Tuesday 6 March 2012

‘Circumcision doesn’t reduce HIV spread’: Gregory Boyle and George Hill challenge Uganda’s Bogus Circumcision Crusade

FIRST READ:

Archbishop Dr. Luke Orombi should fight HIV using the bible and not conjectural science

http://watchmanafrica.blogspot.com/2011/06/archbishop-dr-luke-orombi-should-fight.html

Ugandan President confronts junk science head on : Museveni warns on male circumcision

http://watchmanafrica.blogspot.com/2011/07/ugandan-president-confronts-junk.html

Circumcision is the same as baptism :Archbishop Dr. Luke Orombi urges Christians to embrace Male circumcision

http://watchmanafrica.blogspot.com/2011/06/circumcision-is-same-as-baptism

‘Circumcision doesn’t reduce HIV spread’



By FLAVIA LANYERO

Posted Tuesday, March 6 2012 at 00:00

Contrary to recent popular claims that male circumcision reduces HIV/Aids transmission by 60 per cent, a group of researchers has disputed the findings, saying the action will only increase the spread of HIV/Aids and can only reduce its transmission by 1.3 per cent at most.

Researchers Gregory Boyle and George Hill in a study published by Australia’s Thomson Reuters, base their argument on a recent male-to-female transmission of HIV study in Uganda, which showed that more women contracted the virus after unprotected intercourse to infected circumcised male partners.

They concluded that male circumcision is associated with a 61-per-cent increase in HIV transmission. “Across all the three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18 per cent) became HIV-positive while among the 5,497 controls, 137 (2.49 per cent) became HIV-positive,” Boyle and Hill said.

“So the absolute decrease in HIV infection was only 1.31 per cent, which is not significant. Examination of epidemiological data shows that male circumcision does not provide protection against HIV transmission in several sub-Saharan African countries, including Cameroon, Ghana, Lesotho, Malawi, Rwanda and Tanzania, all of which have higher prevalence of HIV infection among circumcised men,” they concluded.

Uganda rolled out medical male circumcision drive two years ago after the World Health Organisation-UNAIDS in 2007 recommended male circumcision as an HIV preventive measure based on randomised clinical trials in female-to-male sexual transmission in South Africa, Kenya and Uganda, which suggested that circumcision could reduce infection by up to 60 per cent.

Thousands of men have undergone the surgical pinch in Uganda. However, President Museveni in July last year castigated the call for male circumcision as a measure to curtail HIV/Aids, saying it was “diversionary” and called for abstienence.

The Permanent Secretary in the Ministry of Health, Dr Asuman Lukwago, yesterday, said he was not aware of the new findings but said should it be proved otherwise, the country will drop the method for other viable ones.

“We do not strongly condone it and neither do we dispute it. We work in a world of information and evidence and when it is proven otherwise we shall be alerted and we change our policies just like we did for malaria medicine,” he said.

flanyero@ug.nationmedia.com



Circumcision-generated emotions bias medical literature




1.Gregory J. Boyle1,
2.George Hill2

Article first published online: 7 FEB 2012
DOI: 10.1111/j.1464-410X.2012.10917.x

Sir,
In the Journal of the American Medical Association, Tobian and Gray [1] seek to re-evaluate the risks and alleged benefits of male circumcision (MC), but seem blithely unaware that two authoritative medical associations, the Dutch Medical Association and Royal Australasian College of Physicians, have just completed comprehensive reviews [2,3]

The authors base their argument on three methodologically deficient African clinical randomised controlled trials (RCTs), which purport to show that MC protects against female-to-male HIV infection. However, these trials were terminated early, thereby overstating any putative protective effect [4]. Despite the assertions of the authors of the three African RCTs, both medical associations, after extensive critical review, independently declined to recommend circumcision of male children [2,3].

In an egregious omission, Tobian and Gray failed to acknowledge that in a parallel RCT into male-to-female transmission of HIV carried out in Uganda [5], MC was associated with a 61% relative increase in HIV infection among the female sexual partners of HIV-positive men.

MC ablates the foreskin, destroying its protective, sensory, mechanical, and sexual functions and carries many potential short-term complications and risks, including haemorrhage, infection, and possible death, as well as possible long-term psychosexual difficulties [4,6–8]. MC invokes an abundance of human rights and ethical issues [4,6].

Tobian and Gray have taken a position in stark opposition to that of two highly respected medical societies. In so doing, they have peremptorily dismissed the very substantial issues of certain inherent injury, complications that may result in irreversible mutilation or death, and intractable moral, child abuse, human rights, and ethical problems [2–4,6].

MC changes human and sexual behaviour [4,6–8]. Most doctors favouring MC are circumcised themselves [4]. Circumcision status ‘plays a huge role in whether doctors are in support of circumcisions or not’[9]. Circumcised doctors often defend circumcision by producing flawed papers that minimise or dismiss the harm and exaggerate alleged benefits [10].

Tobian and Gray are products of circumcising cultures. Their article exudes Freudian defences of denial and rationalisation [6,10]. The authors seem blinded by their own circumcision-generated emotional needs. The readers of such articles must be aware of the culture-of-origin and circumcision status of the authors, in order to properly evaluate assertions about MC [4].

Invariably, when biased opinions promoting MC are published by doctors trying to justify their own psychosexual wounding [10], uncircumcised doctors (who mostly see no need for amputating anatomically normal healthy erogenous tissue) are quick to refute such overstated claims [2,4]. We fully expect that this distortion of the medical literature [11] will continue until non-therapeutic male circumcision is prohibited by law and most circumcised male doctors have passed from the scene.

References

•1
Tobian AA, Gray RH. The medical benefits of male circumcision. JAMA 2011; 306: 1479–80
oCrossRef,
oPubMed,
oCAS,
oWeb of Science®
•2
Anonymous. Non-therapeutic circumcision of male minors. Utrecht: Royal Dutch Medical Association, 2010. Available at: http://knmg.artsennet.nl. Accessed January 2012
•3
Circumcision of Male Infants. Sydney: Royal Australasian College of Physicians, 2010. Available at: http://www.kids.vic.gov.au/downloads/male_circumcision.pdf. Accessed January 2012
•4
Hill G. The case against circumcision. J Men's Health Gender 2007; 4: 318–23
o CrossRef
•5
Wawer MJ, Makumbi F, Kigozi G et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009; 374: 229–37
oCrossRef,
oPubMed,
oWeb of Science® Times Cited: 55
•6
Boyle GJ, Goldman R, Svoboda JS et al. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 2002; 7: 329–43
oPubMed,
oWeb of Science® Times Cited: 15
•7
Boyle GJ, Svoboda JS, Price CP et al. Circumcision of healthy boys: criminal assault? J Law Med 2000; 7: 301–10
•8
Bensley GA, Boyle GJ. Physical, sexual, and psychological impact of male infant circumcision: an exploratory survey. In Denniston GC, Hodges FM and Milos MF eds, Understanding circumcision: a multi-disciplinary approach to a multi-dimensional problem. New York: Kluwer/Plenum, 2001: 207–40
•9
Muller AJ. To cut or not to cut? Personal factors influence primary care physicians' position on elective circumcision. J Men's Health 2010; 7: 227-32.
oCrossRef,
oWeb of Science®
•10
Goldman R. The psychological impact of circumcision. BJU Int 1999; 83 (Suppl. 1): 93–102
Direct Link:
oAbstract
oPDF(105K)
•11
LeBourdais E. Circumcision no longer a ‘routine’ surgical procedure. Can Med Assoc J 1995; 152: 1873–6
oPubMed,
oCAS,
oWeb of Science® Times Cited: 5