Saturday, January 8, 2011

Unethical Tuskegee Style Trial Being Re-run in African Countries

The issue of male circumcision has cropped up on this blog because of claims that it can reduce HIV infection in men. It is not claimed that it reduces infection in women, though there is often that implication. In fact, circumcised men may be more likely to transmit HIV to women.

However, here's what one of the 'experts' and flag-waving proponents of mass male circumcision, Dr Maria Wawer, has to say: "Circumcision removes the foreskin of the penis, which is rich in immune system cells targeted by HIV and perhaps other viruses. Taking off the foreskin likely makes the penis less likely (sic) to carry a range of microbes."

The lack of certainty that I express using the word 'likely' stems from the fact that I am not a scientist, nor am I collecting and analyzing data directly. There is conflicting evidence, to a large extent because much of the research has concentrated on demonstrating the effectiveness of male circumcision, rather than considering if it is really going to reduce HIV transmission.

But 250,000 Kenyan adult men have been circumcised because Dr Wawer and her colleagues think the operation is 'likely' to be effective. They have no idea why it might be effective, if it really is. Worse still, the best that can be hoped for in terms of transmittion reduction is really nothing to get excited about.

The claimed 60% reduction in HIV transmission was achieved in groups of people who were 'counseled' (indoctrinated) at length on 'safe' sex, urged to use condoms and monitored regularly for a relatively short time. What was really established was that if people, circumcised or uncircumcised, used condoms consistently every time they have sex, HIV transmission issignificantly reduced.

Far from publishing critical analyses of these rather poor results, much has been made about the protective benefits of circumcision against other sexually transmitted infections, such as human papilloma virus (HPV), which can cause cervical and other cancers. Yet again, the figures are not that impressive. Their '28% lower rates of transmission' in field trials could be far lower in practice.

But supposing the protection was real and male circumcision does give some protection against some STIs, or even just one? Would this mean that those who seem so vehemently opposed to mass male circumcision, and that includes me, need to backtrack?

I'm not opposed to proven interventions that reduce HIV transmission, such as prevention of mother to child transmission (PMTCT). What I am opposed to is half-baked interventions that may appear to give some small benefit but may also be doing a lot of harm.

The trial Wawer is involved in like the Tuskegee syphilis trial, where the ultimate outcomes for those taking part is not the concern of those doing the research. They are not worried whether participants become infected with HIV or anything else, they just want to know the circumstances so they can develop interventions for Western countries.

Why circumcision is still of so much interest is not clear, it of no use among men who have sex with men and unless people use condoms during heterosexual sex, it is of no use to them either. It's big in the US and must make a lot of money for the healthcare industry.

But it doesn't appear to protect people much in the US, either. HIV prevalence in the US, especially in some cities, is far higher than in European countries, where circumcision is not very common. Other STIs are also more common in the US, sometimes 10 or 20 times higher than in many European countries.

In African and other developing countries, though, the risks associated with circumcision are far higher than they are in Western countries, with their good health services and fairly numerous health personnel. Countries like Tanzania, Kenya and Uganda have deplorable health services, chronic shortages of skilled personnel, inadequate supplies of equipment and a serious lack of safety and infection control processes.

Going for an operation, even getting a tooth pulled or receiving an injection in many African and other developing countries is a serious risk. The Tuskegee syphilis style trials mentioned above don't bother checking what non-sexual risks people face in their day to day lives, so obsessed are they with sex.

Those taking part in circumcision, vaccine, microbicide, pre-exposure prophylaxis (PrEP), treatment as prevention and other trials, many of whom eventually become infected with HIV, are not warned about non-sexual risks. Researchers don't check to see if those who become infected were infected non-sexually or sexually.

In short, most of these trial results are not even valid and certainly do not justify the green light that mass circumcision campaigns have received. Circumcision has not been shown to be of benefit and its safety has not been assurred. The health and even lives of millions of African people are being put at risk by a bunch of well financed Western researchers. Doesn't that bother anyone?


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