Re: AIDS Prevention Inspires Ways to Make Circumcisions Easier January 30, 2012 by DONALD G. McNEIL Jr.
The NYT has reached a new highwater mark for poor journalism. McNeil gleefully writes an advertorial for the “PrePex” device, while completely ignoring any of the controversies surrounding circumcision.
The advocates of male circumcision (MC) tout three African based clinical trials that seemingly showed a reduction in HIV transmission after MC. However, opponents of MC have strongly denounced the methodology of the trials. McNeil fails to examine if the methodology and analysis of the data these trials used arrived at predetermined results. Furthermore, how does the quest for grant money affect the outcome of the studies, and influence the objectivity of the researchers? Some of the researchers had a personal bias in favor of circumcision before the studies even commenced. McNeil also fails to report other studies that showed no significant reductions in infection rates after MC was performed.
Interestingly the government of Malawi has not endorsed MC as a measure against HIV. “We have no scientific evidence that circumcision is a sure way of slowing down the spread of AIDS,” said Dr. Mary Shaba, a top HIV/AIDS official in Malawi. Shaba said she had seen studies that showed a comparatively low rate of HIV/AIDS in countries where circumcision is encouraged or mandated. But she said she believed circumcision may not be the only reason for this.
McNeil writes circumcision is “one of the most effective vaccines against AIDS.”
However, a vaccine that only offered an efficacy rate of 60% would be rejected by the FDA. Even the most optimistic promoters of MC only claim that uninfected males have a reduced risk of infection vectored from infected females. Uninfected females do not obtain any benefit from infected circumcised males. Also keep in mind the claimed 60% reduction in infection actually means the overall drop in virus transmission would be from 2% per encounter to about 1%. The bottom line from a statistical viewpoint is that any person engaging in unprotected sex with infected partners will soon enough become infected, regardless of circumcision status. MC should not be touted as an “effective vaccine.”
McNeil states “Circumcision is believe to protect heterosexual men because the foreskin has many Langerhans cells, which pick up viruses and present them to the immune system — which H.I.V. attacks.” If MC offers such protection due to elimination of Langerhans cells, why does recent CDC studies of gay circumcised men in the US show no similar correlation?
Proponents concede that MC offers no protection against other means of infection from sexual activity other than transmission from an infected female to male during intercourse. MC would offer no protection from any other form of sexual activity, straight or gay. MC doesn’t offer protection from infection due to drug use, unsanitary medical procedures, and other practices where body fluids are exchanged. The only proven means of HIV prevention is abstinence, safe sex practices, safe medical procedures, and avoiding exchange of body fluids.
What really concerns us is that the efforts to use MC as a prophylaxis against HIV in Africa has been overly hyped by the news media in the United States. Americans may read this article and assume that being circumcised will also provide them with protection from HIV infection. Claiming that MC acts like a “vaccine” will only serve to undo the safe sex education that took so many years, and so many dollars, to instill in the public conscience over the last three decades.
Additionally, major medical associations worldwide have stated that circumcision for infants is “unnecessary,” “unethical,” and “exposes babies to needless risk for negligible benefit.”
We would urge the NYT to address the issues raised here in a corrective follow-up article.