Comment by reubenmorais | Hacker News Reader

Comment by reubenmorais | Hacker News Reader

> Circumcision reduces a man’s risk of contracting HIV by 60 percent, Skorochod said in an interview.

I was surprised by this, so I looked it up: http://www.who.int/hiv/topics/malecircumcision/en/

> There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.

The CDC reaches a similar conclusion: circumcision lowers the risk of HIV acquisition by heterosexual men, but doesn't change male-to-female transmission of HIV, and studies have found no statistically significant protective association for male-to-male transmission.

http://www.cdc.gov/hiv/pdf/prevention_research_malecircumcis...

> But that’s just the tip of the iceberg. As Boyle and Hill point out, the men who were circumcised got additional counseling about safe sex practices compared to the control group, and then they had to refrain from having sex altogether for the simple reason that their lacerated penises had to be wrapped in bandages until their wounds healed — leading to what Boyle and Hill refer to as “time-out discrepancy” in the quote above. By contrast, the non-circumcised men got to keep having sex during the full two month period during which the treatment group was in recovery mode. Then (due to a statistically significant effect having been detected) the trials were stopped early — which tends to lead to an overestimation the true effect size of the treatment.

http://blog.practicalethics.ox.ac.uk/2012/05/when-bad-scienc...

Circumcision is done very early(between 2-6). If you are doing after, is either because some medical problem or you are moving to Islamism.

Dying young reduces the risk of getting cancer, but surely it is not the recommended method for cancer prevention.

That's ridiculous. The problem with circumcision isn't that it's always a bad idea, it's that it's often done involuntarily and unsafely. There's nothing wrong with voluntary, safe circumcision for the purposes of lowering HIV transmission, or with public health campaigns that advocate it, as long as they don't misinform.

There's nothing wrong with voluntary, safe circumcision for the purposes of lowering HIV transmission

There is when that's a highly contested claim! And when condom use or strict monogamy overshadow it in effectiveness. The best thing you could do is invent a less annoying condom (go go Bill Gates), not slice bits off men's sex organs.

There's nothing wrong with voluntary, safe suicide for the purposes of cancer prevention, or public campaigns that advocate it, as long as they don't misinform? Does that sound less ridiculous to you?

You don't ignore an effective solution in favor of a bad one. Circumcision is not the best way to prevent HIV. It's not. And misinformation in this case is advocating for it in favor of more effective methods.

Sure, extreme measures will solve lots of problems. But that doesn't justify them, because you have to go to extreme measures in the first place. You simply do not need surgery to prevent HIV.

The other problem is that the predictor for HIV is risky sexual behavior. Circumcision is not correlated with reduced risky behavior.

Isn't that the point? People will have risky sexual behavior whether circumcised or not, so if circumcision reduces the likelihood of AIDS transmission in people with risky sexual behavior, it's a net win.

EDIT: the downthread comment clarified the parent comment for me.

As I said even further downstream, if the study was done naively, where we simply took circumcised vs. uncircumcised people and compared their HIV rates, I would agree 100%.

But the original study was taking a population of adult uncircumcised males in africa and circumcising 50% of them randomly, and then tracking their HIV infection rates. That should control for upbringing. From the studies:

"In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a small number of men who had been assigned to be circumcised did not undergo the procedure; likewise, a small number of men assigned to the control groups did undergo circumcision. When the data were reanalyzed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised."

I think the parent post was inferring the opposite causation, ie, the families that tend to give their children circumcisions tend to be conservative and would probably have a lower hiv infection rate even if they would not have circumcised their children.

Under this interpretation, being conservative is the cause of both circumcision and low hiv rates, and circumcision is negatively correlated with hiv rates.

Ahhh, but that's due to a lack of understanding of the studies, which weren't "let's start with people who are circumcised and compare their behavior vs. those who aren't".

It was, "We're going to take a chunk of individuals in Africa who engage in risky sex, and circumcise half of them, and then track how many of them end up with HIV after a few years"

Actually no, my point was the nature of HIV means that the timeframe of whether or not someone gets infected is somewhat irrelevant.

If someone is engaging in risky sexual behavior, and they will continue to do so, then the 10 year span of whether or not they get HIV may be irrelevant since the disease itself is incurable and ultimately fatal because they will continue to expose themselves to the risk factor until they join the infected population.

It's also highly questionable if it would even control an epidemic in Africa effectively, seeing as how the spread is caused by misinformation in a huge part - a widespread campaign of male circumcision would likely increase the exact behavior which spreads it.

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