circumcision may lower aids risk

[mama2BnG]

http://news.yahoo.com/s/ap/20050727/ap_on_he_me/brazil_aids_circumcision;_ylt=ApKy0IKVvipIYxSfLWyf bSqs0NUE;_ylu=X3oDMTA3czJjNGZoBHNlYwM3NTE-

[Chickadee]

I read that on the news yesterday. I don't believe it. I mean, I believe the study results were as they reported, but I wonder whether other factors that could affect HIV transmission were also considered. Like whether circumsized men in S.Africa were more likely to have been raised in a religious, cultural, family or socio-economic setting that makes them more likely to be monogamous or to use condoms.

[AM]

Apparently female circumcision also lowers the risk of HIV

http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138

Angie

[Dr Terry Russell]

It's true that circumcision lowers the risk of acquiring HIV / AIDS. There are now more than 30 studies showing that circumcised males have a reduced risk of HIV acquisition, and therefore less chance of infecting their female partner!

It has been shown that Langerhan's Cells on the inner surface of the foreskin are responsible for the uptake of the AIDS virus. Circumcision removes most or all of those cells, and therfore removes the portal of entry.

I recently visited Africa to advise on modern circumcision technique as part of their AIDS minimisation strategy -- using the Plastibell device after prior application of EMLA anaesthetic cream -- a safe, painless procedure for boys to the age of puberty.

[christyc]

Dr Terry Russell has reported a study given at a recent aids conference. However the New Zealand aids foundation is concerned at the report stating ‘…Though there is evidence that circumcision might lower a man's chances of contracting HIV, there is no evidence that the reduction in risk takes unprotected sex for circumcised men out of the high-risk category… Of the millions of men worldwide with HIV, many are circumcised’.
(An interesting fact that this study was rejected for publication in the well respected ‘Lancet’ journal, the study has never been officially published!).

The well respected Cochrane reviewers(Informed health online) has looked at all studies ‘…the Cochrane review concluded that there is a strong association between circumcision and lower HIV infection in men - and it was especially strong for those at high-risk. However, this does not mean that getting circumcised can reduce your risk - or that if you are circumcised you can be sure your risk is lower… there is no strong evidence that circumcising more boys and men would slow down the spread of HIV/AIDS.’ The report also said other factors known as confounders such as sexual and hygiene factors may have an impact on becoming infected!

The Paediatrics and Child Health Division of The Royal Australasian College of Physicians have stated in their circumcision policy that ‘…Whilst there is some evidence, particularly from sub-Saharan Africa, that male circumcision reduces the risk of acquisition of HIV, evidence is conflicting and would not justify an argument in favour of universal neonatal circumcision in countries with a low prevalence of HIV.’ Australia has a low prevalence of HIV! There is no correlation between HIV and a lack of Circumcision in Australia!

Unfortunately Dr. Russell likes to put unnecessary fear into forcing parents into circumcising their boys! Contra to what he states, this procedure is painful, totally unnecessary and has a 2-10% complication rate!


After extensive research, the Paediatrics & Child Health Division of The Royal Australasian College of Physicians, Australasian Association of Paediatric Surgeons, New Zealand Society of Paediatric Surgeons, Urological Society of Australasia, Royal Australasian College of Surgeons, and Paediatric Society of New Zealand have concluded in their circumcision policy statement reaffirming ‘... that there is no medical indication for routine neonatal circumcision.’

Would you listen to a GP well known in the media for his strong stance supporting circumcision and who profits from this (his website full of biased and inaccurate information and a direct advertisement for his clinic) or the Australian medical experts?

I am a parent with 2 boys intact and proud of it. I urge all parents to be very cautious with any recommendations concerning circumcision made in these forums, do speak with your local GP and be referred to a specialist if needed!

[andrewJ]

There are health benefits to removing virtually any normal part of the body, since a missing body part can never become diseased or injured. Removing healthy breast tissue prevents breast cancer, amputating a toe prevents nail fungus, and so on. Even female circumcision has health benefits, since anyone whose clitoris and labia have been cut off will never suffer from vulvar agglutination, lichen sclerosus, or cancer of the labia.

