Thursday, July 21, 2011

New "Studies" Give Ongoing Circumcision Campaigns a "Boost"

So recently the International AIDS Society held their yearly conference in Rome, Italy. As usual, circumcision advocates are out in full force promoting genital mutilation as HIV prevention. The usual suspects usually tout three famous "RCTs" and talk about how "successful" their "mass circumcision campaigns" are becoming, with more and more men getting circumcised, and communities "embracing" circumcision as a method of HIV prevention. This year, though, it's a bit different.

Perhaps fearing that the big "RCTs" have become lackluster, the usual circumcision advocates have decided to give a "boost" to their mass circumcision initiatives by injecting "new studies" into their mix of "evidence." I've already discussed the "boost in sex" that circumcision is supposed to give in my last blog post. In retrospect, I'm not exactly how "new" this "information" is; circumcision advocates have been trying to argue that circumcision is not sexually damaging, even "improving" it for years. But now, "new studies" report, not a "60% decrease in HIV transmission," but get this, a whopping 76%! Wow. Really?

I think it all becomes clear when you look behind who came up with these numbers. The new figure is the result of a "study" headed by none other than, according to a Bloomberg article, Bertran Auvert, the same man who headed one of the first big three African "RCTs." (Incidentally, the British medical journal The Lancet refused to publish Auvert's first big study, they didn't say why.) Auvert has been trying to correlate a lowered risk in HIV transmission with circumcision since at least 2003. He is good friends with Bill Gates, another avid circumcision promoter, and his last big "study" was funded by none other than the American National Institutes of Health. (Where doctors have vested interest in seeing the practice of circumcision, particularly infant circumcision continue.) It must be pointed out that none of the "new studies" presented at the IAS conference have been published in peer-reviewed journals.

What I'd like to know is how Auvert managed to come up with that incredible 76% figure. What did he do differently this time, and does he seriously expect the world to believe this number? Let's take a short look through time at the slow but sure increase of this number. According to Yahoo news article:

"In 2006, trials in Kenya, Uganda and South Africa found foreskin removal more than halved men's risk of infection by the human immunodeficiency virus (HIV).

Longer-term analysis found the benefit to be even greater than thought, with a risk reduction of around 60 percent."

And now that number is at 76%! I'm guessing that by 2016 that figure will be a full 100%?

Numbers sound real good on paper, but what I'd like to know is, if circumcision is so "effective" at "reducing the risk of HIV transmission," why isn't the 60%, and now 76% figure manifesting itself in real world situations where there is already a prevalence of circumcised men? Why arent these figures true outside of these so-called "trials?"

The rest of the Yahoo article is almost a complete verbatim repeat of the iafrica article I critique in my last blog post. Maybe iafrica and Yahoo are affiliates?

The Yahoo article does end with a word of caution by France's 2008 Nobel laureate Francoise Barre-Sinoussi, who in 1983 co-identified HIV as the source of AIDS;

"...over-confidence in circumcision [is] a major anxiety... Nothing provides 100-percent protection, not even a vaccine... Let's stop thinking that one preventative tool is enough. Circumcision has to be part of a combined approach."

She's mistaken though. We need to stop thinking that circumcision can actually be forced into the HIV prevention equation. Presenting circumcision confuses the message that people need to be engaging in safer sex, watching who they sleep with and employing the use of condoms.

It is a mistake to promote a dubious alternative
to the most effective method of HIV prevention known to us.

Back to the Bloomberg article, the same old debunked myths keep getting repeated:

"Circumcision is the surgical removal of a skin that covers the tip of the penis."

Actually, no, it's more than just skin; circumcision is the removal of an entire fold of flesh laden with blood vessels and nerves.

"Studies have shown the pocket between the foreskin and the tip of the penis gives viruses and bacteria a spot to grow, and circumcision eliminates it."

This is a reference to the penile microbiome study, which comes to an irrelevant conclusion; although it does show that there is a change in the penile microbiome after circumcision, it fails to demonstrate how circumcision prevents HIV. The authors present another hypothesis they must prove; that a change in the microbiome of the penis does indeed result in a reduced risk of HIV.

 "The foreskin has been shown to be rich in cells that carry HIV into the body."

The Langerhans cells. Which, contrary to what is stated here, have been shown to be a natural barrier to HIV.

It ends with a very disconcerting note by Centre for HIV and AIDS Prevention Studies program manager Dirk Taljaard:

"It’s really quite simple as an intervention... it’s not something that you’re trying to get somebody to do every day of his life."

It is NOT simple. Circumcision is cutting off part of a person's penis. It is a permanent alteration to normal male anatomy, and a man has to deal with it every day of his life, whether he likes the resulting product or not. And it sounds like Dirk Taljaard intends on circumcising men and just forget about them afterwards.

Wearing a condom; it's something a man has to do every time he has sex with an untested stranger if he wants any real protection from HIV transmission. What an absolutely irresponsible thing for anybody to say.

The Call
I've had enough of all this circumcision study nonsense crap. Using "study" to legitimize mass genital mutilation has reached some ridiculous proportions. 76%? 76! Am I seriously supposed to believe this? How far does Auvert seriously think he can fool people? Who's checking this crap? Who's checking to make sure everything presented has been peer reviewed? Are IAS conferences the ultimate venue to spew unmitigated garbage? Is the AIDS situation that much hopeless in Africa that no idea is too stupid to try?

What would be the reaction of people present at these IAS conferences would that somebody actually presented a "study" that showed a "reduced risk in HIV transmission" in women who have undergone labiaplasties? What would people think if somebody actually presented the madness that we need to remove the labia of as many people as possible? How would Auvert be viewed if he were bragging that his efforts were successful in "increasing the percentage of circumcised women" in a given area? Would he be welcomed or would he be openly shamed? What if he spewed that magical 76% number?

There are some things that are simply always wrong no matter how much "study" you try to veil it with. There has got to be something wrong with "researchers" who seek to necessitate a surgical procedure on healthy individuals. "Studies" that begin with a surgical procedure as a solution a priori have got to be the most logically flawed studies in existence. Where is the voice of reason in all of this? How can people suddenly pretend like circumcision isn't this historically controversial religious ritual that "scientists" have been trying to legitimize with a pseudo-medical alibi for over a century? When does the madness stop?

I think it's about time people concerned with basic human rights demanded an investigation behind all this circumcision "study." Real world data simply does not add up. Circumcision isn't this "simple" procedure. If it were really this "simple snip" then there wouldn't be so much opposition. Circumcision is radical surgery; it is a permanent alteration. It is cutting off part of a person's penis. Instead of focusing on necessitating it, real scientists should be working to render it obsolete. WHY are "researchers" like Auvert allowed to spew their madness? Who is checking his work? Who is double-checking the work of all these circumcision "researchers" to make sure it's all legit? It is disconcerting that this crap actually goes unchallenged.

It's about time we got together and demanded an investigation. Investigate the "researchers." Those at the WHO who endorsed these so-called "studies." Those institutions funding "mass circumcision campaigns." WHO ARE these people? What conflicts of interest are they failing to declare? Is it really people who are interested in the reduction of HIV transmission? Or is it the same old folks trying to vindicate an age-old religious ritual steeped in controversy?

Let's just say for the sake of argument that all of the "study" is true. Who is researching alternatives? By when can we expect circumcision to be phased out? Is there a future in sight where people can protect themselves from HIV transmission without having to cut off part of their penises? Are there any researchers working to this end? Or is everybody interested in finding more uses for circumcision? Who are the researchers responsible for seeking to find alternatives to circumcision? I want to know! I want to know why nobody's talking about NOT circumcising at these so-called AIDS conferences!!!

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