Circumcision and HIV: Difference between revisions
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'''{{FULLPAGENAME}}''' discusses the relationship of male '''circumcision and HIV''' infection. For a discussion of [[circumcision]] and other sexually transmitted infections, see [[Circumcision and STDs]]. | |||
Recently, circumcision has been heavily promoted as a method of preventing [[HIV]]. The [[World Health Organization|World Health Organization]] (WHO), now known to be corrupted, hasitly endorsed male circumcision as a form of [[HIV]] prevention in 2007, based on three studies (2005) & (2007) conducted in Africa (Kenya, South Africa, and Uganda) which claim that male circumcision is supposed to "reduce the risk of [[HIV]] transmission by 60%."<ref>{{REFweb | Recently, circumcision has been heavily promoted as a method of preventing [[HIV]]. The [[World Health Organization|World Health Organization]] (WHO), now known to be corrupted, hasitly endorsed male circumcision as a form of [[HIV]] prevention in 2007, based on three studies (2005) & (2007) conducted in Africa (Kenya, South Africa, and Uganda) which claim that male circumcision is supposed to "reduce the risk of [[HIV]] transmission by 60%."<ref>{{REFweb | ||
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|chapter="This Little Operation", Jewish American Physicians and Twentieth-Century Circumcision Advocacy | |chapter="This Little Operation", Jewish American Physicians and Twentieth-Century Circumcision Advocacy | ||
|page=206 | |page=206 | ||
|location=New York, | |location=New York, NY | ||
|publisher=Oxford University Press | |publisher={{UNI|Oxford University|Oxon}} Press | ||
|isbn=0-19-517674-X | |isbn=0-19-517674-X | ||
|quote=What if circumcision protected against infection with HIV... | |quote=What if circumcision protected against infection with HIV... | ||
| Line 93: | Line 93: | ||
}}</ref> without any kind of proof whatsoever. | }}</ref> without any kind of proof whatsoever. | ||
In 1986, Fink sent a letter to the ''New England Journal of Medicine'' titled "A possible Explanation for Heterosexual Male Infection with AIDS," where he argued that the hard and toughened glans of the circumcised male resisted infection, while the soft and sensitive foreskin and glans mucosa of the intact male were ports of entry.<ref>{{REFjournal | In 1986, Fink sent a letter to the ''New England Journal of Medicine'' titled "A possible Explanation for Heterosexual Male Infection with [[AIDS]]," where he argued that the hard and toughened glans of the circumcised male resisted infection, while the soft and sensitive foreskin and glans [[mucosa]] of the intact male were ports of entry.<ref>{{REFjournal | ||
|last=Fink | |last=Fink | ||
|first=Aaron J. | |first=Aaron J. | ||
| Line 106: | Line 106: | ||
|url=https://www.nejm.org/doi/full/10.1056/NEJM198610303151818 | |url=https://www.nejm.org/doi/full/10.1056/NEJM198610303151818 | ||
|pubmedID=3762636 | |pubmedID=3762636 | ||
|}}</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 | |}}</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 | ||
|url=http://www.who.int/hiv/facts/hiv2003/en/ | |url=http://www.who.int/hiv/facts/hiv2003/en/ | ||
|title=A global view of HIV infection | |title=A global view of HIV infection | ||
| Line 130: | Line 130: | ||
|page=207 | |page=207 | ||
|location=New York, NY | |location=New York, NY | ||
|publisher=Oxford University Press | |publisher={{UNI|Oxford University|Oxon}} Press | ||
|isbn=0-19-517674-X | |isbn=0-19-517674-X | ||
|quote=This is nothing I can prove. | |quote=This is nothing I can prove. | ||
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|Source="This Little Operation". ''Marked in Your Flesh.'' p.206-208 | |Source="This Little Operation". ''Marked in Your Flesh.'' p.206-208 | ||
}} | }} | ||
Alcena and Fink lacked a hypothesis to explain why the foreskin would be an entry point for HIV infection, but this was supplied by circumcision promoter [[Gerald N. Weiss]] and two colleagues. Weiss et al. (1993) produced the plausible but incorrect hypothesis that [[Langerhans cells]] attracted HIV. A medical journal in [[Israel]] was willing to publish the paper by Weiss et al.<ref name="weiss1993">{{REFjournal | |||
|last=Weiss | |||
|first=Gerald N. | |||
|init=GN | |||
|author-link=Gerald N. Weiss | |||
|last2=Sanders | |||
|first2= | |||
|init2=M | |||
|author2-link= | |||
|last3=Westbrook | |||
|first3= | |||
|init3=KC | |||
|author3-link= | |||
|etal=no | |||
|title=The distribution and density of Langerhans cells in the human prepuce: site of a diminished immune response? | |||
|journal= Isr J Med Sci | |||
|location= | |||
|date=1993-01 | |||
|volume=20 | |||
|issue=1 | |||
|article= | |||
|page= | |||
|pages=42-3 | |||
|url= | |||
|archived= | |||
|quote= | |||
|pubmedID=8454447 | |||
|pubmedCID= | |||
|DOI= | |||
|accessdate=2022-10-28 | |||
}}</ref>. | |||
