Tuesday, January 25, 2011

UNAIDS: HIV Industry Misinformation is their Business

The constant baying for foreskins from the HIV industry has always been difficult to comprehend. Especially considering that the few countries where HIV prevalence is lower among circumcised men are actually anomalies, rather than the norm.

These HIV experts could just as easily have advocated against circumcision if they had selected a different few countries, where HIV transmission is higher among circumcised men.

Rather than making spurious assumptions about causality on the basis of non-statistically significant correlations, the industry should abandon circumcision. There are too many arguments against it and none for it that stand up to scrutiny.

A number of arguments against circumcision have been made for countries with low HIV prevalence, but when you take into account the conditions of health services in high prevalence countries, attempted arguments for circumcision still fall flat.

But far from backing off on the basis of poor trial results for circumcision as a HIV prevention intervention, the industry insists that the results are actually very good. That if people just wear condoms and get circumcised, they will be ok.

You may do a double take on reading the last paragraph: because circumcision only works if you use condoms. But if you use condoms, your circumcision status is irrelevant. Condoms give the best currently available protection against sexually transmitted HIV.

So people in developing countries are being asked to risk all sorts of consequences, including the risk of infection with hepatitis, bacterial infection or even HIV, for an operation that will not even protect them against HIV unless they also continue to use condoms.

They could opt to use condoms all the time, and would be well advised to do so. But because they have been promised some additional protection against infections and they haven't been warned about the risks, many people have already agreed to be circumcised and hundreds of thousands of others are being persuaded to do so. They may well be told they will still have to wear condoms, but what impact will that have after they have undergone an operation?

Not content to lie about circumcision and HIV alone, others claim that circumcision protects against human papilloma virus (HPV). Yet, a recent study found that circumcision is not associated with HPV in heterosexual men. Not only that, condoms don't give complete protection either.

The study confirms that the part that genital hygiene might play in HPV transmission was not considered. But if neither condoms nor circumcision give full protection, perhaps it's time for it to be considered. There is more than a suspicion that genital hygiene could play a major role in sexual health as a whole. It would be surprising if it didn't.

However, I'm not advocating genital hygiene as a sole protection against HIV, HPV or any other sexually transmitted infection. I'm advocating access to clean water and sanitation as a human right. I'm also advocating access to good education, especially health education, decent infrastructure and living conditions, and good health services.

If people in developing countries were allowed their basic rights, diseases such as HIV, HPV, diarreal conditions and acute respiratory infections would be decimated. Picking a few choice diseases and throwing money at them has never worked. The money spent on this vertical approach to diseases (as opposed to health) would be far better spent on basic human needs.



Paddy O'Gorman said...

when Aids hit the gay clubs of New York etc in the 1980s, it didn't spare the Jews

Simon said...

Hi Paddy, thanks for your comment. Yes, in Western countries circumcision doesn't show much evidence of reducing HIV transmission. Of course, the industry don't claim it reduces HIV transmission among men who have sex with men.

But even regarding heterosexual transmission, prevalence is substantially higher in the US, where circumcision is common, than it is in Europe, where circumcision is not common.

Similar remarks apply to common sexually transmitted infections, which are much more common in the US than in Europe.

Interestingly, when there are well publicized cases of someone deliberately or carelessly transmitting HIV, it is usually not mentioned that those involved may have injected drugs or engaged in (heterosexual) anal intercourse.