Changes

This article '''{{FULLPAGENAME}}''' discusses the relationship of male '''circumcision and HIV''' infection. For a discussion of [[circumcision]] and other sexually transmitted infections, see [[Circumcision and STDs]].

|}}</ref> Fink proposed in his letter: "I suspect that men in the United States, who, as compared with those in Africa and elsewhere, have had less acquisition of [[AIDS]], have benefited from the high rate of newborn [[circumcision ]] in the United States," regardless of the fact that the United States has one of the highest circumcision rates, and one of the highest [[HIV]] rates, in the western (industrialized) world (compare with European countries, Canda, and Australia).<ref>{{REFweb

Thomas et al. (2004) studied the incidence of [[HIV]] in circumcision [[circumcised]] and [[intact ]] men in a United States Navy population. A slightly higher incidence of [[HIV]] infection was found in circumcised men (84.9%) as compared with intact men (81.8%). The authors concluded:

deWitte found that not only are Langerhans cells found all over the body and that their complete removal is virtually impossible, but furthermore, deWitte found that Langerhans cells that are present in the [[foreskin]] produce ''Langerin'', a substance that has been proven to kill the [[HIV]] virus on contact, acting as a natural barrier to HIV-1 transmission by Langerhans cells.<ref>{{REFjournal |last=de Witte |first=Lot |init=L |last2=Nabatov |first2=Alexey |init2=A |last3=Pion |first3=Marjorie |init3=M |last4=Fluitsma |first4=Donna |init4=D |last5=de Jong |first5=Marein A.W.P. |init5=MAWP |last6=de Gruijl |first6=Tanja |init6=T |last7=Piguet |first7=Vincent |init7=V |last8=van Kooyk |first8=Yvette |init8=Y |last9=Geijtenbeek |first9=Teunis B.H. |init9=TBH |title=Langerin is a natural barrier to HIV-1 transmission by Langerhans cells |journal=Nature Medicine |volume=13 |issue=3 |pages=367-71 |url=http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf |format=PDF |pubmedID=17334373 |pubmedCID=10.1038/nm1541 |DOI=10.1038/nm1541 |date=DeWitte etal 2007-03-04 |accessdate=2020-07-02}}</ref> ==== Bacterial environment hypothesis ====This hypothesis attempts to identify the change in [[microbiome| bacterial environment ]] that results in the [[penis ]] as a result of [[adult circumcision]], as the mechanism whereby circumcision reduces the spread of [[HIV]] transmission. A desperate ad-hoc hypothesis, the explanation is rather farfetched. The argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflammation, a condition that facilitates the transmission of viruses. The chances for penile inflammation are reduced, thereby reducing the chances of sexually transmitted viruses, such as [[HIV]].<ref>{{REFjournal |last=Price

|url=httphttps://wwwjournals.plosoneplos.org/plosone/article/info%3Adoi%2F10?id=10.1371%2Fjournal/journal.pone.00155520008422

Presenting this hypothesis presents a two-fold problem. First, it presents an irrelevant conclusion; the discredited randomized control trials were measuring frequency in [[HIV]] transmission, not for frequency in penile bacterial inflamationinflammation, and whether said inflamation inflammation facilitated sexually transmitted [[HIV]]. And secondly, circumcision advocates give themselves the new burden of proving the newly introduced hypothesis, that change in bacterial infection does indeed result in a significant reduction of [[HIV]] transmission. A new study is needed to measure [[HIV]] transmission in men who have been [[circumcised]], [[intact ]] men with constant penile inflamationsinflammations, and [[intact ]] men who don't suffer constant penile inflammation. Unless the randomized controlled studies were limited to only [[intact ]] men who suffered constant penile inflammation.

The [[foreskin]]'s inner fold and the [[glans ]] of the penis are comprised of [[Preputial mucosa|mucous membrane]] tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions.

All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the [[penis ]] from viral and bacterial pathogens. The immunological functions of the human [[prepuce ]] have been extensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref>

Circumcision destroys the natural [[Immunological and protective function of the foreskin| immunological protections of the foreskin ]] and [[preputial sac]], so it results in increased risk of contracting [[infection]].