Fink abandoned the circumcision/[[HIV]] controversy in 1991, and he died in 1994. He left behind an indelible legacy nonetheless; the circumcision/[[HIV]] hypothesis continues to be supported by researchers and scientists that are adopting his assertions and writing studies based upon them, and the campaign to establish a causal link between [[HIV]] infection and the presence of the foreskin continues to this day. | Fink abandoned the circumcision/[[HIV]] controversy in 1991, and he died in 1994. He left behind an indelible legacy nonetheless; the circumcision/[[HIV]] hypothesis continues to be supported by researchers and scientists that are adopting his assertions and writing studies based upon them, and the campaign to establish a causal link between [[HIV]] infection and the presence of the foreskin continues to this day. | ||
| Line 150: | Line 182: | ||
* Female circumcision and [[infibulation]]. | * Female circumcision and [[infibulation]]. | ||
* Promiscuity. | * Promiscuity. | ||
* | * Homosexuality and anal intercourse. | ||
* Practices resulting in exposure to blood. | * Practices resulting in exposure to blood. | ||
* Practices involving the use of shared instruments. | * Practices involving the use of shared instruments. | ||
| Line 240: | Line 272: | ||
</ref> | </ref> | ||
Thomas et al. (2004) studied the incidence of [[HIV]] in | Thomas et al. (2004) studied the incidence of [[HIV]] in [[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: | ||
<blockquote> | <blockquote> | ||
Although there may be other medical or cultural reasons for male circumcision, it is not associated with [[HIV]] or STI prevention in this U.S. military population.<ref name="thomas2004">Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA. [http://www.cirp.org/library/disease/HIV/thomas1/ Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. Navy population]. Abstract no. TuPeC4861. Presented at the XV International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.</ref> | Although there may be other medical or cultural reasons for male circumcision, it is not associated with [[HIV]] or STI prevention in this U.S. military population.<ref name="thomas2004">Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA. [http://www.cirp.org/library/disease/HIV/thomas1/ Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. Navy population]. Abstract no. TuPeC4861. Presented at the XV International [[AIDS]] Conference, Bangkok, Thailand, July 11-16, 2004.</ref> | ||
</blockquote> | </blockquote> | ||
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==== Keratinization hypothesis ==== | ==== Keratinization hypothesis ==== | ||
Perhaps the oldest hypothesis on the mechanism whereby circumcision prevents the transmission of [[HIV]] is the theory that suggests that the [[Keratinization| keratinized]] surface of the penis in circumcised male resists infection, while the mucosa of the glans and inner of the intact male are ports of entry, which was purported by [[Aaron J. Fink]]. | Perhaps the oldest hypothesis on the mechanism whereby circumcision prevents the transmission of [[HIV]] is the theory that suggests that the [[Keratinization| keratinized]] surface of the penis in circumcised male resists infection, while the [[mucosa]] of the glans and inner of the intact male are ports of entry, which was purported by [[Aaron J. Fink]]. | ||
Recent studies, however, disprove this hypothesis. One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why [[uncircumcised]] men are at higher risk for [[HIV]] infection."<ref>{{REFjournal | Recent studies, however, disprove this hypothesis. One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why [[uncircumcised]] men are at higher risk for [[HIV]] infection."<ref>{{REFjournal | ||
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==== Langerhans cell hypothesis ==== | ==== Langerhans cell hypothesis ==== | ||
Recent circumcision studies in Africa were conducted under the hypothesis that the [[Langerhans cells]] were the prime port of entry for the [[HIV]] virus. According to the hypothesis, circumcision was supposed to prevent [[HIV]] transmission by removing the Langerhans cells found in the inner | Recent circumcision studies in Africa were conducted under the hypothesis that the [[Langerhans cells]] were the prime port of entry for the [[HIV]] virus. According to the hypothesis, circumcision was supposed to prevent [[HIV]] transmission by removing the Langerhans cells found in the inner [[mucosa]]l lining of the foreskin. | ||
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>{{ | 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>{{DeWitte etal 2007}}</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 | |||
}}</ref> | |||
==== Bacterial environment hypothesis ==== | |||
This hypothesis attempts to identify the change in bacterial environment that results in the penis as a result of 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 | |||
|first=Lance B. | |first=Lance B. | ||
|init=LB | |init=LB | ||
| Line 375: | Line 367: | ||
|volume=5 | |volume=5 | ||
|issue=1 | |issue=1 | ||
|url= | |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0008422 | ||
