How Far has Medical Male Circumcision for HIV Prevention in Africa Advanced?
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March 6, 2012 | Three recent studies have shown that Medical Male Circumcision (MMC) is one of the most effective tools to fight HIV and AIDS, reducing chances of infection by near 60 percent. Within the next five years, initiatives including those of PEPFAR (The President's Emergency Plan For AIDS Relief) and the Bill and Melinda Gates Foundation will perform Voluntary MMC (VMMC) on over 20 million men in Africa. Faith-inspired organizations and interfaith collaborations are among those spearheading the initiatives. Dr. Inon Schenker, one of Israel's leading professionals in the field, presented on how Jewish-Muslim-Christian collaborations are paving the way for innovations in biomedical interventions in HIV prevention in PEPFAR priority countries. This event was jointly organized by the Berkley Center, the World Faiths Development Dialogue, and Operation Abraham Collaborative.
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As a European health professional, I can say that most STD studies find that the national distribution of STDs is about EQUAL between circumcised and non-circumcised men. Moreover, among the developed nations, the USA has both the highest circumcision rate (about 80% of adult U.S. men are cut) AND the highest HIV/STD rates!
European nations (where circumcision is uncommon) have the LOWEST HIV rates (along with Japan).
It's ironic that claims of circumcision benefits only emanate from the USA!.
It’s insanity. Israel and the USA are so obsessed with circumcision and will even twist studies in their favor. The USA has been taken over by Israelis, so it’s why circumcision is so popular in the USA.
The male circumcision campaign "to prevent HIV infection " in Africa is led and imposed by the USA .
No, your analysis is wrong! Randomisation into "Control" and "Intervention" does NOT counter self-selection bias.THINK!
If the trial conscripts had statistically more foreskin pathology than general population men, then on randomisation this occurs:
Men assigned to "Circumcision" LOSE their foreskin pathology, but men assigned to "Control" KEEP their foreskin pathology. So results are skewed to favour the "Circumcision".
So you can't project circumcision's effect onto the general population.
leave those foreskins alone...I have one and I lived in the 1970-80's in nyc...epic center of hiv infection....but what kept me away from the infection was the ability to educate myself...and most of all always thought that my homosexuality was more than sex....touch, spiritual growth, healing...my opinion is that most of the people who practice unsafe sex have no knowledge of the many aspects of sexuality...that is what we should be focusing...more education on prevention,
I agree. HIV is mostly caused by anal sex between gay men, IV drug use, and bi men going from men to women. Circumcision will not protect any man from HIV, I actually think it will increase HIV in gay men, since the circumcised one tends to be more rough and will scratch the anal wall.
"...other studies that suggest circumcision increases heterosexual infections rates to a place like America...". Evidence, please, in the form of peer-reviewed papers published in mainstream academic journals.
WHO may "seek out" a strategy, but that doesn't prove its analysis is correct. And it certainly doesn't establish that circumcision benefits outweigh risk of harm (itself a huge problem!). In Africa,circumcision complication rates are alarming.
There is much evidence inconsistent with claims circumcision curbs HIV. E.g. I refer again to the 2009 USAID report which found that in TEN of the 18 African countries investigated, CIRCUMCISED men had statistically MORE HIV than the intact. How come?
I gather this was rebutted here: J Sex Med. 2013 Feb;10(2):613-4 ("Faulty analysis leads to erroneous conclusions", Klausner JD.), but I'm having trouble finding an online copy. Do you know of one?
I would just bet those who conducted this study in Africa are circumcised themselves.
And you would be correct all of them are on the pro circumcision task force there's no validity to these African studies it's all bulshit it's the cycle of circumcision they're going on 150 whatever the current medical issue is they dust off circumcision try to package it and sell it to gullible consumers there are no benefits to circumcision it was never meant to provide any benefit from its Inception only to harm and in flick a defect to bring about lifelong complications to secure the medical industry the American Medical industry
Yup.
Dr. Inon Schenker
@perrypriolo9969
Americans should reject circumcision. I’ve seen way too many botched ones and the poor guy is suffering in silence.
In Kenya the majority are circumcised ;so the circumcised mayoity of Kenya want to impose the Luo to get circumcised .In Ethiopia the majority in Northern Ethiopia are Muslim and circumcised. That is those countries, but the program is sponsored by the USA government and by Bill Gates who is a circumcised Jew.
yes, American circumcised men, and they have even brought Israeli doctors to show Africans how to circumcise.
No! Your assumption that the "odd ten or twenty in a sample of over 3,000 isn't going to make a huge difference,," is false. E,g, refer to the Ugandan RCT, where 45 intact men got HIV vs. 22 Circumcised. Of those 45 intact men, if you conjecture that 20 HIV cases could be attributable to foreskin pathology (rather than healthy foreskin), then the picture changes hugely:
45-20 = 25 (intact group). This compares to 22 HIV cases in the Circumcised. That difference isn't statistically significant!