Assuming that the reduced AIDS risk is true (there is evidence both ways) then this is a relevant point.

Tha annoying thing is that when the fashion of circumcision began in the developed world, nobody claimed that it would reduce the risk of AIDS at the time. The health benefits we hear about over the years (most are, in time proven to be false) are used as a way to justify circumcision and to perpetuate it.

It began in the developed world as a means of sexual control. This was seen as a good thing. it was later that the health benefits were claimed. If we had not become used to the idea of circumcision, I dont think that we would be able to justify it today based on some, debatable evidence suggesting a possible health benefit, in the same way that we do not justify removing girls breast buds to prevent them from contracting breast cancer (a much more tangeable possibility than penile cancer).

[serendipity22]

All the studies on this I seen have been badly flawed, a simple example is monogamous clean teetollating circumcised Muslim are being compared with heathens who sleep with HIV positive prostitutes who are too drunk to be able to put on a condom. A sound study would be very difficult to do and would be completely unethical. Its irrelevant anyway. Ignorance re HIV is rife in Africa, and
there is apparently a condom shortage.

Terry Russell had many strange things on his website, though much of it has been removed recently.

Terry, if you read this, can you please explain who you were giving all those foreskins to and what the research was?

Also please explain why you don't allow parents present during circumcision.

I wouldn't leave a child alone with a doctor (or dentist) in a purple fit.

[J281090]

Even if circumcision did lower the rate of HIV infection (which it doesn't) males still need to wear protection to keep them selves safe from a vast range of other STD's, and of course, to stop the female from getting pregnant.

So even in assuming that your son should turn out to be a male ***** (the only people really who should be worry about such infection), this does not diminish their chances of being infected, and they are still prone to other diseases and in causing unwanted pregnancies.

Myth dismissed.

[Heids]

I really don't think we have to worry about Aid's these days at all... its the Bird flu that could kill majority of the population now !!!

[Chickadee]

lol Dilly. A bit of an extreme measure!

[mollyandkurtsmum]

dilly I completely agree with you mouths and noses are disgusting and not needed. Imagine the positive side of having these removed

weight loss
money saved on tissues, toothpaste, dentists,lipstick etc etc
no more yelling at the kids not to pick their noses in public

why hasnt anyone thought of this earlier

[JohnC]

Whatever happens in Africa, this debate is clearly irrelevant to developed countries such as Australia because the male acquisition of HIV through unprotected sex with infected women is virtually a non-existent problem.

There are currently about 1.5 million uncircumcised Australian males between the ages of 15 and 34. If we circumcised all of them over the next year (at a hospital costmix of $1600 per patient, and generating at least 30,000 moderate to severe complications), how many AIDS cases would we prevent? By the most "optimistic" projections of this unproved theory - about 2.

Go figure !

[8thMarch2006]

I think that what it comes down to are personal values and experiences. My aunt was disgusted at the risk I was exposed to when I was immunised as a baby. She felt that with a lot of the major illness' being uncommon now days, it was an unnessicary risk to immunise new borns in our society. Her children were fine, and so were my mothers. But at the end of the day, both weighed up the options and did what they thought was right for their children.

Likewise with neo-natal circumcision.

My husband's family has endured huge losses through penial cancer, and consequently, we will look into how much the risks could be reduced if we have our son circ'ed. It is not a huge problem in Australia, but it is in our family.

I'm sure that people out there have lost loved ones to HIV and AIDS, and having seen the suffering, put more thought into the benefits of lowering the risk of infection than we who haven't. Although, of course, there are always alternate ways to address these things, please don't judge those who want to discuss the benefits. :o

I'm sure that many parents and parents to be have come in contact with these diseases throughout their travels, and have been effected to varying degrees.

I don't think that neo-natal circumcision should be routine, but it should be an option for parents, who after A LOT of thought, feel that the balance of risks is in favour. And that is something very personal and cannot be summarised by statistics (which is hard for me to say, as I am a statistician! :D )

[JohnC]

Hi 8th March 2006,

Surely before exercising personal choice one must ascertain the facts first - and these can only be gleaned from the relevant statistics. These facts underpin responsible public health policy, which must form the essential context of any responsible parental decision. This is as true for immunisation (where the benefits outweigh the risks) as for circumcision (where the reverse is true, according to all the relevant professional bodies).

