, it sounds like being circ'd means you can step out on the Mrs. and have less chance of giving her cancer because of it. (The article said they are also studying to see if this is true for HIV.)

All the studies I've seen before these have been *very* shaky and contradictory in their attempt to justify circumcision through health benefits.

Check out NOCIRC for more info.

[E-Z-B]

21. Men don't always think logically, act ethically, carry protection, etc.

This is procedure that is more likely to save lives then promising to be "faithful", virtuous, etc.

[endarkenment]

48. You've managed flat out sexism as well.

Africans can't use condoms so they need to have their dicks clipped, and men in general aren't to be trusted so cut them up too. Thanks.

I'll stick with the 100% effective if used consistently condoms.

[depakid]

83. Unfortunately, the reality is that they don't

which is why HIV has spread like wildfire across the continent.

Not to even say that NGO's and governments shouldn't be actively promoting condom use- of course they should, and not just because of HIV.

[raebrek]

105. Condoms break N/T

[kutastha]

32. As one who's performed circumcisions

and talked with parents about it, many have already made their decision before they even deliver, based on cultural or other personal beliefs. Not one has said they were asking for it for prevention of STDs. I've looked at these studies and can't see the "shakiness" in the results, though I admit I haven't found ones that try to justify circumcision. The AAP's stance on circumcision is one that leaves it up to the parents. I would never convince someone of circumcizing their child, just provide information if they are curious.

At least from a pediatric standpoint, I'd bet these studies on STD prevention would have as much impact in parents' decision to circumcise as the decision to immunize with Gardasil. Few parents get all excitied about the thought.

[jaybeat]

42. Infants are a different matter

You can't ask an infant whether the benefits outweigh the risks. And there are *no* risks to leaving the body intact, at least until a child becomes sexually active. Though they may not be "mature" by that time ("may"??), they do have the power to take actions that will have life-long consequences (getting someone pregnant comes to mind), so they at least could be asked (like the men in the control group of this study) to decide for themselves if the benefits of the procedure outweigh the risks.

After all, it is their body.

And I'm not sure I get the comparison with an immunization. Sure, there can be unwanted side effects, even severe ones. But if the benefits would kick in before the child is old enough to decide for themselves, then the parents have to be the ones to weigh the risks and benefits and decide. With circumcision, there *are* no risks to skipping the procedure without sexual activity, so I don't see how parents should get to decide over ten years in advance of any possible harm! When the risks (associated with not having the procedure) are there, the child is old enough that they can decide for themselves.

And any benefits to the procedure are, as you point out, unintended side effects that do not enter into most parents' decision-making process.

The primary effect is pretty clear and hard to miss!

[kutastha]

44. "And I'm not sure I get the comparison with an immunization"

One of the issues some parents have with Gardasil is that it is recommended for teenagers and they can't fathom the idea that their child will be having sex. I was stating that these circumcision studies will likely carry as much impact on parents as Gardasil, e.g. "one of the benefits for little Johnny is that he's less likely to get STDs if he's circumcised" would likely leave a similar bad taste in the parents' mouths.

Additionally, by waiting for the child to achieve an age where they can make an informed decision on circumcision would certainly greatly reduce the procedure since after about 2-4 weeks, circumcision becomes much more involved (including general anaesthesia) and is considered a cosmetic procedure, costing thousands of dollars. By then, the skin is tougher and the increased blood supply to the foreskin makes bleeding quite an issue.

Though, I have referred a 25 and an 80 year old to Urology for elective circumcisions.

[jaybeat]

46. Presumably, adult circumcision should no longer be seen as "cosmetic"

It either has been proven "safe and effective" (against HIV, STDs, or being sent to Hell when you die), or it hasn't been.

And, sorry, my ignorance that Gardasil was for teenagers. Presumably they can also decide for themselves, and obtain the vaccine with or without parental consent, just like with reproductive care?

[aquart]

34. You fight that circumcision! You go!

Christians are NOT required to offer symbolic sacrifice.

You go be happy with your teeny weeny tiny turtlenecks.

