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Published online 28 October 2009 | Nature 461, 1187 (2009) | doi:10.1038/4611187a
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Jury still out on HIV vaccine results
Some experts see hope in trial findings, but others say that the data do not back up such optimism.
Paris
More than 1,000 researchers in Paris last week rapturously applauded formal results from the largest-ever HIV vaccine trial. In a preliminary announcement in September, the trial, which included 16,402 people in Thailand, was said to show that a vaccine combination reduced the risk of HIV infection by nearly one-third (see "_Nature _ doi:10.
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Circumcision is still the best form of prophylaxis that cannot be forgotten in the heat of a passionate moment.
Vaccines were the great success story of 19th and early 20th century medicine, but that doesn't make them a panacea. Right now we have a big roll-out of a not too effective vaccine against cervical cancer, and very little success with an HIV vaccine. Male circumcision is a more effective prophylaxis in both cases. Why is it not getting more aggressively promoted in the western world?
When there is no effective vaccine or cure for a disease, one out of twenty independent protocols will pass the 0.05 threshold simply by chance. This HIV vaccine is the fifth one, but it is not clear that it has really attained the 0.05 threshold. Therefore, given that the rationale for this vaccine has been disputed when it was initiated, it is impossible to say whether it is effective or not, which is by far the worst situation in science.
A clear conclusion can be drawn, which is that the vaccine cannot be used. But if one wants to conclude that it has some effect, then a booster vaccination should be performed on the same volunteers.
While we are waiting for further trials to prove the efficacy of the vaccine trials, it is extremely necessary to use other means to help reduce the possibility of exposure to the HIV virus. Circumcision is one of those effective measures. Although it is not the complete answer, it is certainly proven that it does reduce the possibility of acquiring the AIDS virus.
There's a couple reasons why circumcision is not more widely practiced: Many men are protective of their sexual organs to the point where they dismiss any perceived benefits as "not worth mutilating my penis;" there's the story that an intact penis has more nerve endings and transmitts more pleasure during sexual stimulation, and so denying this level of pleasure is not fair to the child; there's a good number of people in this world who harbor disdain toward Hebrews and would never participate in their religious "cult" practices; also there are people who think that any form of body manipulation is the same as dessicrating a temple. I am thankful that my parents put my health on a higher pedestal than pop culture.
I guess it's relevant for me to clarify that circumcision is favorable, and non-circumcision is typically justified by fallacy.
Here we go with the "circumcision prevents aids" garbage.
Circumcision never has and never will prevent aids. If it did, then the United States wouldn't have this problem because on a broad perspective, it wasn't long ago that the entire nation was %90 circumcised. Studies (IN OTHER COUNTRIES) that have attempted to prove otherwise, have not been followed through with. They have proven nothing. And shortly after proving nothing, they called the studies off.
And Mr. Alex Cranson, circumcision is VERY much a part of pop culture. It is a cosmetic procedure. If foreskin was this big health risk, then Canadians and Europeans would be dying from it. When in fact, they are generally more healthy than Americans. Especially in the disease department. You're parents did put popular choice on the pedestal, rather than doing research and allowing you to be a whole human being.
If you want to talk about health. Take a look at this page on circumcision deaths.
http://www.cirp.org/library/death/
Death doesn't sound very healthy to me. And this isn't as rare as you and your doctors would like to believe or pretend. Its often covered up or they simply find another reason to blame the death on. "He died from heart failure" Never mind if the heart failure was a direct result of shock and trauma from circumcision.
How about those cancer talkers? Cutting off the skin on your arms will prevent you from getting skin cancer there too, you know.
Also, if you think your penis is working properly, you should read about circumcision and sexual dysfunction.
http://www.cirp.org/library/sex_function/
But most importantly, stop spreading your lies about all of this. You arn't helping anything or anyone. No one deserves to be stripped of their human rights, before they even have a moment to enjoy life.
Wow. It seems that the first 6 comments were written by one guy who really, really like circumcision.
Unfortunately, circumcision is a failed experiment in the US. About 80% of all sexually active men in the US are circumcised, but the US has a much higher HIV rate than Europe, which has very few circumcised men. Circumcising the remaining 20% will not appreciably impact the current HIV rate.
A vaccine is the best hope for HIV in the long run. We can only hope that these vaccine trials and tests get us closer to stopping HIV.
Did I just read that correctly? You're all implying that respecting an infants, (When that infant will develop into being his own person who may have preferred having a CHOICE in the matter, as I now do.) basic human rights is better considered as a "fallacy"? Please tell me that you're joking. It's a matter of basic human decency. Without enforcing such respect for others, our society would be quickly driven to ruin.
That said, I'll give you the benefit of the doubt in an effort to remain courteous, but it is something that simply cannot be argued against that circumcising a newborn boy without an immediate and valid indication strips and violates his rights. (Please note, I have no issue with circumcision that actually corrects an ailment.) Just because it MAY (emphasis on this key word) protect against something in the future. "MAY", There is no guarantee there that it will return a benefit despite the considerable costs it requires. Why rely upon such a shaky foundation? The simple fact of the matter is that EVERY part of the body is at risk for a breakdown. I ask you to think of and name anything else that we might consider socially acceptable to be routinely cutting off an infant's body at birth JUST ENCASE to guard against a future infection that MIGHT occur. Can you name anything? I know I can't.