|quote=The anoxic microenvironment of the subpreputial space may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. Thus, the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases. | |quote=The anoxic microenvironment of the subpreputial space may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. Thus, the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases. | ||
|DOI=10.1371/journal.pone.0008422 | |DOI=10.1371/journal.pone.0008422 | ||
| Line 382: | Line 374: | ||
}}</ref> | }}</ref> | ||
Presenting this hypothesis presents a two-fold problem. First, it presents an irrelevant conclusion; the randomized control trials were measuring frequency in [[HIV]] transmission, not for frequency in penile bacterial | 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 inflammation, and whether said 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 inflammations, 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 immunological function of the foreskin == | == The immunological function of the foreskin == | ||
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. | 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. | ||
Certain components such as [[Langerhans cells]],<ref>{{REFjournal | Certain components such as [[Langerhans cells]],<ref>{{REFjournal | ||
| Line 559: | Line 551: | ||
}}</ref> | }}</ref> | ||
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">{{ | 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> | ||
}}</ref> | |||
Circumcision destroys the natural immunological protections of the foreskin and results in increased risk of contracting infection. | 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]]. | ||
== African RCTs == | == African RCTs == | ||
| Line 656: | Line 626: | ||
Boyle & Hill (2011) have shown these RCTs to be have significant methodological flaws and statistical errors that render their claims invalid. Although a 60 percent ''relative'' reduction in [[HIV]] was claimed, the ''absolute'' reduction was a statistically insignificant 1.3 percent.<ref name="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref> | Boyle & Hill (2011) have shown these RCTs to be have significant methodological flaws and statistical errors that render their claims invalid. Although a 60 percent ''relative'' reduction in [[HIV]] was claimed, the ''absolute'' reduction was a statistically insignificant 1.3 percent.<ref name="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref> | ||
Concerns about the three randomized controlled clinical trials (RCCTs) in Africa (in South Africa, Uganda, and Kenya)<ref>{{ | Concerns about the [[HIV trials in Africa|three randomized controlled clinical trials (RCCTs) in Africa]] (in South Africa, Uganda, and Kenya)<ref>{{RCT Auvert et al 2005}}</ref><ref name="bailey2007">{{RCT Bailey et al 2007}}</ref><ref name="gray2007">{{RCT Gray et al 2007}}</ref>: | ||
* The three RCTs were terminated early because results had reached a signifıcent level showing reduced [[HIV]] infections in experimental compared with control groups; however, it was too soon to gauge long-term effectiveness. | |||
* The results have no relevance for women or for men who have sex with men. | |||
* Far more participants were lost to follow-up than were reported to have contracted [[HIV]]. | |||
* A substantial number of participants appeared to have contracted [[HIV]] from nonsexual sources: 23 of the 69 infections reported in the South African trial and 16 of the 67 in the Ugandan study.<ref>{{REFbook | |||
}}</ref><ref name="bailey2007">{{ | |||
}}</ref><ref name="gray2007">{{ | |||
}}</ref>: | |||
* The three RCTs were terminated early because results had reached a signifıcent level showing reduced [[HIV]] infections in experimental compared with control groups; however, it was too soon to gauge long-term effectiveness. | |||
* The results have no relevance for women or for men who have sex with men. | |||
* Far more participants were lost to follow-up than were reported to have contracted [[HIV]]. | |||
* A substantial number of participants appeared to have contracted [[HIV]] from nonsexual sources: 23 of the 69 infections reported in the South African trial and 16 of the 67 in the Ugandan study.<ref>{{REFbook | |||
|last=Gisselquist | |last=Gisselquist | ||
|first=D. | |first=D. | ||
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=== Countries in Africa === | === Countries in Africa === | ||
According to demographic health studies performed in other countries in Africa, [[HIV]] transmission was prevalent in circumcised men in at least 6 different countries: | 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 | 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 | ||
|last=Mosoko | |last=Mosoko | ||
|first=Jembia J. | |first=Jembia J. | ||
| Line 791: | Line 713: | ||
}}</ref> | }}</ref> | ||
==== Ghana ==== | |||
In Ghana, the ratio is 1.6 vs 1.4 (95.3% circumcised). ''"...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the [[HIV]] prevalence by circumcision status..."''<ref>{{REFbook | In Ghana, the ratio is 1.6 vs 1.4 (95.3% circumcised). ''"...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the [[HIV]] prevalence by circumcision status..."''<ref>{{REFbook | ||
|last=Marum | |last=Marum | ||