For as long as you survive. Oh, heck, it won't kill all of you.

[E-Z-B]

18. Agreed. It's been around for thousands of years.

It's generally been widely known that hygene is a problem with the extra skin. This just reinforces why it should be performed on males.

It's not tramatic. Men will be fine afterwards.

[aquart]

30. Well, yes, but that isn't it.

That's like saying pork isn't kosher because of trichynosis (sic?).

However, it is proof that God likes us best.

Some days.

[closeupready]

38. If you are ashamed of sexuality,

then yes, I understand why a discussion about circumcision would scare and amuse you, thus the laughter.

If, on the other hand, you love sex, the body and embrace them, this is an issue as serious as any other issue regarding disfiguring the human body. Interestingly, this issues intersects with religious fundamentalism, health care, childcare - no wonder it's so controversial.

[aquart]

58. Honey, I'm not scared.

I'm not the one facing HIV infection because of personal vanity.

And I don't care if you find circumcision controversial. I'm Jewish. It's a settled issue for me. Discuss it all you want, I'll still eat the bagels at the next bris.

This passionate clinging to the teeny tiny turtlenecks is just funny...but it has nothing to do with fear. At least, not my fear. This hysteria from Christian males makes me positively giddy.

[closeupready]

74. Oh, "personal vanity." I see.

That's how you think about it. Gotcha.

[xchrom]

19. may i chime in with the others?

dr de cock?!?!?!

oh where, oh where is herb kaen when you need him?

[pinto]

39. NIH press release (12/13) here:

http://www.nih.gov/news/pr/dec2006/niaid-13.htm

EMBARGOED FOR RELEASE
Wednesday, December 13, 2006
12:00 Noon ET

Adult Male Circumcision Significantly Reduces Risk of Acquiring HIV
Trials in Kenya and Uganda Stopped Early

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), announced an early end to two clinical trials of adult male circumcision because an interim review of trial data revealed that medically performed circumcision significantly reduces a man's risk of acquiring HIV through heterosexual intercourse. The trial in Kisumu, Kenya, of 2,784 HIV-negative men showed a 53 percent reduction of HIV acquisition in circumcised men relative to uncircumcised men, while a trial of 4,996 HIV-negative men in Rakai, Uganda, showed that HIV acquisition was reduced by 48 percent in circumcised men.

<snip>

"Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition," notes NIAID Director Anthony S. Fauci, M.D. "We now have confirmation — from large, carefully controlled, randomized clinical trials — showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse. While the initial benefit will be fewer HIV infections in men, ultimately adult male circumcision could lead to fewer infections in women in those areas of the world where HIV is spread primarily through heterosexual intercourse."

The findings from the African studies may have less impact on the epidemic in the United States for several reasons. In the United States, most men have been circumcised. Also, there is a lower prevalence of HIV. Moreover, most infections among men in the United States are in men who have sex with men, for whom the amount of benefit provided by circumcision is unknown. Nonetheless, the overall findings of the African studies are likely to be broadly relevant regardless of geographic location: a man at sexual risk who is uncircumcised is more likely than a man who is circumcised to become infected with HIV. Still, circumcision is only part of a broader HIV prevention strategy that includes limiting the number of sexual partners and using condoms during intercourse.

The co-principal investigators of the Kenyan trial are Robert Bailey, Ph.D., M.P.H., of the University of Illinois at Chicago, and Stephen Moses, M.D., M.P.H., University of Manitoba, Canada. In addition to NIAID support, the Kenyan trial was funded by the Canadian Institutes of Health Research and included Kenyan researchers Jeckoniah Ndinya-Achola, M.B.Ch.B., and Kawango Agot, Ph.D., M.P.H. The Ugandan trial is led by Ronald Gray, M.B.B.S., M.Sc., of Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Additional collaborators in the Ugandan trial were David Serwadda, M.Med., M.Sc., M.P.H., Nelson Sewankambo, M.B.Ch.B., M.Med.M.Sc., Stephen Watya, M.B.Ch.B., M.Med., and Godfrey Kigozi, M.B.Ch.B., M.P.H.

