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Circumcision and HIV

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|accessdate=2011-05-06
}}</ref> and the promotion of male circumcision as a HIV-prevention method by the [[Centers for Disease Control|Centers for Disease Control]]<ref>{{REFweb
| quote= | url=http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm | title=Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States | last= | first= | publisher= | work= | date=2008-02 | accessdate=2011-06-01
}}</ref><ref>{{REFweb
| quote= | url=http://www.cdc.gov/botusa/Success-Stories/0307-MaleCircumcision-Botswana.htm | title=Success Stories: Male Circumcision: A Question and Answer Session | last= | first= | publisher= | work= | date=2007-03 | accessdate=2011-06-01
}}</ref><ref>{{REFweb
| quote= | url=http://www.cdcnpin.org/Display/FundDisplay.asp?FundNbr=4285 | title=Funding | last= | first= | publisher= | work= | date=2011-01-09 | accessdate=2011-06-01
}}</ref>
|page=1167
}}</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
| quote= | url=http://www.who.int/hiv/facts/hiv2003/en/ | title=A global view of HIV infection | last=WHO/UNAIDS | first= | publisher=[[World Health Organization]] | work= | date=2004 | accessdate=2011-02-27
}}</ref>
}}</ref> This didn't stop other physicians from conducting "research" leading to a steady stream of widely publicized articles arguing that circumcised men were less likely to contract HIV--with the result that prevention of HIV infection has now surpassed even cancer prevention as the most popular claim of circumcision advocates.
{{Citation
| Title=Fink's Own Words | Text=This is nothing I can prove. | Author=Aaron J. Fink | Source="This Little Operation". ''Marked in Your Flesh.'' p.206-208
}}
Various hypotheses have been suggested in regards to the mechanism whereby circumcision prevents the tarnsmission of HIV. They have all been disproven, however, and all of the "studies" attempting to establish a causal link between circumcion and HIV transmission remain unsubstantiated by a working hypothesis.
==== Hardened Skin Hypothesis skin hypothesis ====Perhaps the oldest hypothesis on the mechanism whereby circumcision prevents the transmission of HIV is the theory that suggests that the 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
}}</ref>-->
==== Langerhans Cell Hypothesis 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 mucosal lining of the foreskin.
}}</ref>
==== Bacterial Environment Hypothesis 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 desparate 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 inflamation, a condition that facilitates the transmission of viruses. The chances for penile inflamation are reduced, thereby reducing the chances of sexually transmitted viruses, such as HIV.<ref>{{REFjournal
|last=Price
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 thetable. 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= | first= | year=2005 | title=HIV Prevalence and Associated Factors | url=http://www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf | work=Lesotho Demographic and Health Survey 2004 | editor= | edition= | volume= | chapter= | page=13 | location=Calverton, Maryland | publisher=Ministry of Health and Social Welfare | isbn= | quote= | accessdate=2011-06-02 | note=
}}</ref>
=====Zambia=====
 
The prevalence of HIV infection among men aged 15-29 has ''not'' decreased despite several campaigns to perform male circumcision.
}}</ref>
== Problems with Promoting Circumcision promoting circumcision as HIV Prevention Policy prevention policy ==
Circumcision advocates use the latest 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 indorsment, 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.
Even if the recent trials were accurate, circumcision would only reduce the relative risk of acquiring HIV between circumcised and uncircumcised men by 60% over a period of about one year. Circumcision is outperformed by condoms, which have an absolute reduction risk of acquiring HIV that's over 95% (closer to 100% when used properly). Even if a man is circumcised, he would still need to use condoms, and even the authors of the latest studies cannot stress this enough.
== Increased Risk risk to Women women ==
A recent prospective study<ref>{{REFjournal
|last=Turner
|}
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
| quote= | url=http://www.avert.org/aids.htm | title=Facts about AIDS & HIV | last= | first= | publisher=avert.org | work= | date= | accessdate=2007-11-30}}</ref> Anti-retroviral treatment 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>
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