Sianick, you fail to understand my comment.
The African RCT recruits SELF-SELECTED themselves, and that introduces subject bias. Most men who choose circumcision have a foreskin malady (e.g. phimosis, or foreskin pathology). But we have known for a long time that those conditions PREDISPOSE to STD transmission. Therefore, the RCT recruits may not statistically represent the general male population. So you can't confidently project the RCT results onto a general, or "real world" population.
Oh stop your verbal diarrhea! I criticise the lack of a methodology to investigate the potential effect of self-selection bias in the RCT recruits (which could have been done quite easily). So we cannot be sure that the results have predictive or quantifiable epidemiiologic value at large. NB. the surgery itself carries risk of harm!
Another, lesser limitation is lack of a robust Control group. Ideally, this should have identical instructions to the Intervention group. It didn't in those RCTs.
Don't put words in my mouth! The RCT design lacks the robustness to produce epidemiologically predictable results.
No medical body in Europe (where most men are intact!) promotes their findings, and even in Africa the RCT results are not reliably projectable onto the general populatlion, UNLESS we can be confident the subjects statistically represent it (in terms of foreskin health).
Do you comprehend that RCT randomisation would NOT counter self-selection bias, or do you meed more help?
Aren't you in danger of assuming here that every male with an "unhealthy foreskin" was 100% certain to contract HIV? If you are not assuming that, then you need to multiply up your presumed cohort of self-selected, undetected sufferers from enhanced risk twice over. Firstly to account for the probability of not being exposed (EG no HIV+ partners during the trial) and secondly to account for the personal (albeit reduced) probability of NOT being infected on any single exposure to an HIV+ partner.
Did he really refer to the foreskin as “unhealthy foreskin?”
why is male circumcision promoted in Africa and not in Asia,Latin America, Europe, etc .
No. Why is it promoted anywhere? It shouldn’t even be done anywhere else, not even the USA.
That would mean that HETEROSEXUAL HIV transmissions should be less than half in US than that of Europe, but that isn't the case. Also, if circumcision only helps heterosexual males, then that is just a minority of the target group. So why not spend the money on something MORE efficient which will help MORE people, like sex education, encouraging condom use etc.? And if you have to wear a condom anyway, what's the point of circumcizing?
It’s population control. African men will be less likely to want to have sex, since they will feel way less.
You have a good point here .There is no difference in heterosexual HIV infection between the USA :where the majority of men are circumcised or Europe,Latin America,India or non-Islamic Asia ,where men are generally not circucmised
1) I explain the follow-up study results easily (i.e. they have no quantifiable epidemiologic value), for they are even more fatally flawed than the original RCTs. First, the follow-up studies suffer from equal self-selection bias as the RCTs, AND they were not done randomised! Once the RCTs stopped, randomisation ceased, and men in the Control could choose to be circumcised, joining the Circumcision arm (many did, which is what most wanted to start with).
So began the "follow-up studies...
Sianick, I've read all 3 studies, and "genital ulceration" (only investigated in one) is just one penile condition that pre-disposes to HIV, (and treatment doesn't mean cured). How many had phimosis? Since the "absolute risk reduction" found for circumcision was very low (less than 1%), confounding factors from poor RCT design can significantly bias results. There was no protocoll to investigate self-self selection bias (it wasn't even considered!).
Epidemiloogically, the RCTs are junk science.
It’s all bias. You have a JEWISH doctor leading the way, because he does not want to accept, that he had a part of his organ cut off, that other men get to enjoy.
Dr. Inon Schenker
Look at the full text report of the first of the "Big 3" RCTs, ANRS 1265 - "Orange Farm". (Auvert et al, 2005, Pubmed 0020298, especially the section "Methods"). It specifically mentions that the participants were screened for pre-existing conditions AND PRE-TREATED. Quote: "Potential participants with genital ulcerations were temporarily excluded until successful treatment." Therefore the whole sample was NOT skewed towards high HIV vulnerability and there was no self-selection bias to counter.
Oh, so now you imagine that the WHO is "favouring low styles" (i.e. "low" circumcision cuts). Would you care to QUOTE the WHO (with reference) that they recommend a "low" cut for circumcision? This could be in relation to any circumcision device.
The WHO hasn't recommended any particular circumcision style.
This reeks of body shaming. I’m sure at least one guy sitting there has his natural foreskin and was feeling bad about himself, because of how he was born.
should be banned, There are no health benefits, it is just mutilation. God bless you
Do enlighten me, please: How do you envisage that your claimed cohort of disease-compromised volunteers might have managed to exclude from the RCT selection process so many healthy individuals that the sample population became totally unrepresentative of the wider society from which they came? And where is your evidence that they succeeded? With 3,274 men involved in the Orange Farm trial, that would have taken some rigging!