For more information on the Kenyan and Ugandan trials of adult male circumcision, see the NIAID Questions and Answers document at http://www3.niaid.nih.gov/news/QA/AMC12_QA.htm.

The World Health Organization (WHO) press statement in response to the NIAID DSMB recommendation is available on the WHO web site, www.who.int/hiv.
http://www.who.int/hiv

[jaybeat]

45. And the WHO release here

http://www.who.int/mediacentre/news/statements/2006/s18/en/index.html

It is anticipated that news of these results will heighten interest in male circumcision from governments, non-governmental institutions, and the general public in a number of countries, in addition to increasing demand for male circumcision services. WHO, the UNAIDS Secretariat and their partners will review the detailed trial findings and will then define specific policy recommendations for expanding and/or promoting male circumcision. These policy recommendations will need to take into account:

• cultural and human rights considerations associated with promoting circumcision;
  
• the risk of complications from the procedure performed in various settings;
  
• the potential to undermine existing protective behaviours and prevention strategies that reduce the risk of HIV infection; and
  
• the observation that the ideal and well-resourced conditions of a randomized trial are often not replicated in other service delivery settings.

Countries or health care institutions which decide to offer male circumcision more widely as an additional way to protect against HIV infection must ensure that it is performed safely by well-trained practitioners in sanitary settings under conditions of informed consent, confidentiality, risk reduction counselling and safety. These countries or institutions must also ensure that male circumcision is promoted and delivered in a culturally appropriate manner and that sufficient and correct information on the continuing need for other HIV prevention measures is provided. This will be necessary to prevent people from developing a false sense of security and, as a result, engaging in high risk behaviours which could negate the protective effect of male circumcision.

In order to support countries or institutions that decide to scale up male circumcision services, WHO, the UNAIDS Secretariat and their partners are developing:

• technical guidance on ethical, rights-based, clinical and programmatic approaches to male circumcision;
  
• rapid assessment toolkits for a) determining circumcision prevalence, determining acceptability, identifying key providers, and estimating costs and b) monitoring numbers of circumcisions performed, their safety, and their potential impact on sexual behaviour; and
  
• guidance on training, standard setting, certification, and accreditation.

[lynne]

47. Two AFRICAN trial studies -

- just keep it in your pants while you're in Africa and your risk is greatly reduced.

[XemaSab]

113. You want to go tell that to the Africans?

:shrug:

[endarkenment]

49. "Hey baby don't worry I'm circumcised."

Uh, no. Use a damn condom.

[goforit]

68. LOL!!! A line that will be well used.

[Redstone]

65. Well, some people are healthier without the appendix they started with.

Redstone

[jaybeat]

72. But it is usually only removed if infected

Otherwise, the risks of surgery would never be worth it against the chance that you *might* need it out someday.

As far as feeling mutilated, some of us do feel that way, others don't, and others choose to have it done to themselves and are happy with the result. It is a rather, er, *personal* decision?

I just don't like the idea that parents can choose this for their kids, prior to the child's exposure to any risk that's (only recently... er, today!) been associated with *not* doing it. And the doctors go ahead and do it on the parents' say-so without a good *medical* reason.

"Doctor, I'd like my 2-day old son's appendix removed, as soon as possible. Can't be too careful, you know?"

I can imagine the State Medical Board's reaction if the doc said, "OK. 'Course, insurance won't cover it. That'll be $25,000, please.":

:nuke: :nuke: :nuke: :nuke:

[Redstone]

66. And by the way, I'm circumcised, and I don't feel "mutilated." Not at all.

Redstone

[stanwyck]

