Comment by ari_elle | Hacker News Reader

Comment by ari_elle | Hacker News Reader

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I am also astonished by that number, but circumcision certainly seems to be an important way of fighting HIV.

"There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%."[1]

"Evidence among heterosexual men in sub-Saharan Africa shows a decreased risk of between 38 percent and 66 percent over two years"[2]

But Circumcision Rates in Africa are relatively high anyways, due to the population's religious background.[3]

Quote of New York Times Article: [4]

"Among those are 14 studies that provide what the experts characterize as “fair” evidence that circumcision in adulthood protects men from H.I.V. transmission from a female partner, cutting infection rates by 40 to 60 percent. Three of the studies were large randomized controlled trials of the kind considered the gold standard in medicine, but they were carried out in Africa, where H.I.V. — the virus the causes AIDS — is spread primarily among heterosexuals. "

"Other studies have linked male circumcision to lower rates of infection with human papillomavirus and herpes simplex Type 2."

" The procedure has long been recognized to lower urinary tract infections early in life and reduce the incidence of penile cancer."

So i guess it just all adds up in a way.

That being said, the number of over 18 billion Dollars (according to the article) being spent on this issue still astonishes me...

[1] http://www.who.int/hiv/topics/malecircumcision/en/

[2] https://en.wikipedia.org/wiki/Circumcision#Sexually_transmit...

[3] https://upload.wikimedia.org/wikipedia/commons/7/79/Global_M...

[4] https://www.nytimes.com/2012/08/27/science/benefits-of-circu...

> So i guess it just all adds up in a way.

It seems to "add up" only for experts from countries that do it traditionally (USA, Turkey, Israel) and recommend it, while basically no European country deems it medically necessary to recommend it, because there it is not traditionally practiced. In some European countries, like Sweden, Germany and Finaland, recently there were even attampts to legally consider circumcision as genital mutilation.

For me most of those 60% studies seem to be some sort of rationalisation based on a predetermined outcome: Let's find some strained statistical "evidence" that this stone age ritual that we are practicing, is somehow medically beneficial, so we can continue to cut our kids genitals to look like their father's without a bad conscience.

> There is compelling evidence that ... by approximately 60%

Did you ever read one of these 60%-papers yourselves and evaluated their reasoning, at how they arrive at their whopping 60%?

Their evidence is btw, even if published in medical journals, completely non-medical. All of those studies just claim that their strained stats show it, but they do not explain why. There is no established chain of causation and even the correlation is doubtful.

Here is a list of counter-arguments, basically claiming that the pro-arguments have been faked by circumcision proponents, many of them (like Prof Brian Morris who authored sevaral of these papers) being "circumfetishists", engaging in circumcisions for sexual pleasure, or having a Jewish background.

[1] http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

[2] http://www.circleaks.org/index.php?title=Main_Page

[3] http://www.circumstitions.com/

[3.2] http://www.circumstitions.com/HIV-SA.html

[3.1] http://www.circumstitions.com/HIV.html

[3.3] http://www.circumstitions.com/HIV-SA-garenne.html

Is there a chance this is a case of correlation studies reported as causation by the media?

I find it unconvincing that it might protect against HIV. Personal incredulity and the endorsing of the WHO aside, how does that work?

This should get you started: http://scholar.google.com/scholar?q=circumcision+aids

I'm not an expert on the field, but it does seem a bit controversial.

The general theory is that circumcision causes a change in the membrane and "microbiomes" around that part of the penis.

I still struggle, however, to believe that a truly controlled study could ever be conducted and I wonder if the money wouldn't be better spent just providing condoms and sexual education to these at risk groups. We already know that condoms are very, very good a reducing HIV transmission rates, plus they work for both partners (circumcision studies only show reduced transmission to men from women), and also consistent use can reduce the risk of cervical cancers, HPV and unwanted pregnancies. In a way, studies and campaigns that focus on circumcision are unethical if they don't also provide access to this highly effective device.

But going back to the studies, the problem I have understanding them is that there is, as far as I'm aware, no way to perform a placebo circumcision. Any adult who has a circumcision is surely likely alter his behavior or perhaps take greater notice of the sexual education he received alongside the circumcision. Or, perhaps he may have the superhero effect, thinking he can have more unprotected sex? That's the part that makes it hard for me to believe that studies are controlled. And for those studies that look only at populations that perform infant circumcisions, it seems even more likely that differences in cultural, religious or social norms of each population would have just as much influence as the operation.

If anyone has details on how these studies control for confounding factors like that, I'd be interested to hear.

> how these studies control for confounding factors like that

The answer is: they simply do not at all.

[1] http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

[2] http://www.circumstitions.com/HIV-SA.html

Some of these studies are contested http://samj.org.za/index.php/samj/article/view/5384/3655

Also, the fact that HIV rates in (mostly uncircumcized) Europe are lower than (mostly circumcized) US is confusing.

The coloring on the Wikipedia picture is horrible and is essentially the equivalent of this optical illusion.

http://en.wikipedia.org/wiki/File:Gray_square_illusion.png

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