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News :: Human Rights
MGM/HIV: Here We Go Again
11 Aug 2005
Fatal flaw in supposedly "definitive" research concerning male circumcision and female->male HIV transmission in africa.
The record of shoddy and self-serving "research" in medicine (not
just wrt circumcision) is an international scandal. These people
are the high priests of salesmanship. The whole system is riddled
with conflicts of interest and corruption, as extensively documented
in medical journals and elsewhere.

The recently released "definitive study" "conclusively demonstrating"
that MGM protects against female -> male HIV transmission has a fatal
flaw. According to the abstract below, the pool of volunteers consisted
of men "wishing to be circumcised". There goes the random selection.
Obviously there can be many reasons a man might want to be circumcised,
one of which is that he's having some kind of sexual problems. According
to the paper at http://www.cirp.org/library/anatomy/parkash/
"... most patients (were) unaware that the prepuce was retractable ..."
This is an amazing statistic on male sexual ignorance. Be that as
it may, it implies that atrophied and tight foreskins are a common
problem in intact men. Tight foreskins are known to be correlated
with micro-tears during intercourse, which would certainly increase
HIV reception in the intact men and skew the statistics. It would
also account for the reports by some men who got circ'd as adults
that there was no loss of feeling: their foreskins weren't retracting
during sex!

If MGM does in fact protect against HIV in a given population, then
why does the USA have by far the highest rate of HIV in the
industrialized world and the second highest rate of MGM?

There is every reason to suspect that MGM INCREASES HIV transmission in the opposite (male->female) direction:
1) intact vaginal and cervical epithelium blocks hiv
infection:
http://jvi.asm.org/cgi/content/full/74/12/5577?view=long&pmid=10823865
2) MGM increases vaginal abrasion during intercourse
http://www.cirp.org/library/anatomy/ohara/
3) abrasion breaks down the epithelial barrier

There is also empirical evidence that MGM increases
male->female HIV: http://www.circumstitions.com/HIV.html#hetero
Male->female transmission efficiency is already about 8 times greater
than female->male. (interestingly, a study presented at the same
conference, which received no media attention whatsoever, supposedly
found that FGM protects against male->female transmission. Of
course such findings are likely to be be corrupted by cultural
cofactors for FGM, such as lower levels of sexual promiscuity in
FGM'ing cultures, just as previous "definitive" MGM studies have
been. But contrasting the language and reaction of the researchers
in the two GM studies (which are both on the same site listed below)
quickly dispells any misconceptions about the objectivity of medical
research in this area)

There are also behavioral cofactors associated with MGM which
increase the risk for HIV.

This is the latest in a long line of "conclusive" studies that turn
out to be hot air. But this whole controversy ignores a crucial
point: you can argue all you want about the purported benefits of
MGM, but it seems to me to be beyond dispute that these know-it-all
control freaks and salesmen are forcing powerless children to undergo
treatments that no sane adult would agree to for himself (surgery on the body's most sensitive anatomy, using no pain relief at all the majority of the time: http://www.ama-assn.org/ama/pub/category/13585.html), dictating
how much of their sexuality they get to keep, how ecstatic they are
allowed to feel, how in love they and their partners are allowed
to be, based on a highly suspect and selective set of medical
research.

This is the real pathology.

Also see: http://www.math.missouri.edu/~rich/MGM/primer.html

=========

http://www.hiv-knowledge.org/iasmaps/i10.htm

10.7 510 10.7 Sexual transmission

Impact of male circumcision on the female-to-male transmission of HIV

26.7 | 10:50 | Manaus | 2675

Auvert B.1, Puren A.2, Taljaard D.3, Lagarde E.4, Sitta R.4, Tambekou J.4

1UVSQ - INSERM U687 - APHP, ST Maurice CEDEX, France, 2NICD,
Johannesburg, South Africa, 3Progressus CC, Johannesburg, South
Africa, 4INSERM U687, St Maurice, France

Prevention | TuOa0402 | Bertran Auvert

Introduction: Observational studies suggest that male circumcision
could protect against HIV-1 acquisition. A randomized control
intervention trial to test this hypothesis was performed in sub-Saharan
Africa with a high prevalence of HIV and where the mode of transmission
is through sexual contact.

Methods: 3273 uncircumcised men, aged 18-24 and wishing to be
circumcised, were randomized in a control and intervention group.
Men were followed for 21 months with an inclusion visit and follow-up
visits at month 3, 12 and 21. Male circumcision was offered to the
intervention group just after randomization and to the control group
at the end of 21 month follow-up visit. Male circumcisions were
performed by medical doctors. At each visit, sexual behavior was
assessed by a questionnaire and a blood sample was taken for HIV
serology. These grouped censored data were analyzed in an "intention
to prevent" univariate and multivariate analysis using the piecewise
survival model, and relative risk (RR) of HIV infection with 95%
confidence interval (95% CI) was determined.

Results: Loss to follow-up was <11%; <1% of the intervention group
were not circumcised and < 2% of the control group were circumcised
during the follow-up. We observed 45 HIV infections in the control
group and 15 in the intervention group, RR=2.77 (95% CI: 1.56 4.91;
p=0.0005). When controlling for sexual behavior, including condom
use and health seeking behavior, the RR was unchanged: RR=2.93
(p=0.0003).

Conclusions: Male circumcision provides a high degree of protection
against HIV infection acquisition. Male circumcision is equivalent
to a vaccine with a 63% efficacy. The promotion of male circumcision
in uncircumcised males will reduce HIV incidence among men and
indirectly will protect females and children from HIV infection.
Male circumcision must be recognized as an important means to fight
the spread of HIV infection and the international community must
mobilize to promote it.
See also:
http://www.math.missouri.edu/~rich/MGM/primer.html

This work is in the public domain
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