Intactivism News

New Vision (Kampala)
March 26, 2008

Uganda: Gov't Drafts Policy On Male Circumcision

Anthony Bugembe And Lynn Komugisha
Kampala

THE government is formulating a national policy on male circumcision to reduce HIV infections.

"We are conducting an assessment of medical male circumcision in the districts of Kampala, Kumi, Gulu and Rukungiri. The results will inform us on how prepared our health sector and the general public are for the new policy.

"The Ministry of health is convinced that male circumcision will reduce HIV/AIDS prevalence, especially among people aged 15 to 49 years," said Dr. Alex Opio, the assistant commissioner of National Disease control. He was addressing a public debate on medical male circumcision on Tuesday in Kampala.

"The ministry is looking at issues like public involvement, access, cultural and religious differences," said Opio, adding that the policy would be part of a national strategy but not an independent programme.

"We should make the procedure available at lower levels through empowering other medical personnel like midwives [Midwives are going to be circumcising sexually active men?] and nurses if we are to meet the increasing demand for medical male circumcision."

"In Uganda, about 24% of males aged between 15 and 24 are circumcised but there is need to increase that figure. This group stands a high risk of HIV/AIDS infection because it is starting to engage in sex," said Prof. George Kirya, the head of the Uganda Health Service Commission.

Kirya said about 130,000 Ugandans get infected with HIV/AIDS every year. "About 6% of Uganda's population is infected with HIV. [Mainly women - 3.8% of circumcised men have HIV, 5.6% of intact men, so circumcision might reduce the rate by 1.8%] The largest number of infections are sex-related," he added.

A medical research carried out between 2005 and 2007 in Uganda, Kenya and South Africa indicated that circumcision reduced the chances of contracting HIV in men by 60%. Based on the findings, the World Health Organisation and the UN Programme on HIV/AIDS in 2007 recognised male circumcision as an additional strategy to prevent HIV.

Circumcision reduces urinary tract infections, inflammation, ulceration of the male organs and penile cancer. It also reduces the risk of cervical cancer among women who have sex with circumcised men.

Reuter Health via Yahoo News
March 19, 2008

Circumcised men no less likely to get sex diseases

NEW YORK (Reuters Health) - Circumcision does not appear to shield men from the types of sexually transmitted diseases (STDs) common in the developed world, according to new research from New Zealand.

While there is "compelling evidence" that circumcision protects men from contracting HIV through sex with women, it is unclear whether circumcised men are at lower risk of other types of STDs, Dr. Nigel P. Dickson and colleagues note in their report in the Journal of Pediatrics.

[Almost every news report based on this study began with this claim. Some even made it seem part of this study, e.g.

To investigate, the researchers, at the University of Otago in Dunedin, followed 499 men born in 1972 and 1973 up to age 32. About 40 percent of the men had been circumcised in early childhood.

Among circumcised men, 23.4 percent reported having had any type of STD by age 32, compared to 23.5 percent of the uncircumcised men.

The most common STDs reported were genital warts, Chlamydia and genital herpes. There was no statistically significant difference in rates of STDs even after the researchers adjusted for sexual behavior and socioeconomic factors.

Another recent study from New Zealand found that circumcision appeared to halve the rate of STDs among men up to age 25, Dickson and his colleagues note. [And it got headlines worldwide - the researchers' climb-down did not.] However, they add, that study was done in a smaller group of individuals with a lower rate of STDs than that reported in the current study, while fewer men in that group had been circumcised.

"Although the reason for the different findings in the 2 cohorts is unclear, when our findings are considered in the context of other recent population-based studies in developed countries, it appears unlikely that circumcision has a major protective effect against common sexually transmitted infections in these populations, although a small effect cannot be ruled out," the researchers conclude.

SOURCE: Journal of Pediatrics, March 2008.

[This story was posted here a month ago.]

Accra Daily Mail (Ghana)
March 7, 2008

NHARCON recommends male circumcision for prevention of HIV infection

A three-day second National HIV and AIDS Research Conference (NHARCON), which ended in Accra on Wednesday, recommended that Male Circumcision (MC) be promoted as an additional strategy for the prevention of heterosexually acquired HIV infection in men and should not replace known methods of HIV prevention.

