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September 07, 2007

You Can't Ignore Condoms if You Want to Fight AIDS

I don't know what it is, but I never pass up an opportunity to debate circumcision, and especially its utility as an HIV prevention method. Today the Washington Post reports that members of the Luos tribe in Kenya are embracing the practice, convinced that their decimation from AIDS relative to other Kenyans is due to their uncircumcised status.

The World Health Organization endorsed circumcision as an HIV-preventative last year in response to studies showing that African men are 60 percent less likely to contract the disease if they are circumcised. This Post article goes further than others I've read on the topic and blames the lack of circumcision among some African tribes for the original spread of the disease:

AIDS emanated from the jungles of Cameroon or Gabon but hit massive epidemic levels after reaching the uncircumcised tribes around Lake Victoria and, later, southern African tribes that had abandoned their own traditional circumcision rites.

I think circumcision shows a lot of promise as a way to beat back the AIDS epidemic in Africa -- the UN estimates the practice could save 5.7 million lives. Whether we should also be promoting circumcision as a public health practice among American men, whose sexual habits and risk levels are very different, is a different debate. American AIDS advocates tend to be wary, as they should be, of any program that shifts emphasis away from condom use. Indeed, men who undergo circumcision as adults, in Africa, the United States, or anywhere else, must understand that unless they practice safe sex, they will remain at risk. So while it's encouraging that the Bush administration is pledging millions of dollars to promote circumcision in Africa, it's dispiriting that it continues to block any U.S. funding of foreign contraception programs.


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I think that you make an excellent point. Additionally, and I noticed that the Post failed to articulate this but it was an important aspect in the findings of the concurrent circumcision studies last fall from both South Africa and Uganda, circumcision does NOT prevent men from SPREADING HIV, it only reduces the risk that the man (circumcised) will CONTRACT the virus.

The necessity for condom use for HIV transmission prevention is always two-fold: reducing risk of contraction AND reducing the risk of transmitting the virus to your partner. (Especially because it's between 8 and 12 times more likely for the virus to be transmitted to the receptive partner.)

The article embraces the notion that circumcision is the predominant problem, which is ridiculous. The basic fact that fishermen in the village have tended to be promiscuous is in the article. It defies common sense to read this article and come away thinking circumcision was the cause, or that circumcising now will make a difference. With such a large HIV+ population among the Luos, as Myra states, it will still be spread around. Circumcision will do nothing if people don't change their behavior. It appears they are, as the article states. Will this be considered in the future should the HIV rate drop, or will all the credit be offered to circumcision?

If nothing else, read the quote from Dr. Robert Bailey in the article. So what if he authored one of the studies, that quote is absurd. Yet, the reporter and editor let it slide without a single comment? That's not reporting.

There's a larger point, though. Not all of Africa conforms to the simplistic high-circumcision-lower-HIV, low-circumcision-higher-HIV thinking that's now accepted. (The U.S. versus other Western nations should be a clue that there might be more than "circumcision is good".) The data in this table ( analyzing circumcision status and HIV in African nations indicates that the problem is far more complex. Many nations conform to the exact opposite of what circumcision advocates are claiming, yet no public health officials advocate discouraging those men to avoid circumcision. Why? There is clearly at least one factor more important than circumcision at work. Condom-free promiscuity is a reasonable, educated guess.

You're right that condoms are important and shouldn't be ignored. But we also mustn't ignore that there isn't much difference between condoms and condoms with circumcision. Use the former and the latter becomes (remains, really) unnecessary.

Typical. You don't see the parallels between MGM and FGM. I suppose you would consider it unethical to even conduct a trail to see the benefits of female circumcision? Have you seen the results of female circumcision as the Indonesians perform it? It is much more pleasing to the eyes than the beefsteaks owned by American feminists. It also reduces HIV transmission? You want to challenge that? Go on, get some data. Oh, that doesn't fit in with your hypocritical world view does it.

One reason why feminists take issue with female circumcision is because of sovereignty over their bodies. Don't you think boys have the same rights?

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