| Line 819: | Line 741: | ||
}}</ref> | }}</ref> | ||
==== Lesotho ==== | |||
In Lesotho, the ratio is 22.8 vs 15.2 (23% circumcised). | In Lesotho, the ratio is 22.8 vs 15.2 (23% circumcised). | ||
''"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 | ''"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 the 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 | ||
|last= | |last= | ||
|first= | |first= | ||
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}}</ref> | }}</ref> | ||
::''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.'' | ::''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 ==== | |||
DHS 2004 - 13.2 vs 9.5 (20% circumcised) | DHS 2004 - 13.2 vs 9.5 (20% circumcised) | ||
:"The relationship between [[HIV]] prevalence and circumcision status is not in the expected | :"The relationship between [[HIV]] prevalence and circumcision status is not in the expected | ||
| Line 876: | Line 798: | ||
::''...where one would expect [[HIV]] to be the most rampant.'' | ::''...where one would expect [[HIV]] to be the most rampant.'' | ||
==== Rwanda ==== | |||
DHS 2005 - 3.8 vs 2.1 <ref>http://www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf p. 10</ref> | DHS 2005 - 3.8 vs 2.1 <ref>http://www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf p. 10</ref> | ||
====South Africa==== | |||
Rosenberg et al. (2018) report that circumcised men in South Africa are more likely to be [[HIV]] infected than intact men.<ref name="Rosenberg2018">{{REFjournal | Rosenberg et al. (2018) report that circumcised men in South Africa are more likely to be [[HIV]] infected than intact men.<ref name="Rosenberg2018">{{REFjournal | ||
|last=Rosenberg | |last=Rosenberg | ||
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}}</ref> | }}</ref> | ||
==== Swaziland ==== | |||
DHS 2006-2007 - 22 vs 20 | DHS 2006-2007 - 22 vs 20 | ||
:"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 not circumcised (22 percent compared with 20 percent).<ref>http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf | :"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 | |||
|title=Swaziland Demographic and Health Survey | |||
|last= | |||
|first= | |||
|date=2006 | |||
|accessdate=2022-06-15 | |||
}}</ref> | |||
==== Zambia ==== | |||
The prevalence of [[HIV]] infection among men aged 15-29 has ''not'' decreased despite several campaigns to perform male circumcision. | The prevalence of [[HIV]] infection among men aged 15-29 has ''not'' decreased despite several campaigns to perform male circumcision. | ||
Garenne & Matthews (2019) report: | [[Michel Garenne|Garenne]] & Matthews (2019) report: | ||
<blockquote> | <blockquote> | ||
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 | 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 | ||
|last=Garenne | |last=Garenne | ||
|init=M | |init=M | ||
|author-link= | |author-link=Michel Garenne | ||
|last2=Matthews | |last2=Matthews | ||
|init2=A | |init2=A | ||
| Line 944: | Line 872: | ||
</blockquote> | </blockquote> | ||
=== 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 | 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> | |||
Interestingly enough, Malaysia is home to the [[TARA KLamp]], a controversial circumcision device being marketed in KwaZulu Natal, Africa in the name of [[HIV]] prevention. | Interestingly enough, Malaysia is home to the [[TARA KLamp]], a controversial circumcision device being marketed in KwaZulu Natal, Africa in the name of [[HIV]] prevention. | ||
=== | === Philippines === | ||
[[Tuli]] or male circumcision, a nearly compulsory cultural practice in the Philippine Islands, causes 93 percent of Filipino males to be circumcised. | [[Tuli]] or male circumcision, a nearly compulsory cultural practice in the Philippine Islands, causes 93 percent of Filipino males to be [[circumcised]]. | ||
In the 2010 Global AIDS report released by UNAIDS in late November, the Philippines was one of seven nations in the world which reported over 25 percent in new [[HIV]] infections between 2001 and 2009, whereas other countries have either stabilized or shown significant declines in the rate of new infections. Among all countries in Asia, only the Philippines and Bangladesh are reporting increases in [[HIV]] cases, with others either stable or decreasing. <ref>http://globalnation.inquirer.net/news/breakingnews/view/20110102-312124/Philippines-HIVAIDS-problem-worries-UN</ref> | In the 2010 Global [[AIDS]] report released by UNAIDS in late November, the Philippines was one of seven nations in the world which reported over 25 percent in new [[HIV]] infections between 2001 and 2009, whereas other countries have either stabilized or shown significant declines in the rate of new infections. Among all countries in Asia, only the Philippines and Bangladesh are reporting increases in [[HIV]] cases, with others either stable or decreasing. <ref>http://globalnation.inquirer.net/news/breakingnews/view/20110102-312124/Philippines-HIVAIDS-problem-worries-UN</ref> | ||