Consider HIV/AIDS: over the course of the epidemic both male acquisition via hetrosexual transmission (16 cases in 2004)and circumcision rates among sexually active men have dropped dramatically. It would of course be unscrupulous to correlate these trends and suggest that circumcision increases the risk of AIDS! But the facts do show clearly that circumcision status in Australia has no meaningful effect on the risk of acquiring HIV/AIDS. It is therefore perverse to take the non-fact of HIV risk into account when considering the circumcision question.

As for penile cancer, I'm sorry to hear that it has occurred in your husband's family. But again we need to start with some facts:
1. Family history has no known bearing on risk for this particular carcinoma.
2. The main risk factors are infection with HPV 14 and 18, and smoking. (This means that the recently announced HPV vaccine to be used in the fight against cervical cancer will also have an impact on penile cancer rates.)
3. The lowest rates of penile cancer worldwide are in developed countries with negligble rates of circumcision, specifically northern Europe.
4 The rate in Australia has been falling (though it was always low - breast cancer in men is more common) for 50 years, as of course has the circumcision rate.

By analogy, I might decide that because my wife almost died of appendicitis when she was 10 that my daughter should have an appendectomy before she starts school. And I might sincerely believe that I am acting in my child's best interest. But no doctor or court would endorse my right to impose this surgery on my daughter in the absence of concrete medical indication. It seems worthwhile to examine this further since it goes to the heart of your post.

You say that "circumcision should be an option for parents". Well, it is not the parents who are getting circumcised :eek: . When is comes to surgery it is the patient (the child), not parents, who have rights. Parents have a responsibility to provide or withhold consent for a medically recommended procedure based on what is objectively in the child's best interests. It is therefore problematic whether parents can give valid consent for a procedure that is not medically indicated, ie not relevant to the current well-being of the child.

This is what the American Academy of Pediatrics has to say: "The pediatrician' responsibilities to his or her patient exist independent of parental desires or proxy consent."

In Australian the Queensland Law Reform Commission's 1993 inquiry into circumcision found "... consent by parents to the procedure being performed may be invalid in the light of the common law's restrictions on the ability of parents to consent to the non-therapeutic treatment of children."

Sorry this was a rather long post, but the issues you raise are serious and warrant a serious response that goes beyond mere impression and anecdote.

John

[cosmic]

Don't apologise for the long post, John. All very valid points.

[andrewJ]

I wonder if dr. terry russel genuinely believes that circumcision prevents penile cancer, as his website states.

National Cancer Institute, Vol. 85, No. 1, January 6, 1993, pp. 19-24.
In a study of 110 penile cancer victims conducted in WA and BC, Canada, 41 were circumcised. Considering the relatively low circumcision rate in Canada, 37% (41 out of 110) is a huge figure.

Im sure that dr. Terry Russels advice is of no consolation to the families of those 41 dead circumcised men.....and really, i think its dangerous advice.

"circumcision is not of value in preventing cancer of the penis."
(american cancer society)

[JohnC]

Andrew,

Certainly agree with your main point, though I still think the most compelling evidence is the fact that the lowest penile cancer rates are in countries with the lowest circumcision rates ~ 2pc. (The famed insularity of American researchers means this European data has been given insufficient weight in the discussion.)

However, on the Maden study to which you refer a few points need to be made in the interests of accuracy.

1. Washington State is in the US, adjacent to BC, which is in Canada.
2. We don't actually know what the real circumcision rates were for the age cohorts the control group was meant to represent, which is the main problem. The study claims to be a population-based, case-control study but a total of only 355 controls (spread across two countries and a couple of decades) makes it impossible to determine the true circ rate (although it was most likely higher than the 37pc you mention).
3. Van Howe et al claim (in J Fam Pract) that when "properly adjusted for age there was no difference between the case group and control group in circumcision status" but they do not demonstrate this adjustment in their paper, and I think the point is rendered moot by my objection in 2 above.