The conference said it was realized that MC has been found to be acceptable amongst community members, in that it was perceived to improve hygiene, reduce risk of Sexually Transmitted Infections and HIV.

Professor John Anarfi, Chairman of the NHARCON Planning Committee presenting the recommendations and the way forward of the conference said though MC was being practiced in Ghana there were some communities that were not practicing it.

“The biggest barriers to MC have been cost, and concerns about safety that is risk of infection or mutilation and pain”.

He advocated that Health Services be strengthened to increase access to safe male circumcision services as part of a comprehensive HIV prevention package

...

The conference highlighted the need to scale up prevention efforts such as condom use, which must be accessible for youth and other marginalized groups.

“Emphasis must also be on abstinence for the adolescent, prevention messages should be accessible for all groups including, the aged, youth and persons living with disabilities and further efforts should be made to galvanise community support for condom use by adolescents”.

...

Dr Eilas Sory, Director-General of the Ghana Health Service ... noted that though the HIV prevalence had dropped from 2.22 per cent in 2006 to 1.9 per cent in 2007, Ghanaians should not be complacent but intensify efforts to ensure further prevalence reduction.

[And according to the National Health and Demographic Survey (p 13/15), the rate is 1.4% among intact men and 1.6% among circumcised men (and higher still among women, hence the national average). The question of circumcision is almost moot in Ghana, though, because 95% of men are circumcised already. The small sample of intact men (210/4468) reduces its statistical significance - we should not conclude that intactness protects against HIV.]

...

The Guardian
March 1, 2008

Pioneering model found dead in Seine

· Drowning theory after month-long disappearance
· 47-year-old campaigned to end female circumcision

Alasdair Sandford

French police have confirmed that a body found in the River Seine was that of Katoucha Niane, one of the first black supermodels, who found fame with Yves Saint Laurent and went on to campaign against female circumcision.

A preliminary postmortem examination found she had died of drowning and there was no sign of violence. Further test results should be known in the next few days, but investigators are thought to believe that her death was an accident.

... it was the publication of her autobiography last year that gave her life and career another dimension. In Dans Ma Chair (In My Flesh), Katoucha revealed she had suffered genital mutilation at the age of nine.

Even though by the early 1960s Guinea was ruled by a communist dictatorship, she described an idyllic family life in Conakry, protected in a "marvellous bubble". Her mother, she said, was an intellectual who had grown up in France and knew how to divert the children's attention from the regime's atrocities. But this golden period was to "blacken in a few seconds. Under a blade".

One day when Katoucha was nine, her mother said that they were going to the cinema. "I found myself the victim of a horror film," she wrote. "An incredible trauma, which I had never managed to speak of, until I found love and wrote In My Flesh."

She launched KPLCE - Katoucha pour la Lutte Contre L'Excision (Katoucha for the Fight Against Circumcision). She travelled in west Africa to campaign against the tradition, reportedly with some success - a number of practitioners agreed to stop. Some of her friends apparently feared her disappearance was linked to her activism.

Victor, her companion for the past two years, recently told the magazine Closer that Katoucha's early experiences haunted her.

...

Vanity Fair's fashion and style director, Michael Roberts, said Katoucha was "one those girls who used her fame to spotlight the misfortunes of others". ...

Associated Press
February 28, 2008

UN Backs Push to End Female Circumcision

By EDITH M. LEDERER – 19 hours ago

UNITED NATIONS (AP) — Ten U.N. agencies have launched a campaign to significantly reduce female circumcision by 2015 and eradicate the damaging practice within a generation.

In a statement released Wednesday, the agencies said female circumcision violates the rights of women and girls to health, protection and even life since the procedure sometimes results in death.

The agencies pledged to support all efforts by governments, communities, women and girls to reduce and end the practice.

Female circumcision, also called female genital mutilation, usually involves the removal of the clitoris and other parts of female genitalia. Those who practice it say it tames a girl's sexual desire and maintains her honor.

"Today, we must stand and firmly oppose this practice because it clashes with our core universal values and constitutes a challenge to human dignity and health," Deputy Secretary-General Asha-Rose Migiro told the Commission on the Status of Women where the campaign was launched.

"The consequences of genital mutilation are unacceptable anywhere, anytime and by any moral and ethical standard," she said. "Often, female genital mutilation is carried out on minors, violating the rights of a child to free and full consent on matters concerning her body and body functions."