The statistics suggest that removal of the protective [[foreskin]] by circumcision increases the risk of contracting [[HIV]] infection. | 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 | Despite circumcision being near-universal, [[HIV]] is an increasing problem in [[Israel]].<ref>{{REFweb | ||
|url=https://www.haaretz.com/1.4998790 | |url=https://www.haaretz.com/1.4998790 | ||
|title=Failing the AIDS Test | |title=Failing the AIDS Test | ||
| Line 978: | Line 913: | ||
}}</ref> | }}</ref> | ||
=== The United States === | |||
In America, the majority of the male population is circumcised, approximately | In America, the majority of the male population is [[circumcised]], approximately 62%,<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> | |||
A common explanation given for this difference is the fact that sex education and instruction in the proper use of condoms is better executed in Europe than in the United States, where sex education is poor. | A common explanation given for this difference is the fact that sex education and instruction in the proper use of condoms is better executed in Europe than in the United States, where sex education is poor. | ||
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. | 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 == | |||
According to USAID, there appears no clear pattern of association between male circumcision and [[HIV]] prevalence—in 8 of 18 countries with data, [[HIV]] prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.<ref>http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf</ref> | According to USAID, there appears no clear pattern of association between male circumcision and [[HIV]] prevalence—in 8 of 18 countries with data, [[HIV]] prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.<ref>http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf</ref> | ||
"Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative [[HIV]] seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs."<ref>http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431</ref> | "Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative [[HIV]] seroprevalence data. The results are important in considering the development of circumcision-focused interventions within [[AIDS]] prevention programs."<ref>http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431</ref> | ||
Results: ...No consistent relationship between male circumcision and [[HIV]] risk was observed in most countries."<ref>"http://apha.confex.com/apha/134am/techprogram/paper_136814.htm</ref> | Results: ...No consistent relationship between male circumcision and [[HIV]] risk was observed in most countries."<ref>"http://apha.confex.com/apha/134am/techprogram/paper_136814.htm</ref> | ||
| Line 1,079: | Line 1,021: | ||
|last=Garenne | |last=Garenne | ||
|init=M | |init=M | ||
|author-link=Michel Garenne | |||
|title=Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa | |title=Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa | ||
|url=http://www.circumstitions.com/Docs/garenne-2.pdf | |url=http://www.circumstitions.com/Docs/garenne-2.pdf | ||
| Line 1,127: | Line 1,070: | ||
|dateto= | |dateto= | ||
|accessdate= | |accessdate= | ||
}}</ref> Both the U.S. and sub-Saharan Africa have relatively high incidence rates of [[HIV]] infection, considering that about 75% of U.S. men and about 70% of sub-Saharan African men are circumcised—higher percentages than in most other regions or countries with lower prevalence of [[HIV]].<ref>{{REFjournal | }}</ref> Both the U.S. and sub-Saharan Africa have relatively high incidence rates of [[HIV]] infection, considering that about 75% of U.S. men and about 70% of sub-Saharan African men are circumcised—higher percentages than in most other regions or countries with lower prevalence of [[HIV]].<ref name="Green etal 2010">{{REFjournal | ||
|last=Green | |last=Green | ||
|init=LW | |init=LW | ||
| Line 1,142: | Line 1,085: | ||
|init6=A | |init6=A | ||
|title=Male circumcision and HIV prevention insufficient evidence and neglected external validity | |title=Male circumcision and HIV prevention insufficient evidence and neglected external validity | ||
|url=https://www.arclaw.org/wp-content/uploads/Green-Circ-HIV-Prev-Insufficient-AmJPrevMed-2010.pdf | |||
|format=PDF | |||
|journal=Am J Prev Med | |journal=Am J Prev Med | ||
|publisher=Department of Epidemiology and Biostatistics, {{UNI|University of California|UCSF}} at San Francisco, USA | |||
|date=2010-11 | |date=2010-11 | ||
|volume=39 | |volume=39 | ||
|issue=5 | |issue=5 | ||
|pages=479-482 | |pages=479-482 | ||
|pubmedID=20965388 | |pubmedID=20965388 | ||
}}</ref> | }}</ref> | ||
| Line 1,243: | Line 1,188: | ||
The fact that the [[World Health Organization]] is corrupt is now well-established: | The fact that the [[World Health Organization]] is corrupt is now well-established: | ||
Circumcision advocates use the | Circumcision advocates use the 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. | ||