In short, this oft-quoted study has generated more smoke than light, and you are undoubtedly correct that its main value lies in conclusively showing that circumcision does not prevent penile cancer, whatever loony assertions ("dangerous" may be going a bit far ;)) Terry Russell and his co-thinkers may make.

But since people are understandably wary of statement made in forums such as this, particularly if they contradict their preconceptions, it is probably worthwhile to quote more extensively from the latest statement (Revised: 06/09/2005) of the American Cancer Society:

"In the past, circumcision has been suggested as a way to prevent penile cancer. This suggestion was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. However, most researchers now believe those studies were flawed because they failed to consider other factors that are now known to affect penile cancer risk ... [M]ost public health researchers believe that the penile cancer risk among uncircumcised men without known risk factors living in the United States is extremely low. The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer."

End of debate, I would have thought :p.

John

[andrewJ]

the 37% meant the percentage of the study group who were circumcised, not the percentage of the whole population.
But yeah, my point was that, even if 1% of the penile cancer victims were circumcised, then telling circumcised men that its impossible for them to get this cancer is dangerous.

[8thMarch2006]

The links between penial cancer (and cervical cancer in their partners) and circumcision were not anounced in Australia due to a study in the US based on percentages. The link is still under investigation in Melbourne by the Royal Children's Hospital and Melbourne Uni, due to the specific cancer causing cells being isolated to the foreskin. And I must insist that there is firm research to support a genetic element to the condition.

You seem to have done a lot of research on this topic, John, but please don't tell me that it has all been on the internet. I turned to the internet to help research this, but some of the 'facts' out there are absolute nonsense! We searched and searched, and yet have found very little substansiated FACTS either way. Everything that we find we take to specialists, and they have dismissed a lot of it. My mother in law's oncologists however all agreed that with a family history like my son will be born with, there is sufficient ground for neo-natal circumcision.

I donnot believe that all new born boys should be circumcised.

However, if I did not believe so strongly in researching both sides of the argument, there is no way I would have relised the risks I could expose my son to by not having him circ'd. I thought that this forum was for open discussion, but I don't really feel that at all. Sorry guys. For this to be a useful tool, there needs to be an environment where it is OK to discuss having it done.

This isn't a debate, it is an individual decision that is not to be taken lightly. A lot of my friends haven't had their boys done because it is too scarey to ask people about it now days. That's sad, and in my opinion, is an uninformed decision. And that, which ever way you decide to go, is the worst decision of them all.

Kate.

[JohnC]

Kate,

If this discussion were just the two of us having a chat over a cup of tea, I would at this point change the subject since you sound a little upset. I'm sorry about that. However, this is by definition a public discussion, and therefore we can't just agree to disagree. So ...

1. You say "please don't tell me that it has all been on the internet". I didn't. The Internet is a great poser of questions but not a decider. If you want to "research" the relationship between penile carcinoma and circumcision then the thing to do is turn to the professional bodies that have already done the hard yards, and on the basis of thousands of hours of research have come to conclusions for the purpose of guiding our (ie parents) decisions. And on this issue there is complete unanimity ... circumcision is not recommended as a preventitive strategy for penile cancer. Do you know something they don't? That would be a big call!

2. You refer to research "not anounced in Australia" about "specific cancer causing cells being isolated to the foreskin" :confused: . I think you are referring to the New England Journal of Medicine paper "Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners". A full version of this study, with a critique, can be found at
http://www.circumstitions.com/Cancer-cervNEJM.html
This paper, by the way, does not say what you think it says. But in any case, the whole issue has been rendered moot by the announcement of a HPV vaccine.

3. You say "there is firm research to support a genetic element" to penile cancer. Well, the oncology world would be very interested in that. Can you refer us to a single published paper that has made this astonishing claim?

4. I note that in an earlier post you say 3 men in your husband's family have died of penile cancer in the past two generations. I am not in a position to cast doubt on this claim but readers of this forum should realise that the odds of such a thing happening are vanishingly small. There were an average 6.1 deaths a year from penile cancer in the 1960s in all of Australia. Kate, you have said you are a statistician - perhaps you could calculate the odds for us of three such deaths happening in a single family.