According to demographic health studies performed in other countries in Africa, [[HIV]] transmission was prevalent in [[circumcised ]] men in at least 6 different countries:

===== Cameroon =====In Cameroon, where 91% of the male population is circumcised, the ratio of [[circumcised [[ men vs. [[intact ]] men who contracted [[HIV]] was 4.1 vs. 1.1. <ref>{{REFbook

===== Ghana =====

===== Lesotho =====

''"The relationship between male circumcision and [[HIV]] levels in Lesotho does not conform to the expected pattern of higher rates among [[uncircumcised]] men than circumcised men. The [[HIV]] rate is in fact substantially higher among circumcised men (23 percent) than among men who are not circumcised (15 percent). Moreover, the pattern of higher infection rates among circumcised men compared with [[uncircumcised]] men is virtually uniform across the various subgroups for which results are shown in thetablethe table. This finding could be explained by the Lesotho custom to conduct male circumcision later in life, when the individuals have already been exposed to the risk of [[HIV]] infection. (Additional analysis is necessary to better understand the unexpected pattern in Table 12.9.)"''<ref>{{REFbook

::''An interesting defense of male circumcision, given the fact that the latest "studies," if they can even be called that, observed [[HIV]] transmission in men [[circumcised ]] as adults. Then again, this demographic health survey was conducted in 2004, BEFORE the newer "studies" in 2006. None the less, the unproven assertion that "circumcision is only effective in reducing the risk of [[HIV]] when done in infancy" persists in some circles.''

===== Malawi =====

===== Rwanda =====

=====South Africa===== 

===== Swaziland =====

:"As Table 14.10 shows, the relationship between [[HIV]] prevalence and circumcision status is not in the expected direction. [[Circumcised ]] men have a slightly higher [[HIV]] infection rate than men who are [[Intact| not circumcised ]] (22 percent compared with 20 percent).<ref>{{REFweb |url=http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf P. 256 |title=Swaziland Demographic and Health Survey |last= |first= |date=2006 |accessdate=2022-06-15}}</ref>

=====Zambia=====

[[Michel Garenne |Garenne]] & Matthews (2019) report:

In a multivariate analysis, based on the 2013 DHS survey, [[circumcised ]] men were found to have the same level of infection as [[uncircumcised]] men, after controlling for age, sexual behaviour and socioeconomic status. Lastly, circumcised men tended to have somewhat riskier sexual behaviour than [[uncircumcised]] men. This study, based on large representative samples of the Zambian population, questions the current strategy of mass circumcision campaigns in southern and eastern Africa.<ref name="garenne-matthews2019">{{REFjournal

|author-link=Michel Garenne

==== Malaysia ====According to Malaysian [[AIDS]] Council vice-president Datuk Zaman Khan, more than 70% of the 87,710 [[HIV]]/[[AIDS]] sufferers in the country are Muslims. In Malaysia, most, if not all Muslim men are circumcised, whereas circumcision is uncommon in the non-Muslim community. 60% of the Malaysian population is Muslim, which means that [[HIV]] is spreading in the community where most men are circumcised at an even faster rate, than in the community where most men are intact.<ref>{{REFweb |url=http://www.mmail.com.my/content/39272-72-percent-aidshiv-sufferers-malaysia-are-muslims-says-council |title= |last= |first= |date= |accessdate=2022-06-15}}></ref>

==== The Philippines ====[[Tuli]] or male circumcision, a nearly compulsory cultural practice in the Philippine Islands, causes 93 percent of Filipino males to be [[circumcised]].

The statistics suggest that removal of the protective [[foreskin]] by [[circumcision ]] increases the risk of contracting [[HIV]] infection.