71. I was routinedly vilified by my liberal

girlfriends when my son was born and my husband and I decided to have him circumcised. My "earth muffin" friends were dead set against circumcision. Very adamantly against it. And I was a terrible mother for even considering it. But my husband wanted his son "to look like him". Which seemed a goofy reason to me. But, fine. My pediatrician advised circumcision for health reasons -- fewer STDs, less chance of cervical cancer for female partners. And so we went with circumcision. This was 23 years ago.
It doesn't seem to be such a big deal to young men now. Many are circumcised -- many are not. And women don't seem to find it a problem either way. Which, unfortunately, was not the case years ago. An uncircumcised friend underwent the procedure as an adult (definitely not recommended) because of women who objected to his uncircumcised member.
And my father, as a soldier in WWII, had the procedure as an adult -- then required for "sanitary" reasons. So. He insisted his son, my brother, be circumcised as an infant.
The friend who gave me the worst time about having my son circumcised quit badgering me after her toddler son contracted a very nasty infection which her doctor blamed on "Mom" not keeping the foreskin properly cleaned.
Yikes. We mothers get blamed. No matter what we do.

[Writer]

77. I always thought the foreskin was vestigial, and that's why it was removed.

But I don't have a penis, so how would I know?

[Cronus Protagonist]

78. As one who loves and uses his foreskin 24/7/365

I can assure you it is not vestigal and there's no way I would part with all the feeling and protection I get from it.

And for those who think there's no risk in circumcision, I think they've not looked at the botched circumcision pictures that are available all over the net. Ewwwwwww... Condoms work better, are cheaper and prevent more than just HIV. When there's an easy solution that does not involve surgery to one that is less effective, costs more and involves cutting the flesh, one must also wonder at the motivation of the proponents and whether or not they are telling us all they should.

I'm keeping mine forever.... as would anyone who's parents were smart enough to let them keep theirs, not that it should even be on the table as a "choice" for parents. Who died and made them God?

[jaybeat]

85. Here, here!

I for one was denied the opportunity to decide for myself, though when I was born, it was so "routine" that they almost could have done it without asking (my parents, that is).

For the complete rundown on the multiple functions of the foreskin and the negative effects of its removal (plus some really awful stuff about what can go wrong), check out NOCIRC.

My son can decide for himself if the benefits outweigh the risks, when he's old enough to have any chance of being exposed to those risks.

I'm glad to see the WHO acknowledge that there is a human rights aspect to this issue. (What other elective, non-medically necessary, disfiguring surgery would we allow a parent to impose upon a child?)

As far as adult males (in Africa and anywhere else), consistent condom use has one prevention rate, inconsistent use a lower one, and circumcision lower still; every man can and should decide for themselves. Providing, of course, that they have access to clear, factual, understandable information.

Unfortunately, fear, myth, intimidation and outright lies can often be seen in such cases. My mother was basically scared into having a "preventative" hysterectomy when I was about 5. No better, really, then the Victorian era (male) "doctors" who routinely removed a woman's ovaries if she suffered "hysteria." Of course, many died on the table. Charming!

[Writer]

89. But aren't there negative effects for the woman?

Increased risk of cervical cancer, given the substance that collects under the foreskin? And a higher risk for other STD's? Sure if you don't want a baby, wear a condom, and that will help. But if you're having sex with your wife sans condom, aren't the risks still there?

[jaybeat]

91. Those would be the negative effects of being married to a scumbag

And you're right, a condom can only protect against some of those. My guess is that having your DH snipped would protect you even less!

[Writer]

92. LOL

Mr. Writer isn't much of a scumbag, I assure you ;) LOL

But from the female perspective, I must say, I prefer a circumcised penis. It works better for certain types of sex... and I have never enjoyed the smegma that collects in a foreskin. Also it's the smegma that delivers the virus that causes cervical cancer. My mother is a testament to that.

[Cronus Protagonist]

94. You are so uninformed on this subject, you should really read NOCIRC

Link provided by my fellow protagonist in an earlier post.

Smegma is simply the skin cells that slough off a mucous membrane. The exact same stuff that your vagina sloughs off every day, and your mouth sloughs off even more often. Your vagina and mouth have a frequent flow that cleanses but foreskins don't have any flow, which is how it can collect with ineffective personal hygene. It's perfectly normal and causes absolutely no harm.