John

[degslou]

hey there, im new to the site & hav been reading bits & pieces of different topics, i came across the topic of circumcision & noticed that alot of people were against it, i hav 2 boys aged 4yrs & 18months, both hav been circimcised, son #1 was done at 2weeks of age & son #2 was done at 5weeks of age, both were done with no complications, & yes it was done by DR. TERRY RUSSELL. every 1 is entitled 2 their own opinion :)

[JohnC]

i hav 2 boys aged 4yrs & 18months, both hav been circimcised ... every 1 is entitled 2 their own opinion :)

Indeed they are! I guess the issue is what you do as a result of your opinions. I would be very interested why you decided to get your sons circumcised. This is something that I don't understand, and I know I'm not alone in my perplexity.

The only recent, reputable research I am aware of was delivered to the Urological Society of Australasia in 2003 and based on responses of about 400 mothers from the Port Macquarie area. It found:

"Mothers who chose circumcision were younger and more likely to have circumcised partners and fathers. They were more likely to profess a religious faith and be less well educated than mothers who did not consider circumcision ... [they] claimed to be unaware of the potential risks of the procedure. They also strongly believed that it was a maternal right to have their son circumcised."

Is this typical of that shrinking minority of mothers who opt for circumcision?

[catnapjack]

I may be way off on a tangent, but seeing that this is the most current circumcision thread, thought I might ask what the current sociological consensus is on circumcision ???

My partner was adamant that my son be circumcised because it is the "done thing for a guy" (obviously a cut father !). I was feeling strongly against it as it doesnt really acheive anything other than "looking different". (The information in this thread also helps support my feelings that it may not also actually be preventing any major issues).

Then someone said something that really made me think seriously about circumcision of todays youngsters.... That an increasing number of boys are NOT being circumcised ( Unlike our partners generation) therefore if my son was to be circumcised he may indeed be a part of a minority group in the future.

What do people think? Will circumcising todays babies make them the "odd ones out" in their future? :confused:

[WeThree]

"Mothers who chose circumcision were younger and more likely to have circumcised partners and fathers. They were more likely to profess a religious faith and be less well educated than mothers who did not consider circumcision ... [they] claimed to be unaware of the potential risks of the procedure. They also strongly believed that it was a maternal right to have their son circumcised."

Is this typical of that shrinking minority of mothers who opt for circumcision?

yes from what i have observed (except in instances when it has been medically necessary) i believe so :)

[catnapjack]

Thankyou for the response. A huge weight is starting to shift regarding this issue. I have told my husband about the fact that his son would be in a minority, and he is actually coming to terms with the fact that circumcision is not the "moderrn" way to go.

I say a huge weight has lifted, as NOONE likes to see their child upset and in discomfort.

YAY>>>> I have made a firm decision that my son will not be circumcised. If like any other acute condition (such as JohnC's appendix example) then we will cross that bridge when we come to it.

Me and my boy thankyou. :D

[WeThree]

YAY Catnap!!:D

[cosmic]

Yay Yay Yay Catnapjack!!!!! :D :D I'm SO glad this thread served a useful purpose for someone! Happy days! :)

[JohnC]

YAY>>>> I have made a firm decision that my son will not be circumcised.

And YAY say all of us :D


Will circumcising todays babies make them the "odd ones out" in their future? :confused:

The actual numbers (which need to include publicly insured patients) for the total circumcision risk (both routine and medically indicated) of Australian-born boys from 0 to 9 years of age are:

1968 85%
1978 50%
1988 25%
1998 18%

The most recent figures show the total number of hospital circumcisions dropped by 1,341 from 2002-03 to 2003-04, with the main falls being in public hospitals in WA, NSW and Victoria for boys under 4 years.

So the "odd ones out" for more than 25 years, now, and into the future are circumcised boys.

[JohnC]

Apparently female circumcision also lowers the risk of HIV

http://www.ias-2005.org/planner/Abstracts.aspx?AID=3138

Angie

In another example of the sickening hypocrisy surrounding circumcision, the above study has not been quoted in the media.