According to a statement from the U.N. agencies, between 100 and 140 million women and girls are estimated to have undergone female circumcision, and 3 million girls are estimated to be at risk of undergoing the procedure every year.

It is practiced by Muslims and Christians alike, deeply rooted in the Nile Valley region and parts of sub-Saharan African, and is also performed in Yemen and Oman. Through migration, the practice has spread to Western countries like Britain.

Migiro said there were no quick or easy solutions to the problem and achieving results would require changing "collective behavior" that has supported female circumcision for generations.

"If we can come together for a sustained push, female genital mutilation can vanish within a generation," Migiro said. "This goal demands both increased resources and strengthened coordination and cooperation among all of us."

The 10 agencies are The Joint U.N. Program on HIV/AIDS; the U.N. Development Program; the U.N. Economic Commission for Africa; the U.N. Educational, Scientific and Cultural Organization; the U.N. Population Fund; the Office of the High Commissioner on Human Rights; the U.N. refugee agency, UNHCR; the U.N. children's agency, UNICEF; the U.N. Development Fund for Women and the World Health Organization.

Inquirer (Philippines)
February 27, 2008

US troops go on medical mission in North Cotabato

By Edwin Fernandez
Mindanao Bureau
First Posted 10:14pm (Mla time) 02/27/2008

MIDSAYAP, NORTH COTABATO – American troopers, armed with medical equipment, on Sunday entered the remote village of Kadigasan here and circumcised six Moro males.

“Residents here, all Muslims, have not seen a doctor since birth and the coming of RP-US Balikatan outreach program was warmly welcomed,” Lt. Col. Julieto Ando, 6th Infantry Division spokesperson, told the Inquirer.

Ando said the village was far from the town centers where government and private hospitals were located. He pointed out that because the farmers were poor and the village isolated, they had never visited a doctor for their health concerns.

“They are more concerned with what to eat at the end of the day than having their health checked by physicians,” he said.

As to the six males, aged 40 years old and above, Ando said their delayed circumcision was “mainly due to poverty and unavailability of doctors to do the job.”

He said some of the male patients claimed that they were already circumcised but the procedure was improperly done. “They want the circumcision corrected so they came forward,” he said.

Kadigasan is accessible only by motorcycle or by horse. “Now medical services were brought to their doorstep,” Ando said.

He said armed conflict since the 1970s had prevented the poor Muslim population in far-flung villages from taking care of their health.

The RP-US medical services were brought to various villages in the area of responsibility of the 6th Infantry Division, said Army Maj. Gen. Reymundo Ferrer, 6th ID commanding general.

“This is purely an outreach program and no combat training as feared by militant groups opposed to the presence of US troops in mainland Mindanao,” Ando said.

“We should look at it (from) a bigger perspective and you will find how noble the project is.”

The local Army spokesperson also belied reports that US troopers selected villages near Maguindanao’s Liguasan marshland to check on possible oil and mineral deposits in the area.

“There’s no need to bring troops in disguise as medical workers to the area purposely for searching oil; the US has all the technology to do that even without us knowing it if indeed that was the motive,” Ando said.

Bernama, the Malaysian National News Agency
February 22, 2008

Uganda To Have Law Against Female Circumcision

KAMPALA, Feb 22 (Bernama) -- Uganda is expected to have a law against female circumcision in the near future after a bill seeking to criminalise female genital mutilation was presented in Parliament on Wednesday, China's Xinhua news agency reported.

The draft titled the Prohibition of Female Genital Cutting Bill defines female genital mutilation as violation or attempted violation of the physical integrity of the female organ, either by total or partial ablation, excision, infibulations or desensitisation.

If enacted, a person found guilty of engaging in the practice is liable to imprisonment of between seven to 10 years or a fine of not less than 1 million Ugandan shillings (about US$600).

Members of Parliament (MPs) on the parliamentary forum on population, food security and development, together with members of the Uganda Women's Parliamentarians, supported the draft bill.

According to the draft bill, an offender who is a member of the medical field risks losing their license if they are found engaging in the act.

The document does not consider beliefs, custom, tradition, ritual or consent as valid defense. The MPs, however, called for a death penalty if the victim dies. "The 1 million shillings fine is nothing, death should be the ultimate penalty," said MP Christopher Kibanzanga, flanked by MP Grace Oburu, calling for tougher laws.

