5.02.2006
Fewer foreskins, less AIDS?
So folks have been asking me about the NYTimes article about how male circumcision appears to prevent AIDS. As you can probably guess, the "AIDS world" is all abuzz about this too, and having a new weapon to fight HIV is always welcomed.
I think the article does draw out the major points on this question. The evidence is strong, but not conclusive yet. It is surprising that men are willing to sign up for this operation that has no cultural basis in these countries (a sign of the desperate fear around HIV). And the big concern is that men who have been circumcised will be more likely to undertake other risk behaviors. As a result, would decreasing men's risk increase the risk to their female partners?
So it appears that a circumcised man has up to a 60% lower risk of becoming infected with HIV. But we have something that does better than that--they're called condoms and they're over 90% effective in this population. And you don't need a surgeon to distribute condoms--you just need a trained peer educator or a community awareness group. Africa is rich with community groups and community associations, it is poor with skilled doctors. The hype around this intervention makes me nervous. Are we so eager to have a magic bullet to fight AIDS that we won't weigh the potential trade-offs for other illnesses? Men want to be circumcised to lower their risk of HIV. But all of these countries have women suffering from the effects of obstetric fistula--where difficult deliveries turn them into social pariahs because they are unable to control their urine or feces. A straightforward surgical procedure would cure them, so what about them? People going blind from trachoma, people dying from injuries from car accidents, babies with cleft palates and Hirschsprung's Disease. In Africa, surgical resources are abundantly rare and abundantly necessary for other afflictions, so circumcision may not be the good news we need.
I think the article does draw out the major points on this question. The evidence is strong, but not conclusive yet. It is surprising that men are willing to sign up for this operation that has no cultural basis in these countries (a sign of the desperate fear around HIV). And the big concern is that men who have been circumcised will be more likely to undertake other risk behaviors. As a result, would decreasing men's risk increase the risk to their female partners?
So it appears that a circumcised man has up to a 60% lower risk of becoming infected with HIV. But we have something that does better than that--they're called condoms and they're over 90% effective in this population. And you don't need a surgeon to distribute condoms--you just need a trained peer educator or a community awareness group. Africa is rich with community groups and community associations, it is poor with skilled doctors. The hype around this intervention makes me nervous. Are we so eager to have a magic bullet to fight AIDS that we won't weigh the potential trade-offs for other illnesses? Men want to be circumcised to lower their risk of HIV. But all of these countries have women suffering from the effects of obstetric fistula--where difficult deliveries turn them into social pariahs because they are unable to control their urine or feces. A straightforward surgical procedure would cure them, so what about them? People going blind from trachoma, people dying from injuries from car accidents, babies with cleft palates and Hirschsprung's Disease. In Africa, surgical resources are abundantly rare and abundantly necessary for other afflictions, so circumcision may not be the good news we need.
Comments:
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You may have the most depressing blog in cyberspace. Every time I check, there's something more I should be concerned about! (Not true - your Easter People message was uplifting.) Reading your blog is really not much more depressing than the emails I get from Planned Parenthood, Move-On, Sierra Club, Sojourners, etc.
# posted by 
: 5/02/2006 7:10 PM
: 5/02/2006 7:10 PM
To answer your Mom's comment, here's an irrelevant and flippant tangent to your post to lighten things up a bit:
To really punctuate the fact there are no males in our family, it was only a few weeks ago that we collectively realized that my new baby cousin Eddie has not been circumcised. When he first came in January I was suspicious and asked Cathy about it, but having never really seen a very, very newborn baby boy's genitalia, I accepted her blase, "Of course he is," and let it be. Not only does this illustrate her definition of 'normalcy' in regard to her children ("Whatever they are, that is normal, and let's never speak of it ever again."). Not only was this NYT article useful, but I actually had an excuse to talk to the white-haired man who stands outside Barnes & Noble on campus and advocates for 'genital integrity.' My grandmother's attempts to inculcate conservative Catholicism in my family only has left residue in the form of our collective ignorance of the penis, but, 'thank god,' we are white, western, and (comparatively) wealthy.
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To really punctuate the fact there are no males in our family, it was only a few weeks ago that we collectively realized that my new baby cousin Eddie has not been circumcised. When he first came in January I was suspicious and asked Cathy about it, but having never really seen a very, very newborn baby boy's genitalia, I accepted her blase, "Of course he is," and let it be. Not only does this illustrate her definition of 'normalcy' in regard to her children ("Whatever they are, that is normal, and let's never speak of it ever again."). Not only was this NYT article useful, but I actually had an excuse to talk to the white-haired man who stands outside Barnes & Noble on campus and advocates for 'genital integrity.' My grandmother's attempts to inculcate conservative Catholicism in my family only has left residue in the form of our collective ignorance of the penis, but, 'thank god,' we are white, western, and (comparatively) wealthy.
# posted by : 5/19/2006 8:52 PM
: 5/19/2006 8:52 PM << Home
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