Alex Blaze

Circumcision, the CDC, and HIV

Filed By Alex Blaze | August 26, 2009 12:00 PM | comments

Filed in: Living
Tags: circumcised penis, comprehensive sex education, condoms, education policy, HIV testing, HIV/AIDS, penis, rates, std

Speaking of penises, circumcision and HIV are back in the news. Various news outlets have had stories this past week because the Centers for Disease Control are about to release recommendations about circumcisions because of a study that linked to to a reduction in HIV infections in African, heterosexual men.

While the debate goes back and forth about whether it's better, aesthetically, sexually, or hygienically, to be cut or uncut, the debate comes down to a question of bodily autonomy to me. If there really is evidence that people who are cut are less likely to get HIV, present boys with that evidence in comprehensive sexual education classes when they're in high school and let them decide when they're 18. I'll agree that there won't be as many men who are cut if we do it that way, but that's the price we pay for living in a free society.

In the US, it would be awfully rich for the CDC to recommend routine circumcision to fight HIV. There's the issue that there's no evidence it would make a dent in HIV rates in the US, but, more importantly, for a government that has done so little to fight domestic HIV to recommend such an extreme measure should really only give people pause about the incoherence in its actions. The same government that can't bring itself to create and mandate comprehensive sex education or universal health care access wouldn't really need to consider an extreme measure like routine circumcision to reduce HIV, right?

You'd think that getting people knowledgeable about how to protect themselves with condoms, getting as many people as possible testing regularly, and then providing the life-saving medications for those who can't afford them would be the most obvious ways to prevent HIV-related deaths. Not so in the US. We haven't even tried the obvious and we're already talking routine circumcision!

Anyway, there's no evidence circumcision reduces MSM HIV transmission, and the CDC also announced new numbers estimating that gay and bi men are 50 times more likely to have the virus.

CDC official Dr. Amy Lansky announced today at a plenary session of the National HIV Prevention Conference the CDC's finding that, in the United States, gay men and other men who have sex with men (MSM) have AIDS at a rate more than 50 times (that's right, FIFTY TIMES) greater than women and non-gay/bi men. This confirms in emphatic terms that of all the disparities and disproportionate impacts in the HIV/AIDS epidemic in the United States, the greatest one is the extraordinarily disproportionate impact on gay and bisexual men -- of all races and ethnicities-- though the most disproportionate impact is on African American gay, bi and other MSM.

AIDS is over, my ass. But if it's true that we're 50 times more at risk than straight people (I do wonder how they came up with a population of not just gay and bi men, but, really, of men who have sex with men who may identify or not identify as anything and therefore be hard to pin down), then why is all the hubbub around a procedure that's been proven to do nothing for us?


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When I took sex ed, I was told that after celibacy, condoms were the most effective way to prevent HIV infection. Sure, condoms can break or be put on improperly, but they're a hell of a lot more effective than lopping off your foreskin.

The thing about circumcision is that even though it was introduced into the English-speaking world on pseudo-scientific premises (i.e. to prevent masturbation), it's managed to become a sort of tradition in the U.S., with new "scientific evidence" coming out all the time to justify its continued practice. I can't help thinking that the CDC's rather illogical behavior on this subject has a lot to do with the supposed health benefits of circumcision being taken for granted in this country.

What scares me is the possibility that guys are going to think that being circumcised alone protects them, and they'll start having lots of unprotected sex as a result. I've already been with enough cut guys who think lack of foreskin absolves them of the need to use soap on their dicks (as a side note, guys in countries where circumcision is rare are usually taught from an early age to pull the skin back and wash thoroughly, so I encountered far fewer unpleasant odors in the nether regions when I was in China than I have here).

I my high school sex ed, we talked a lot about dry skin vs wet skin and how viruses can get in through wet skin. It's a simple enough equation, wet skin + wet skin = risk.

But we were taught to avoid wet skin contact or cover it. The idea of surgically eliminating wet skin as national health strategy is distrubing.

Besides, if the CDC was really motivated solely by decreasing risk and not cultural factors, there would be a much better option. Penises are very effective delivery devices by design. That's part of why those whose sexual partners don't have penises have lower risk of getting HIV. If the CDC wanted to take a proven track to reduce risk through surgical intervention, they should be advocating vaginoplasty, not circumcision. Of course they wont, but that proves that lowered risk is not their only or biggest priority.

Love it, Tobi. Something tells me they wouldn't do that in a billion years.

Yeah I remember when this story popped up last year, every article I read didn't mention that wearing a condom totally nixes any medical recommendation for circumcision.