What causes cervical cancer is HPV, Human Papiloma Virus, and your husband can have that inside the urethra, on or around the glans, in and around his anus and other places not so easy to get, but possible nonetheless. In other words, cutting part of his body off is not guaranteed protection, not even close.

And rest assured, if he's not fucking other people, and neither are you, you can fuck all you want, smegma and all, without fear of HPV, HIV or any other STD.

Your mother, if she had cervical cancer, was likely, but not certainly, infected with HPV and since it's such a very powerful virus and doesn't die too easily, it can be caught from her dildo if she shared it with anyone or used it on her husband's anus and he had HPV there. Simply sleeping in close contact with someone with HPV can give it to you. Smegma is not the carrier, nor the delivery system for HPV.

And besides, I don't have any smegma as I wash daily. Anyone who doesn't wash regularly, well, that's a hygene issue, not an indication of the need for surgery. I hope he brushes his teeth too, or you might want his lips removed...

:evilgrin:

[Writer]

95. You know, that was just rude.

Why would you assume me as being "uninformed?" I've just read different material than you.

Forget it. I have other things going on at my desk.

[Cronus Protagonist]

98. Pearls before swine and all that...

Sorry for pointing it out.

Also it's the smegma that delivers the virus that causes cervical cancer. My mother is a testament to that.

[endarkenment]

99. The clipping club knows no reason. nt.

[Cronus Protagonist]

107. Sadly, that's true, and the carnage continues.

It's sad, really sad. I wince every time I think of a little baby tied up in restraints getting a part of its perfect little body chopped off.

[subterranean]

102. That's a myth that refuses to die.

It's surprising how many Americans still believe these myths, even though they were debunked decades ago.

Consider this: The vast majority of European men are not circumcised, yet as far as I know, there is no epidemic of cervical cancer among European women.

As for the smegma problem, there's a simple solution for that: soap and water.

And that's all I have to say on the subject of smegma.:)

[Cronus Protagonist]

108. One caveat, don't use soap on the glans penis

Plain water is perfect. Soap tends to dry up the membrane and can lead to infections due to abrasion. I use saliva when there's no shower available. Works perfectly. I also read of soldiers in the field being told to use their own urine, which is sterile, by holding the foreskin closed and letting the area fill with urine before letting it out. That is also supposed to help guard against other STDs if done immediately after sexual intercourse with someone one can't be sure is healthy.

[Freddie Stubbs]

86. And it makes it look bigger too

[closeupready]

93. According to some who had teeny eeny weenie teeny teeny

weeny ones before they had it snipped for very important reasons, it doesn't make a difference. :evilgrin:

[Prisoner_Number_Six]

87. ...So a man can cover himself by uncovering himself...

I guess I'm covered then! :rofl:

[phrenzy]

96. Dick Cheese...

Man, I know it's backwards of me - but I just find (and many females do to) circumcised penii to be less 'strange' looking and some girls have mentioned they are easier to 'suck'. Good enough for me.

[endarkenment]

101. Then by all means go for it.

But make it your choice and realize that it is cosmetic surgery.

[Lipton64]

103. I don't see what the big deal is....

Jews, Muslims, and many Christians practice it. I'm circumcised and I'm a Christian. Maybe the bible told us to do it for a reason after all.....lol

[Cronus Protagonist]

109. Religions have a lot of responsibility for this barbaric practice

I wouldn't be so cavalier about bringing religion into the discussion, if I were you.

[Lipton64]

110. I don't see it as a barbaric practice.....

to me it's a symbol of my relationship with God. Of course that sounds insane to most non-Jews/non-Christians but it was a symbol of the strength of the covenant of God and Abraham. As far as I'm concerned God told Abraham to do it for a reason and I believe it as such.

[phrenzy]

111. As a circumcized non-christian

Who came from non-relgious parents - Claiming to do it as a 'covenant' with god or whatever is bizarre. That's up there with some Opus Dei shit. And we call OTHER religions fanatic!

Oh, and his procedure - now that it has proven medical benefits should no longer be considered simply 'cosmetic' or religious.