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Stanford Medicine

HIV/AIDS

Circumcising newborns to prevent HIV

Circumcision as a way to prevent HIV emerged as a hot topic in 2007, when the first large-scale studies from Africa showed it could reduce infection rates by about 55 percent. I remember seeing former President Bill Clinton stand before the International AIDS Conference in Toronto in 2006, when preliminary results on these studies were reported, touting the value of circumcision as a new prevention tool. Still, he cautioned that cultural practices, the availability of sterile facilities and costs all could be limiting factors in the use of the procedure, which is now recommended by the World Health Organization.

Now a new study out of Rwanda suggests that the most cost-effective approach is to circumcise newborns, rather than adolescents or adults. The study, published this week in PLoS Medicine, found that circumcising boys just after birth costs just $15 per child, compared to $59 for an adult or adolescent. Moreover, circumcision after birth is quick and easy and rarely produces complications, whereas complications, particularly infections, are more common in adolescents and adults, the writers note.

“Given the low cost and long-term benefits, this study suggests that countries with moderate HIV epidemics should offer routine infant circumcision, integrated into existing health services,” the writers conclude.

In Rwanda, male circumcision is not traditionally practiced, and only about 15 percent of men are circumcised, the authors estimate. But because of the ongoing debate about the practice, the Rwandan Ministry of Health reports that the demand for the service is rising. And though Rwanda’s HIV infection rate is relatively low, less than 3 percent, implementation of a national circumcision program could help keep those rates in check. The study collaborators included researchers from the Rwandan Ministry of Health, UNAIDS and UNICEF.

3 Responses to “ Circumcising newborns to prevent HIV ”

  1. Tom Says:

    “Now a new study out of Rwanda suggests that the most cost-effective approach is to circumcise newborns, rather than adolescents or adults”

    Of course, mutilating innocent chidren is always easier than adults. At least adults can compare before and after and realize how circumcision remove a ton of sensitive nerves.

  2. Restoring Tally Says:

    It seems everyone is focusing only on the trials that showed a benefit to men and ignoring the trial that showed the opposite result for women. The Lancet published a study that showed that the women partners of circumcised men have a more than 50% increased risk of HIV infection. The study looked at the partners of the men from Uganda who participated in one of the three cited Africa trials.
    See http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract

    We need to start doing some real thinking instead of just listening to some pro-circumcision fanatics push their agenda. All the studies that do not support the circumcision campaign are either stopped early because of “unexpected results” or are not publicized.

  3. JackieNO Says:

    “Could reduce”, but may not, at least not in the US.

    The alleged 55% HIV risk change is not found elsewhere. Let us put aside the propaganda numbers game in which 55% is really 1.79% risk change still leaving high risk.

    The fact that the “trials” data are at odds with real world data should set off an alarm. The “trials” have many flaws as have been noted by the critics but ignored by the WHO and others (loss of more cut men than the number that got HIV — their status would change the outcome, the cut men did not have sex during large part of trial, condom advice was given to the cut men, no real understanding of the sexual practices nor the change in behavior caused by amputation of part of the penis). A real glaring flaw and an issue is the fact that real life data does not show the 1.8% risk change alleged from the trials. Besides the curious fact that Europe and Japan have low circumcision rates and low HIV rates and the US has high circumcision rates and high HIV rates, in the US and other places there is no correlation between HIV risk change and circumcision. Take for example the study Prevalence of Circumcision and its Association With HIV and Sexually Transmitted Infections in a Male US Navy Population with the Conclusions: Although known HIV risk factors were found to be associated with HIV in this military population, there was no significant association with male circumcision. Look also to the fact that the Africa trials (Kenya and Uganda) were done by Americans desperately trying to push circumcision. Did they tell HIV positive men that were circumcised to get LOST? Someone must at least look into this before using their data, hundreds of circumcised were lost! Is this not a flag then that the discord with the real world must imply a fraud, a lie, fudging the numbers? The real world should show the same 1.8% risk change and it does NOT.

    Cutting babies leads to more botches and more disfigurement. And still when they grow up they need to wear a condom!! This shows how much of a waste of time and money this male circumcision campaign is. It proposes taking away main male pleasure zones of an infant without consent and STILL one must use a condom, after losing pleasure sensors. The circumfreaks pushing this don’t understand the importance of the foreskin for PLEASURE. If one must wear a condom, one should not also mutilate the penis and reduce its capacity for pleasure.

    This surgery takes away the main male pleasure zones with about 20000 fine touch and stretch nerve endings amputated. The foreskin can normally be slipped all the way, or almost all the way, back to the base of the penis, and also slipped forward beyond the glans. This wide range of motion is the mechanism by which the penis and the orgasmic triggers in the foreskin, frenulum, and glans are stimulated. Circumcision deprives man of 2/3ds of the main erogenous zone constituted of the foreskin and the glans.

    If a condom is needed ANYWAY, this mutilation program has zero purpose. If the 1.8% risk change is not observed in the real world, the male circumcision studies cannot be relied on. Until they can be observed in the real world setting, they must be considered a LIE.

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