On their [http://www.who.int/hiv/topics/malecircumcision/en/ website], the WHO acknowledges that, ''"[m]ale circumcision provides only partial protection,"'' and that it should be part of a ''"comprehensive [[HIV]] prevention package"'' that includes [[HIV]] testing and counseling services, treatment for STD infections, the promotion of safer sex practices and the provision of condoms and the promotion of their correct and consistent use. | On their [http://www.who.int/hiv/topics/malecircumcision/en/ website], the WHO acknowledges that, ''"[m]ale circumcision provides only partial protection,"'' and that it should be part of a ''"comprehensive [[HIV]] prevention package"'' that includes [[HIV]] testing and counseling services, treatment for STD infections, the promotion of safer sex practices and the provision of condoms and the promotion of their correct and consistent use. | ||
Van Howe & Boyle (2018) pointed out numerous reasons that one should doubt the published results of the randomised clinical trials (RCTs)<ref name= "vanhowe2018">{{REFjournal | [[Robert S. Van Howe|Van Howe]] & Boyle (2018) pointed out numerous reasons that one should doubt the published results of the randomised clinical trials (RCTs)<ref name= "vanhowe2018">{{REFjournal | ||
|last=Van Howe | |last=Van Howe | ||
|first=Robert S. | |first=Robert S. | ||
| Line 1,273: | Line 1,218: | ||
}}</ref> | }}</ref> | ||
[[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.) | [[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.)]], 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 | ||
|title=World Health Organization, HIV, and male circumcision | |title=World Health Organization, HIV, and male circumcision | ||
|url=https://pool.intactiwiki.org/images/2020-06-15b_LettertoPEPFAR.pdf | |url=https://pool.intactiwiki.org/images/2020-06-15b_LettertoPEPFAR.pdf | ||
| Line 1,279: | Line 1,224: | ||
|last=Denniston | |last=Denniston | ||
|first=George C. | |first=George C. | ||
|publisher=Doctors Opposing Circumcision | |publisher=[[Doctors Opposing Circumcision (D.O.C.)]] | ||
|format= | |format= | ||
|date=2020-06-29 | |date=2020-06-29 | ||
| Line 1,331: | Line 1,276: | ||
}}</ref> | }}</ref> | ||
Threre now is credible evidence that the massive, expensive African circumcision programs have ''not'' been effective in preventing [[HIV]] infection. | |||
== Increased risk to women == | |||
|last= | A recent prospective study<ref>{{REFjournal | ||
|last=Turner | |||
|init= | |init=AN | ||
|last2=Morrison | |||
|last2= | |init2=CS | ||
|last3=Padian | |||
|init2= | |init3=NS | ||
|etal=yes | |||
|last3= | |title=Men’s circumcision status and women’s risk of HIV acquisition in Zimbabwe and Uganda | ||
|journal=AIDS | |||
|init3= | |date=2007 | ||
|volume=21 | |||
|pages=1779–1789 | |||
}}</ref> showed that male circumcision offered no protection to women, and an RCCT<ref>{{REFjournal | |||
|last=Wawer | |||
|init=MJ | |||
|last2=Makumbi | |||
|init2=F | |||
|last3=Kigozi | |||
|init3=G | |||
|etal= | |etal=yes | ||
|title= | |title=Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial | ||
| | |journal=Lancet | ||
| | |date=2009 | ||
| | |volume374 | ||
| | |pages=229-237 | ||
}}</ref> found that male circumcision actually increased the risk to women. Women also are placed at greater risk from unsafe sex practices when they, or their circumcised male partners, wrongly believe that with circumcision they are immune to [[HIV]] and therefore they choose not to use condoms.<ref>{{REFweb | |||
| | |last=Nyakairu | ||
| | |first=F. | ||
| | |title=Uganda turns to mass circumcision in AIDS fıght | ||
| | |publisher=Reuters Africa | ||
| | |date=2008-08-13 | ||
| | |url=https://www.reuters.com/article/idUSLD23235720080813 | ||
| | }}</ref><ref>{{REFweb | ||
| | |title=Circumcision gives men an excuse not to use condoms | ||
| | |publisher=UN Offıce for the Coordination of Humanitarian Affairs | ||
| | |website=The New Humanitarian (formerly IRIN News) | ||
| | |url=http://www.thenewhumanitarian.org/news/2008/07/31/circumcision-gives-men-excuse-not-use-condoms | ||
| | |date=2008-07 | ||
}}</ref> | |accessdate=2020-01-05 | ||
|last= | |||
|first= | |||
|title= | |||
| | |||
|date= | |||
| | |||
| | |||
| | |||
| | |||
|url= | |||
| | |||
|accessdate= | |||
}}</ref> | }}</ref> | ||
There | There are legitimate additional concerns about: | ||
* How male circumcision programs, or being circumcised, will influence human behavior. | |||
* The sidelining of women when considering male circumcision as a prevention method. | |||
* The tendency of both men and women to ascribe undue power to a technical fıx for what must remain a matter of human control, as in the use of condoms and other safe sex practices.<ref name="Green etal 2010"/> | |||
== Effective prevention == | |||
== | {| class="wikitable" border="1" style="float:right; font-size:85%; margin-left:15px;" | ||
|- style="background:#efefef;" | |||
|last= | |+ Estimated per act risk for acquisition<br/>of [[HIV]] by exposure route (US only) <ref name=MMWR3>{{REFjournal | ||
|init= | |last=Smith | ||
|last2= | |init=DK | ||
|init2= | |last2=Grohskopf | ||
|last3= | |init2=LA | ||
|init3= | |last3=Black | ||
|init3=RJ | |||
|etal=yes | |etal=yes | ||
|title= | |title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States | ||
|journal= | |journal=MMWR | ||