The bill, which was drafted by East African Legislative Assembly MP Dora Byamukama, also the director of the Law and Advocacy for Women in Uganda, would soon be presented to the House.

Female circumcision is a practice which involves the cutting of parts of the external female genitalia. In Uganda, it is mainly practiced among the Sabiny and the Pokot clans.

FDA News
February 22, 2008

FDA Pins Warning Letter on Medical Action Industries

The MQN Weekly Bulletin
Feb. 22, 2008 | Vol. 2 No. 8

A medical kit and tray maker received an FDA warning letter after it switched the size of safety pins in one of its circumcision trays.

Medical Action Industries ran out of existing safety pins for a tray so a larger safety pin was substituted, the letter said. After the change, the company received at least two customer reports of excessive bleeding.

The letter noted that the product family coordinator made the change but did not sign the product authorization form or proceed through the change process.

The company’s latest response to this complaint appears to be adequate, the letter said.

The warning letter, posted recently to the FDA website, can be seen at www.fda.gov/foi/warning_letters/s6660c.pdf. [The document does not mention safety pins.]

Afrik.com
February 21, 2008

Male Circumcision and HIV / AIDS

Is mass male circumcision the new big thing in HIV prevention, or is it a risky social experiment that threatens to divert funding from tried and tested interventions?

UNAIDS is careful in its assessment: "Without question, we absolutely have to ensure that men and women are aware that male circumcision is not a ’magic bullet’; it doesn’t provide total protection and it doesn’t mean people can stop taking the safe sex precautions they were already using."

The caution is a response to the excitement - and debate - triggered by the results of three randomised trials in South Africa, Kenya and Uganda in 2005 and 2006, which seemed to demonstrate that circumcision reduced the risk of HIV infection among men by between 50 percent and 60 percent.

After the slow slog of behaviour-change messaging, here was a simple medical procedure - already widely accepted in many African cultures - that could have a significant impact on HIV acquisition. A broad front of UN agencies, key US-based donors and, recently, African health ministers, have been rallying around an endeavour to make the foreskin history.

Dissent
But there are voices of dissent among some social scientists and researchers. They argue that there is not enough incontrovertible evidence to rush to scale-up circumcision (it is still not even certain how a foreskin increases the risk of HIV infection); and why in South Africa, for example, there does not seem to be a significant difference in prevalence between communities that circumcise, and those that do not. [And in at least six other countries, there is a significant difference - in the "wrong" direction]

Frustration over the slow headway made by orthodox AIDS programmes has resulted in "a desperation to find something that works, with a growing lobby for biomedical intervention", Prof Peter Aggleton, a researcher at the University of London, told IRIN/PlusNews. "It involves the construction of an agenda that claims to be evidence-based but where the jury is still out." The danger that men will see circumcision as a quick-fix snip, ignoring public health exhortations to also condomise and reduce partners, is acknowledged by both sides of the debate. But the dissidents question why any potential dilution of the latex message should be risked when condoms provide close to 90 percent protection, and it has been such a struggle in the first place to persuade men to put them on.

For Richard Delate, communications director of the South African health and education programme of Johns Hopkins University, circumcision is simply an additional prevention method. "But we need to give men a choice ... and circumcision provides an entry point where we can engage men to talk about their penises in relation to sexual and reproductive health."

Despite almost a quarter of a century of AIDS awareness programmes, consistent condom use remains frustratingly low, he points out.

But circumcision is not just a medical or cosmetic procedure - for many men it is loaded with significance related to identity and manhood. Social scientists, who feel they have been sidelined in the debate, argue that it is also deeply political, serving as a marker for status, power and social differentiation.

Culture changes
Can a mass rollout work among men in ethnically mixed societies, where foreskins - or their absence - are shorthand for kinship, culture and, almost inevitably, chauvinism? Delate is clear that culture can change: South Africa’s Zulus, who used to be circumcised, obeyed a decree by King Shaka sometime in the 19th century and stopped.

"We need to work with traditional structures to explain to them, engaging not just on circumcision but HIV in general," Delate said.