In all honesty, the cases against cutting also apply to a health perspective. Why deprive boys of their full sexual potential and choice? (I have a hard time believing removing all those nerves WOULDN'T affect pleasure.) Why risk psychological trauma? (I went through depression when I learned what was done. It happens, but you don't see that categorized as a "complication.") There are also negative effects circumcision can cause that don't manifest until late puberty when the organ has grown. (Tight, painful skin during erection. Hair-bearing skin dragged up. Cosmetic imperfections, etc. Again, all not considered complications by the medical establishment strangely.)
I've ranted too much, but here is the bottom line and a point far more relevant to the article at hand: STD's of all kinds (not just HIV) are spread by risky behaviors. And possibly a lack of education. Circumcised or not, a penis is still a penis, still made of flesh. It will continue to retain the capacity to transmit infections of all kinds because of this simple fact alone. Education and encouraging safer sexual practices and behavior are a far more cost-effective means to reduce infection rates. If people truly care about their health, then they will heed what they are taught if it is reasonable, common sense, which I personally think that is.
If the vaccine is not as promising as initially thought, that just means we revert to the best known method to prevent HIV transmission: safer sex practices including consistent condom use.
Circumcision is not a relevant preventative. Most of the US men who have died of AIDS were circumcised at birth. In Sweden, where almost nobody is circumcised, AIDS is as rare as it is in 97%-circumcised Israel. In seven African nations it is the circumcised who have markedly higher HIV prevelance.
Aside from all that, African researchers announced in August that the HIV+ men they circumcised were 50% more likely to transmit HIV to their monogamous female partners than the HIV+ men they left intact were.
Even if circumcision where 100% protective, infants don't have sex. It should be left for an adult to decide about his own genitals. When he's an informed adult he could choose pleasure-reducing cosmetic surgery or safer sex practices. It is not for us to decide on his behalf how he thwarts HIV.
Most of the world is genitally intact and quite happy about it because foreskin feels really good.
I am sorry to see the popular press has made an inroad on the science of HIV prevention. First of all, there is no evidence that circumcision reduces the incidence of HIV in the developed world. This is because the main route of infection are gay sex and IV drug abuse. If you look at WHO's data base you find that in the English speaking countries of Canada, Australia, Great Britain and the USA that the incidence of HIV correlates very well with the circumcision rates of 15 to 20 years ago. In my analysis R^2 was 94% suggesting a strong correlation between increased circumcision and increased HIV infection. If you take the whole of the developed world the correlation is still there but is not very strong. The bottom line is that not only does circumcision not work, it may actually increase the likelihood of contracting HIV in developed countries.
Since correlation does not establish causality the reasons are open to speculation. I suspect a reluctance to speak openly about sex and sexual practices in the US keeps information about condoms and condoms themselvs out of the hands of high risk youth. In countries where parents are more open with their adolescent children about sex and expectations of behavior and STD & pregnancy prevention the rate of ALL STDs is lower than in the Victorian US. This also explains the high rate of circumcision in the US, if no one talks about the foreskin as a healthy valuable body part with a function, then cutting it off is no big deal. Where people are more open and share their experiences the obvious becomes, well, obvious and genital reduction surgery goes away, as it should.
Since circumcision only reduces the infection rate in heterosexual men who engage in risky behavior the effect is tiny in the developed world. For example, in the US, 6 men in 10,000 contract HIV thru heterosexual contact. Circumcision can be expected to prevent at most about 3 infections in 10,000 If the vaccine was 30% effective, as suggested in the trial, it would prevent 18 infections in 10,000. Dr. Anthony Fauchi, the head of the National Institute for Allergy and Infectious Disease has said that 30% effctiveness is much too ineffective as it would engender a sense of false security which could increase, not decrease, the HIV rate in the US. Yet, the vaccine, if effective at the 30% level, would be 6 times more effective than the most optimistic estimation for circumcision. Worse, the popular press by extoling the false virtues of a cultural practice has potentially incited sexually active circumcised men to increase risk taking by thinking they are protected today.
Surprisingly, this is true for Africa as well. epidemiological models predict from 3% to 20% reduction in HIV infection in South Africa. The vaccine would reduce the rate by 30%. Again, the vaccine is too risky to roll out, but a much less effective strategy is considered to good to miss.
What is going on is politics on its most evil level. This is not about saving lives or reducing HIV infections! This is about doctors trying to justify what has always been an unjustifiable cultural practice. This is not about science, it is about belief and cognitive disonance and it is why the RACP has come out against circumcision as a prevention strategy for HIV in their official policy paper. Only the US and therefore the CDC is mired in a cultural battle trying to justify their culture with doctors trying to avoid "iatrogenic" as a label to circumcision. If this were 150 years ago, the CDC would be extoling the virtues of slavery, 100 years ago they would be telling women they should not vote, 70 years ago it is OK for children to work in sweat shops.
One final note. Wawer et al tried to find out if circumcision helped reduce the HIV rate in women married to HIV positive men. They found it increased it. They tried to explain it away by claiming a too early return to sexual activity prior to healing after surgery. Of course pain would prevent an early return until things were mostly healed. The observations could also be explained by an increase in activity following a period of abstinance or even excitement over a new experience or even a false sense of security. All of which points to injury to women. The data were not statistically significant in a two tailed test. I ran the data thru a one tailed Fisher Exact test looking for harm and found an 82% chance the data showed a real risk to women. Not the 95% required for significance, however, we are not talking about a benefit but a harm so we should be a bit more circumspect and there is only an 18% chance circumcision has a neutral or beneficial impact on women. The conclusion of the paper was that the control group of men should be circumcised to prevent stimatization! Increased danger to the women was not considered relevent. This has to be the most overtly misogynistic conclusion I have ever read in a peper by a major medical organization and a women author to boot. If Betty Freidan were her, she would rip thier lungs out.
Scot Anderson