A PowerPoint version of the full paper is available at:

www.ias-2005.org/planner/Presentations/ppt/3138.ppt

It concludes with obvious discomfort:
"The surprising and perplexing significant inverse association between reported female circumcision and HIV seropositivity has not been explained by other variables available and examined in these analyses. As no biological mechanism seems plausible, we conclude that it is due to irreducible confounding."

Well if there is a plausible biological mechanism to explain this inverse association in men, then it would also apply to women.

But no-one is going to support a campaign of mass female circumcision to retard the spread of HIV in Africa, let alone suggest such a thing for Australia.

You cannot have it both ways!

[cosmic]

In another example of the sickening hypocrisy surrounding circumcision, the above study has not been quoted in the media.


Unfortunately, the original link that started this thread has now been removed (so I can't compare it with what I just read)... but I still thought it was worthwhile mentioning this article which casts some doubt on the assertion that circumcision lowers AIDS risk.. and yes, it appears that what gets reported is not necessarily all the facts! :rolleyes:

Apparently, there were some major ethical issues surrounding the study which purportedly proved beyond a shadow of a doubt that circumcision protects against HIV infection.

For starters, all men were tested at the outset of the study and 146 of them were found to be HIV positive, but weren't told of their infection (so they wouldn't feel stigmatised.. :confused: ) and just left to go off and infect other people. :eek: Um.. ok well that raises a few ethical issues...

And secondly, the study was shut down early, apparently due to the 'conclusive' evidence found - but many believe the early results they found linking circumcision to lowered AIDS infection were more likely to be statistical anomalies and not real results.

Hmmm... so why did they stop the study early? The author of this article (below) suspects it's because they felt a tad guilty about letting all those HIV infected males run around infecting people... methinks there could be something in that theory!

Here it is if anyone is interested..

http://www.cbc.ca/news/viewpoint/vp_strauss/20051121.html

[melfunction]

Hmmm... so why did they stop the study early? The author of this article (below) suspects it's because they felt a tad guilty about letting all those HIV infected males run around infecting people... me thinks there could be something in that theory!

Here it is if anyone is interested..

http://www.cbc.ca/news/viewpoint/vp_strauss/20051121.html

I think you are probably right cosmic. These doctors may as well have given the men a gun and told them to go out and shoot people.....

[reAllytee]

I have read this thread & find some things disturbing. One that studies are done yet seem lacking in evidence as well as being unethical you think we could expect a lot more from the medical profession & two the way some seem to think & speak of those whose ideas differ to theirs.
I understand a lot of people being against circumcision & that it their own beliefs as well as what they choose as a way to bring their son up.
Yes show the pro & cons but dont just villify (sp?) us for choosing something different to what you would.
But i think some of what is being said here is rather nasty to those of us who choose to have it done.
I dont live in the dark ages & i made a very informed decision.
Now im not saying im going to start a campaign that every boy needs to be circumcised i just think every parent should make a decision based on what they think is best & what they choose as the right decision for them.
Some people do make false claims etc & that is wrong so i would advise any new mother who was wondering whether to or not to circumcise that she make sure she reads everything she can get her hands on (& dad also).
I am not a bad mother for making a different choice to you.

[Chickadee]

The following, excerpted from the 24 Oct 2005 BBC Online article (BBC news (http://news.bbc.co.uk/1/hi/health/4371384.stm)), should close the discussion.


UNAids has said the trial found promising results, but more work needs to be done to confirm its findings and "whether or not the results have more general application."

Keith Alcorn, of the National Aids Manual, said: "Although this study showed that men who were circumcised were less likely to become infected with HIV, it must be stressed that circumcised men did become infected in this study, and that circumcision does not provide total protection against HIV.

"I don't think that any country will be moving towards promotion of circumcision for HIV prevention on these results alone.

"Two further studies in Kenya and Uganda have yet to be completed, and will give us more information."

Deborah Jack, chief executive of the National Aids Trust, added: "There is a danger that people who have been circumcised will feel that they are fully protected from HIV when they are not.

"We need more research and clear guidance, as circumcision can never be a substitute for condom use."

The study is just that, a study. Not supported by other evidence yet and results are being further investigated. There is no recommendation from the AIDS agencies for circumcision to prevent contracting HIV.