The new Kenya health department policy on male circumcision is not based on
science but cultural prejudice. There is no scintela of prove that
circumcision reduce contraction of Hiv virus. what they are doing is
simply saying, I do not like your culture and so I’m going to change it.
Any scientist worth there salt have conclusively asserted based on
actual laboratory study that circumcision is not a factor to contracting
HIV. The department is citing some chunk studies which is purporting that
there is different rates of contracting the viruses between circumcised male
and un-circumcised male. But even assuming the result is correct, you can
not come with causation because there tends to be a correlation: “Causation
does not mean correlation.”Not withstanding some confounding variables all
the above result do is simply telling you there is significant difference
worth studying , but in the case of those studies there is a lot of
confounding variables.
The department is promoting abstinence and safe sex through the use
of condom, how then do they turn to promote un- protected sex . Because by
draconianly adopting circumcision as another slogan they are championing
un-protected sex, otherwise circumcision does not matter. Sounds like
contradiction and confused or unfairly prejudicial policies.
Some of those study done in Kisumu by Dr. Achola are non ethical and
skewed to satisfy his donors. There is a link between alcohol consumption
or prostitution and un-protected sex why don’t the government form a task
force on this. Why not even task force on female genital mutilation.
The issue here is not a neutral department policy but cultural war and
it is high time Kenyans respect other people. Now that the issue of
circumcision could not make a difference in the political arena (remember
kihii politics), the same perpetrators have moved the same forum under the
disguise of health and Hiv prevention. Until the department of Health is
willing to do actual science study not “arm chair” research they are simply
playing politics. I find this tortured interpretation of science arbitrary
and capricious, because cultural war and superiority complex should have no
place in shaping policies, but I am afraid it is.
– – –
Date: Wed, 23 Apr 2008 01:51:16 -0400
From: DUNCAN OJWANG
Subject: DRACONIAN MALE CIRCUMCISION LAWS
You should read this website for more information: http://www.circumcisionandhiv.com/
Circumcision can only possibly help men who have unsafe sex with HIV partners, so it seems bizarre to focus on genital surgery when we know that ABC works better than circumcision ever could? (ABC=Abstinence, Being Faithful, Condoms). The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circed men than in intact men, yet they’ve just started a nationwide circumcision campaign. Other countries where circumcised men are *more* likely to be HIV are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. Something is very wrong here. These people aren’t interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives.
Latest news is that HIV men are more likely to transmit the virus to women if they are circumcised.
Female circumcision seems to protect against HIV too btw, but we wouldn’t investigate cutting off women’s labia, and then start promoting that.
Three Randomised Controlled tests, in South Africa, Kenya and Uganda, found that after circumcising 5,400 men and leaving a similar number intact, 64 of the circumcised men contracted HIV and 137 of the intact men after two years. On this. the whole of the claim that “circumcision protects against HIV” is built. So Mr Ojwang is not quite correct that there is “no scintilla of proof”.
However, the gold standard of scientific trials is the Placebo-Controlled, Double-Blinded randomised controlled test. This means they give the control (intact) group something they can’t tell from the the thing being tested (circumcision), and neither experimenters nor subjects know which is the experimental group (circumcised) and which are controls.
Because they didn’t do this (and maybe it’s impossible to do thi) the men would behave differently depending on whether they were circumcised or not. They certainly gave the men being circumcised more advice about safe sex.
Another serious problem is that 673 men, 327 of them circumcised, dropped out of the trials and never came back, so we have no idea how many of them got HIV. There could easily be enough of them to make nonsense of the results.
The experimenters assumed that the only way men got HIV was by sex, and from women. If they got it some other way – and dirty injection needles are a big problem – that messes up the results more.
So Mr Ojwang is basically right that Luo men would not be protected by getting circumcised, and absolutely right that circumcision will encourage unprotected sex. Sticking to one partner and using condoms are still the safest things to do.
Just listen to the anti-circumcision activists! You would be tempted to believe their case has some merit … until you read this joint statement from WHO and UNAIDS:
Conclusions and Recommendations
Conclusion 1: The research evidence is compelling
The research evidence that male circumcision is efficacious in reducing sexual transmission of HIV from women to men is compelling. The partial protective effect of male circumcision is remarkably consistent across the observational studies (ecological, cross-sectional and cohort) and the three randomized controlled trials conducted in diverse settings.
The three randomised controlled trials showed that male circumcision performed by well-trained medical professionals was safe and reduced the risk of acquiring HIV infection by approximately 60%.
The efficacy of male circumcision in reducing female to male transmission of HIV has been proven beyond reasonable doubt. This is an important landmark in the history of HIV prevention.
Recommendations :
1.1 Male circumcision should now be recognized as an efficacious intervention for HIV prevention.
1.2 Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.
New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications
http://data.unaids.org/pub/Report/2007/mc_recommendations_en.pdf
The WHO and UNAIDS also have said circumcision must not displace current prevention efforts, nor be promoted without informed consent, nor is it of value in low prevalence settings. Interestingly, Rwanda, Ghana, Kenya, and Lesotho all have higher rates of HIV among circumcised men than among uncircumcised men. I guess the WHO and UNAIDS formulated their statement before they had all the facts, a not unusual occurrence in these international bodies dominated by circumcised Americans.
Pro-circumcision activist Joshua follows us around, always appealing to the authority of that statement (cutting and pasting it again and again if you argue with him), but the facts are as I have stated them.
The studies are not “compelling”. The 60% Relative Risk Reduction sounds impressive (IF the studies are not otherwise flawed) but that represents an absolute risk reduction of 1.3% – from 2.5% to 1.2 – and a Number Needed to Treat of 39. So the cost, time and effort of 38 circumcisions to prevent HIV out of 39 are wasted, more where the incidence of HIV is lower.
WHO and UNAIDS (fallible arms of the United Nations) seem to have been hijacked on this matter by circumcision activists (the names Halperin and Bailey, among others, seem to crop up again and again).