==== [[Israel =]] ===Despite circumcision being near-universal, [[HIV]] is an increasing problem in [[Israel]].<ref>{{REFweb

==== The United States ====In America, the majority of the male population is [[circumcised]], approximately 7562%, <ref name="moore2015">{{REFweb |url=https://today.yougov.com/topics/lifestyle/articles-reports/2015/02/03/younger-americans-circumcision |title=Young Americans less supportive of circumcision at birth |last=Moore |first=Peter |date=2015-02-03 |accessdate=2022-06-15}}</ref> while in most countries in Europe, [[circumcision ]] is uncommon. One would expect for there to be a lower transmission rates in the [[United States]], and for [[HIV]] to be rampant in Europe; [[HIV]] transmission rates are in fact higher in the [[United States]], where most men are [[circumcised]], than in various countries in Europe, where most men are [[intact]].<ref>http://data.unaids.org/pub/Report/1998/19981125_global_epidemic_report_en.pdf</ref>

However, it is precisely these reasons given, that sex education and condoms aren't catching on in Africa, why circumcision advocates say "mass circumcision campaigns" should be promoted in Africa. What failed in the [[United States ]] is somehow supposed to work miracles in Africa.

=== Studies with contrary conclusions ===

Circumcision advocates use the latest discredited RCT African studies and WHO's endorsement based on them as proof "beyond reasonable doubt" that circumcision "reduces the risk of [[HIV]]." However, there are problems with the WHO's endorsement, as the studies on which it is based on suffer various flaws and confounding factors that bring their credibility in to question, many of which will be discussed in this article.

[[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.)| Doctors Opposing Circumcision]], in a letter to Ambassador Deborah L. Birx, {{MD}}, {{MPH}}, (2020), the head of the President’s Emergency Plan for AIDS Relief (PEPFAR) has called on [[PEPFAR]] to suspend the provision of male [[circumcision]] because it is ineffective and may increase the reception of [[HIV]] infection due to the loss of [[Immunological and protective function of the foreskin| immunological protections]] of the [[foreskin]], and to focus on the provision of anti-retroviral therapy and condoms.<ref name="denniston2020">{{REFdocument

|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

===September 2021===September 2021 saw Threre now is credible evidence that the publication of two huge population studies on the relationship of massive, expensive African circumcision and programs have ''not'' been effective in preventing [[HIV]] infection.

Mayan et al. (2021) carried out a massive empirical study of the male population of the province of Ontario, [[Canada]] (569,950 males), of whom 203,588 (35.7%) were circumcised between 1991 and 2017. The study concluded that circumcision status is not related to risk of [[HIV]] infection.<ref name="mayan2021">{{REFjournal |last=Mayan |first=Madhur |init= |author-link= |last2=Hamilton |first2=Robert J. |init2= |author2-link= |last3=Juurlink |first3=David N. |init3= |author3-link= |last4=Austin |first4=Peter C. |init4= |author4-link= |last5=Jarvi |first5=Keith A. |init5= |author5-link= |etal=no |title=Circumcision and Risk of HIV Among Males From Ontario, Canada |trans-title= |language= |journal=J Urol |location= |date=2021-09-23 |volume= |issue= |article= |page= |pages= |url=https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000002234 |archived= |quote=We found that circumcision was not independently associated with the risk of acquiring HIV among men from Ontario, Canada. |pubmedID=34551593 |pubmedCID= |DOI=10.1097/JU.0000000000002234 |accessdate=2021-10-02}}</ref> [[Morten Frisch]] and Jacob Simonsen (2021) carried out a large scale empirical population study in [[Denmark]] of 855,654 males regarding the alleged value of male circumcision in preventing [[HIV]] and other sexually transmitted infections in men. They found that circumcised men have a higher rate of STI and [[HIV]] infection overall than [[intact]] men.<ref name="frisch2021">{{FrischM SimonsenJ 2021}}</ref> There now is credible evidence that the massive, expensive African circumcision programs have ''not'' been effective in preventing [[HIV]] infection. == Increased risk to women ==A recent prospective study<ref>{{REFjournal |last=Turner |init=AN

|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

|last=[[Foregen ]] Staff

|publisher=[[Foregen]]