| | |volume=54 | ||
| | |issue=RR02 | ||
|pages= | |pages=1-20 | ||
}}</ref> | |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1 | ||
|last= | |quote= | ||
|init= | |pubmedID= | ||
|last2= | |pubmedCID= | ||
|init2= | |DOI= | ||
|last3= | |date=2005 | ||
|init3= | |accessdate=2009-03-31 | ||
}}</ref> | |||
|- style="background:#efefef;" | |||
! style="width: 100px" abbr="Route" | Exposure Route | |||
! style="width: 130px" abbr="Infections" | Estimated infections<br/>per 10,000 exposures<br/>to an infected source | |||
|- | |||
! style="text-align:left"| Blood Transfusion | |||
| 9,000<ref name=Donegan>{{REFjournal | |||
|last=Donegan | |||
|init=E | |||
|last2=Stuart | |||
|init2=M | |||
|last3=Niland | |||
|init3=JC | |||
|etal=yes | |etal=yes | ||
|title= | |title=Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations | ||
|journal= | |journal=Ann. Intern. Med. | ||
| | |volume=113 | ||
| | |issue=10 | ||
|pages= | |pages=733-739 | ||
}}</ref> | |url= | ||
|last= | |quote= | ||
| | |pubmedID=2240875 | ||
|title= | |pubmedCID= | ||
| | |DOI= | ||
| | |date=1990 | ||
|url= | |accessdate= | ||
}}</ref> | |||
| | |- | ||
| | ! style="text-align:left"| Childbirth <small>(to child)</small> | ||
| | | 2,500<ref name=Coovadia>{{REFjournal | ||
| | |last=Coovadia | ||
|date= | |init=H | ||
|accessdate= | |title=Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS | ||
|journal=N. Engl. J. Med. | |||
|volume=351 | |||
|issue=3 | |||
|pages=289-292 | |||
|url= | |||
|quote= | |||
|pubmedID=15247337 | |||
|pubmedCID= | |||
|DOI=10.1056/NEJMe048128 | |||
|date=2004 | |||
|accessdate= | |||
}}</ref> | }}</ref> | ||
|- | |||
! style="text-align:left"| Needle-sharing injection drug use | |||
| 67<ref name=Kaplan>{{REFjournal | |||
|last=Kaplan | |||
|init=EH | |||
|last= | |last2=Heimer | ||
|init= | |init2=R | ||
|last2= | |title=HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data | ||
|init2= | |journal=J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. | ||
| | |volume=10 | ||
| | |issue=2 | ||
| | |pages=175-176 | ||
| | |url= | ||
| | |quote= | ||
| | |pubmedID=7552482 | ||
| | |pubmedCID= | ||
| | |DOI= | ||
| | |date=1995 | ||
| | |accessdate= | ||
|date= | |||
| | |||
}}</ref> | }}</ref> | ||
|- | |||
! style="text-align:left"| Percutaneous needle stick | |||
| 30<ref name=Bell>{{REFjournal | |||
|last=Bell | |||
| | |init=DM | ||
| | |title=Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview | ||
|last= | |journal=Am J Med | ||
|init= | |volume=102 | ||
|issue=5B | |||
|pages=9-15 | |||
|url= | |||
|title= | |||
|journal= | |||
|volume= | |||
|issue= | |||
|pages= | |||
|url= | |||
|quote= | |quote= | ||
|pubmedID= | |pubmedID=9845490 | ||
|pubmedCID= | |pubmedCID= | ||
|DOI= | |DOI=10.1016/S0002-9343(97)89441-7 | ||
|date= | |date=1997 | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
|- | |- | ||
! style="text-align:left"| | ! style="text-align:left"| Receptive anal intercourse<sup>*</sup> | ||
| | | 50<ref name=ESG>{{REFjournal | ||
|last= | |last=European Study Group on Heterosexual Transmission of HIV | ||
|first= | |||
|title=Comparison of female to male and male to female transmission of HIV in 563 stable couples | |||
| | |journal=BMJ | ||
|volume=304 | |||
|issue=6830 | |||
|pages=809-813 | |||
|title= | |||
|journal= | |||
|volume= | |||
|issue= | |||
|pages= | |||
|url= | |url= | ||
|quote= | |quote= | ||
|pubmedID= | |pubmedID=1392708 | ||
|pubmedCID= | |pubmedCID=1881672 | ||
|DOI= | |DOI=10.1136/bmj.304.6830.809 | ||
|date= | |date= | ||
|accessdate= | |||
}}</ref><ref name=Varghese>{{REFjournal | |||
|last=Varghese | |||
|init=B | |||
|last2=Maher | |||
|init2=JE | |||
|last3=Peterman | |||
|init3=TA | |||
|last4=Branson | |||
|init4=BM | |||
|last5=Steketee | |||
|init5=RW | |||
|title=Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use | |||
|journal=Sex Transm Dis | |||
|volume=29 | |||
|issue=1 | |||
|pages=38-43 | |||
|url= | |||
|quote= | |||
|pubmedID=11773877 | |||
|pubmedCID= | |||
|DOI= | |||
|date=2002 | |||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
|- | |- | ||
! style="text-align:left"| | ! style="text-align:left"| Insertive anal intercourse<sup>*</sup> | ||
| | | 6.5<ref name=ESG /><ref name=Varghese /> | ||
|last= | |- | ||
|init= | ! style="text-align:left"| Receptive penile-vaginal intercourse<sup>*</sup> | ||
|title= | | 10<ref name=ESG /><ref name=Varghese /><ref name=Leynaert>{{REFjournal | ||
|journal= | |last=Leynaert | ||
|volume= | |init=B | ||
|issue= | |last2=Downs | ||
|pages= | |init2=AM | ||
|last3=de Vincenzi | |||
|init3=I | |||
|title=Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV | |||
|journal=Am J Epidemiol | |||
|volume=148 | |||
|issue=1 | |||
|pages=88-96 | |||
|url= | |url= | ||
|quote= | |quote= | ||
|pubmedID= | |pubmedID=9663408 | ||
|pubmedCID= | |pubmedCID= | ||
|DOI= | |DOI= | ||
|date= | |date=1998 | ||
|accessdate= | |accessdate= | ||
}}</ref> | }}</ref> | ||
|- | |- | ||
! style="text-align:left"| | ! style="text-align:left"| Insertive penile-vaginal intercourse<sup>*</sup> | ||
| | | 5<ref name=ESG /><ref name=Varghese /> | ||