The two largest studied done in African straight men on this issue have to be held suspect. They were both authored by known proponents of this procedure. They both included in their statistical analysis the time period in which the circumcised men were unable to have sex because of the procedure and both studies were stopped early because the early statistical data confirmed the value of the operation. The earlier the statistics gathered the more effective the procedure was and as the studies advanced the statistics started to not be so extremely on sided.
This is very poor scientific procedure and excellent pseudoscience. The only thing that these studies should be considered to have shown is that if you have your penis operated on and cannot have intercourse for a while you are extremely unlikely to get HIV.
How does one reason then that it is the circumscision that provides protection rather than the period of celibacy?
The one has to consider issues such as the relative resistance to HIV present among some people. There is a heightened susceptability to HIV in Africa and one has to wonder how much this was considered and how much this may interplay in the study.

Circumcision is torture...plain and simple.

Would the CDC promote female genital mutilation if there was a nebulous study that claimed having it done would lower HIV transmission rates? No - as they shouldn't. This is similar.

In this morning's St. Petersburg's Times there was,
in the letters to the editor, a letter written by
an RN. The letter addressed the issue of circumcision as a means of dealing with male to
male sex and HIV transmission. The author stated
that she felt that the issue that should be addressed to really discrimination. The author stated that in states that allow same sex marriage,
the rate of HIV infection has dropped.

wildmonkeysects | August 27, 2009 9:58 AM

Follow the money. There is an increased "need" for raw, fresh embryonic stem cell material...aka infant foreskins.

Here's the formula: Cite a study of dubious validity, place a few "editorials" invoking fear of HIV, and voila: more material.

Trauma: brain scans of infants post circumcision show they are in shock for days, yes days afterwards. Culture of Life, eh?

I work with an organization called IntactAmerica.org, which is devoted to protecting the rights of newborn baby boys, and stopping infant circumcision. THANK YOU for this post. The more people are willing to speak out on this issue and why circumcision is NOT the answer to HIV prevention (or anything else), the closer we'll get to stopping the CDC from recommending it for all baby boys born in the U.S. The Chicago Tribune published a great article today (http://tinyurl.com/ma66xv) that sheds light on both sides of the issue.

Thanks again to you and your readers for your support!

Dave Llewellyn | August 27, 2009 6:20 PM

You make more sense that the assembled CDC worthies who this week were promoting circumcision on the basis of the African RCTs, the conclusions of which were presented by one presenter as being "beyond a reasonable doubt." Katrina Kretsinger, MD, of the CDC was asked if the RCTs would be repeated in the U.S. She replied that they would not be because it would be unethical to do so! Then how were they ethical to start with? When I attended the session where Deborah Gust of the CDC presented a paper demonstrating that circumcision made no difference in the acquisition of HIV by insertive gay males, I asked why these results did not bring into question the conclusions of the RCTs since the anus supposedly contains more HIV than the vagina. The reply, as I understood it, was that since the insertive males also were sometimes receptive males you could not say how they got HIV. Of course, if that is the case, then the study was worthless. But since it was presented as being worthy (otherwise why present it?), I am of the opinion that it does bring into question the validity of the RCTs, as does the known fact that the U.S. has the highest rate of HIV in the industrialized world (a fact one speaker brought up), the highest STD rate in that same world, and the highest rate of male circumcision in that same world. So much for the great American circumcision experiment!

At one of the last sessions the speaker from "Operation Abraham", a Jerusalem, Israel group that apparently hopes to be engaged to assist the U.S. in circumcising the black and Hispanic males who are not circumcised, put a photo of an intact male up on the screen. The figure of an elephant had been drawn around the penis so that the intact penis looked like an elephant's trunk. The words "Help circumcise me" or something similar had been added to the photo. I remonstrated loudly until this smear was taken down and then promptly left the session. I am still awaiting a deserved, written, direct apology from Dr. Peter Kilmarx, Chief of the Epidemiology Branch of the Division of HIV/AIDS Prevention of the CDC, who was in attendance and from whom I demanded an apology. I think this shows the mindset of the CDC. They seem to have abandoned all scientific objectivity to promote a useless and mutilating surgery. I expect the men are all circumcised and the women are all married to circumcised men. So the trauma repeats itself and those who have been traumatized fulfill their need to traumatize others. And apparently they think it is socially and ethically acceptable to denigrate a normal body part and to attempt to humiliate all intact boys and men into submitting to circumcision.

Those who are as outraged as I can write appropriate letters to the CDC. Addresses can be found at www.circumcisionandhiv.com. And since the CDC is consulting with the AAP (indeed Operation Abraham's abstract for its presentation mentioned "lobbying" the AAP), a letter to the Circumcision Task Force is needed. You can get the AAP's address at its website.

After reading this article I came up with a T-shirt idea which my friend Andrew Caldwell designed. Here's a link to it:
http://www.zazzle.com/foreskin_warning_tshirt-235979593491339251