July 20, 2010

HIV Vs Circumcision, Not Conclusive Proof

HEALTH/SEX - The World Health Organization and several other health groups are trying to promote circumcision as a way to prevent the spread of HIV/AIDS in Africa. They conducted three test studies wherein the men who were circumcised 15 to 20 years ago are 60% less likely to have HIV.

However, this doesn't prove anything.

The areas where they did the test studies were more affluent/wealthy and the 6,500 men who agreed to be circumcized were more likely to be better educated and well-off, more access to condoms, etc.

And more so, these men were agreeing to do this because they were afraid of catching a STD. So really all this proves is:
Educated men who are paranoid about catching a STD and take preventive measures like using condoms or abstinence are 60% less likely to get HIV.
The concept that circumcision alone prevents HIV is based on false reasoning. There are other factors such as wealth, education, access to condoms, paranoia, how often they have sex, whether they have multiple sexual partners, whether they re-use needles, etc. The mere fact these men volunteered for the procedure showed they were at least paranoid about STDs.

This false logic has fooled even former U.S. President Bill Clinton and philanthropist Bill Gates who have since become advocates of higher circumcision rates in Africa. Proof that you don't have to be stupid to get fooled by faulty research.

More conclusive evidence would have been to simply determine what percentage of men were already circumcised and what the HIV prevalence rate was amongst these men. Creating a test group of volunteers from one community which already has better access to condoms/etc is not conclusive evidence.

For centuries people have been pushing the superstition that circumcision can prevent everything from masturbation, genital herpes, homosexuality and other problems related to the male sexual reproductive organs. None of these have ever been proven.

1 comment:

  1. You are right, but for the wrong reasons. The trials were faulty, but their faults were not differences between the men who chose to be circumcised and the general population.

    They were Random Controlled Trials (RCTs), meaning a comparable control group, randomly chosen from the volunteers, was left intact till the end, for comparison.

    They circumcised a total of 5,400 men and left a similar group intact. After less than two years, 64 of the circumcised men and 137 of the intact men had HIV. That difference, 73 circumcised men who didn't get HIV, is the whole basis of the claim that circumcision "reduces HIV by 60%".

    The true gold standard of medical trials is the placebo-controlled, double-blinded random controlled trial. In these trials, the non-circumcised men (the control group) were simply left alone.

    They were not given a token operation or one that would fool them into thinking they had been circumcised. In that case, their behaviour and that of the researchers would have been affected in the same way as those who had a real operation. (It may not have been practical, but it is still a shortcoming of the study.)

    All the men, and all those who dealt with them, knew whether they had been circumcised or not, which could affect their behaviour, and even encourage "mistakes" in the direction favouring circumcision. (Everybody wanted circumcision to be protective.) In the gold standard of trials, that information is concealed from those involved. Again, not practical, but falling short of the ideal.

    327 circumcised men, and a comparable number of non-circumcised men, left the trials, their HIV status unknown. That is easily enough for the 73-man difference to be non-significant. Circumcised men who found they were HIV+ would leave because the trial had let them down. Non-circumcised men would leave because they had decided they didn't want to get circumcised - perhaps after talking to the circumcised men.

    There are other flaws with the studies, such as assuming that all HIV transmission was by sex with women. In parts of Africa, there are "needle men" everywhere who offer an injection for every ailment, using very dodgy needles.

    You can find more here, about circumcision and HIV in general, and here about the African trials in particular.

    You are right that observation studies offer useful information: in at least six African countries, the HIV rate is higher among the circumcised men than the non-circumcised. In Malaysia, where 60% of the population is Muslim (and virtually all Muslim men are circumcised and hardly anyone else), 72% of new HIV infections are of Muslims. That certainly needs to be explained before pressing ahead with mass circumcision campaigns.

    And you are right that the latest hysterical push to circumcise (not just men but babies, who are not at risk from sexually transmitted HIV)) is of a piece with the previous campaigns, mainly by circumcised men who can't bear others to have something they lack.

    Circumcision is a "cure" still looking for a disease.


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