|- | |||
! style="text-align:left"| Receptive oral intercourse<sup>*§</sup> | |||
| 1<ref name=Varghese /> | |||
|- | |- | ||
! style="text-align:left"| | ! style="text-align:left"| Insertive oral intercourse<sup>*§</sup> | ||
| | | 0.5<ref name=Varghese /> | ||
|- style="background:#efefef;" | |||
! colspan=5 style="border-right:0;"| <sup>*</sup> assuming no condom use <br /> <sup>§</sup> source refers to oral intercourse<br/>performed on a man | |||
|} | |||
The three main transmission routes of [[HIV]] are [[sexual contact]], exposure to infected body fluids or tissues, and from mother to [[fetus]] or child during [[perinatal]] period. It is possible to find [[HIV]] in the [[saliva]], [[tears]], and [[urine]] of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.<ref>{{REFweb | |||
|url=http://www.avert.org/aids.htm | |||
|title=Facts about AIDS & HIV | |||
|last= | |||
|url= | |first= | ||
| | |publisher=avert.org | ||
| | |date= | ||
| | |accessdate=2007-11-30 | ||
| | }}</ref> Anti-retroviral treatment (ART) of infected patients also significantly reduces their ability to transmit [[HIV]] to others, by reducing the amount of virus in their bodily fluids to undetectable levels.<ref>[http://www.npr.org/templates/story/story.php?storyId=128495103 NPR.org]</ref> <ref name="denniston2020" /> | ||
|date= | |||
|accessdate= | == Population-based studies == | ||
}}</ref> | {{Population-based studies}} | ||
==Two African surveys== | |||
The previously reported studies were from developed Western nations. Now we have information from Sub_Saharan Africa. | |||
French scientist [[Michel Garenne]], Ph.D. has published two reports in 2022 comparing the incidence of HIV infection in [[circumcised]] and [[intact]] men. | |||
| | In his first report, Garenne presented the findings from a study in Lesotho, the enclave in South Africa. He reported: | ||
| | <blockquote> | ||
| | In couple studies, the effect of circumcision and VMMC on HIV was not significant, with similar transmission from female to male and male to female. The study questions the amount of effort and money spent on VMMC in Lesotho.<ref name="garenne2022A">{{REFjournal | ||
| | |last=Garenne | ||
|url= | |first=Michel | ||
| | |init=M | ||
| | |author-link=Michel Garenne | ||
| | |title=Changing relationships between HIV prevalence and circumcision in Lesotho | ||
|DOI=10. | |url=https://pubmed.ncbi.nlm.nih.gov/35373731/ | ||
| | |date=2022-04-04 | ||
|accessdate= | |journal=J Biosoc Sci | ||
}}</ref><ref name= | |volume=online ahead of print | ||
|last= | |pages=1-16 | ||
| | |DOI=10.1017/S0021932022000153 | ||
| | |pubmedID=35373731 | ||
| | |accessdate=2022-10-28 | ||
}}</ref> | |||
</blockquote> | |||
In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe). He reported: | |||
<blockquote> | |||
| | "Results matched earlier observations made in South Africa that [[circumcised]] and [[intact]] men had similar levels of HIV infection."<ref name="garenne2022B">{{REFjournal | ||
|title= | |last=Garenne | ||
| | |first=Michael | ||
| | |init=M | ||
| | |author-link= | ||
| | |etal=no | ||
| | |title=Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa | ||
| | |trans-title= | ||
| | |language= | ||
| | |journal=J Biosoc Sci | ||
| | |location= | ||
| | |date=2022-10-26 | ||
| | |season= | ||
|volume= | |||
| | |issue= | ||
|article= | |||
|page= | |||
|pages=1-13 | |||
|url=https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/abs/ageincidence-and-prevalence-of-hiv-among-intact-and-circumcised-men-an-analysis-of-phia-surveys-in-southern-africa/CAA7E7BD5A9844F41C6B7CC3573B9E50 | |||
|archived= | |||
| | |||
|quote= | |quote= | ||
|pubmedID= | |pubmedID=36286328 | ||
|pubmedCID= | |pubmedCID= | ||
|DOI= | |DOI=10.1017/S0021932022000414 | ||
|accessdate=2022-10-27 | |||
}}</ref></blockquote> | |||
|accessdate= | |||
}} | |||
{{SEEALSO}} | {{SEEALSO}} | ||
| Line 1,677: | Line 1,581: | ||
* [[Immunological and protective function of the foreskin]] | * [[Immunological and protective function of the foreskin]] | ||
* [[PEPFAR]] | * [[PEPFAR]] | ||
* [[Preputial sac]] | |||
* [[World Health Organization]] | * [[World Health Organization]] | ||
* [[Bill & Melinda Gates Foundation]] | * [[Bill & Melinda Gates Foundation]] | ||
| Line 1,705: | Line 1,610: | ||
|first= | |first= | ||
|author-link= | |author-link= | ||
|publisher=Doctors Opposing Circumcision | |publisher=[[Doctors Opposing Circumcision (D.O.C.)]] | ||
|website= | |website= | ||
|date=2016 | |date=2016 | ||
| Line 1,725: | Line 1,630: | ||
|trans-title= | |trans-title= | ||
|language=English | |language=English | ||
|last=Foregen Staff | |last=[[Foregen]] Staff | ||
|first= | |first= | ||
|author-link= | |author-link= | ||
|publisher=Foregen | |publisher=[[Foregen]] | ||
|website= | |website= | ||
|date=2021-03-08 | |date=2021-03-08 | ||
| Line 1,742: | Line 1,647: | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Sexually transmitted disease]] | [[Category:Sexually transmitted disease]] | ||
[[Category:Circumcision in Africa]] | |||
[[Category:From Intactipedia]] | [[Category:From Intactipedia]] | ||