In societies that do cut, traditional rites are imbued with far more meaning than just removing the foreskin: it is an initiation into manhood where cultural and behavioural codes are passed on, which could also have an important bearing on HIV transmission. Northern Zambia, where circumcision is the norm, has the lowest HIV prevalence in the country. But, according to Mutamba Simapuka of the Maina Soko Military Hospital in the capital, Lusaka, the protective benefits are more than biomedical; young men also receive lessons on fidelity in sexual relationships imparted to initiates. [Could that account for the lower rates of HIV - where they are lower?]

When northern men migrate to Lusaka, with its looser sexual mores, "their prevalence rates equate with the local population", Simapuka told IRIN/PlusNews.

Traditional methods of cutting, however, are not the safest way to perform the procedure; the point, afterall, is for the initiates to prove their fortitude and endurance. Issues of consent are also a problematic area. "To ensure safe and clean operations, male circumcision should only be performed by well-trained practitioners in sanitary settings under conditions of informed consent, confidentiality, proper counseling and safety," is the politically correct advise from UNAIDS.

In the end it boils down to money. Circumcision adds a newly found option for HIV protection, but health services in Africa are already overburdened, under-resourced and struggling to provide even the most basic care. Should circumcision be added to that load?

A concern among dissidents is that new financing might be dangled in front of governments to promote adoption, which would "undermine the existing comprehensive and balanced approach to HIV", according to Aggleton.

The contrary concern is that there will not be enough money. "We will have to look at resourcing to beef up the capacity of health systems, which would have an added benefit [beyond circumcision]," Delate stressed.

by IRIN

Pulse
February 22, 2008

Call for more NHS circumcisions to cut HIV rate

By Emma Wilkinson

Men recently emigrated from countries with HIV epidemics, like sub-Saharan Africa, should be offered circumcision on the NHS, says a leading public health expert.

He has also called for a UK trial to assess circumcision for HIV prevention in men who have sex with men.

Professor Harold Jaffe is head of the department of public health at the University of Oxford and was previously director of the US National Centre for HIV, STD, and TB Prevention.

His warnings in Sexually Transmitted Infections, come after the World Health Organisation recommended scaling up access to male circumcision services in areas of the world with high prevalence, generalised heterosexual HIV epidemics.

Three African trials have shown that circumcision halved the rate of HIV infection in heterosexual men [in Africa, where conditions are vastly different from, and HIV prevalence is much greater than, the UK.].

Professor Jaffe said current UK practice was to discourage the procedure in adults but NHS bodies needed to re- examine their policies.

He added that the yearly number of new UK HIV diagnoses had increased by 157% since 1997 and of the new diagnoses reported in 2006, 12% were in black African men and 36% were in men who have sex with men.

‘New prevention strategies for these groups are urgently needed,' he said.

‘The UK has the opportunity to lead in revising its male circumcision guidelines in accordance with new African data and to develop data upon which to consider new circumcision strategies for men who have sex with men.’

But his comments were dismissed by Dr Colm O’Mahony, past president of the British Association for Sexual Health and HIV and Consultant in Genito-Urological Medicine at the Countess of Chester Foundation Trust Hospital.

He said: ‘Anything that runs the risk of diluting the message that unprotected sex causes HIV infection is unhelpful to say the least.

‘And data released last month suggests circumcision has no effect at all on male-to-female transmission [or transmission between men].

Dr Richard Ma, north London GP and member of the RCGP sex, drugs and HIV working party said: ‘I don’t think this will work in the UK. It’s difficult to see how merely circumcising men who want to be circumcised is going to make any impact on HIV rates in this country - which are still relatively small.’

Jounal of Paediatrics
March, 2008

Circumcision and risk of sexually transmitted infections in a birth cohort

Dickson NP, van Roode T, Herbison P, Paul C.

Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.

OBJECTIVE: To determine the impact of early childhood circumcision on sexually transmitted infection (STI) acquisition to age 32 years.

STUDY DESIGN: The circumcision status of a cohort of children born in 1972 and 1973 in Dunedin, New Zealand was sought at age 3 years. Information about STIs was obtained at ages 21, 26, and 32 years. The incidence rates of STI acquisition were calculated, taking into account timing of first sex, and comparisons were made between the circumcised men and uncircumcised men. Adjustments were made for potential socioeconomic and sexual behavior confounding factors where appropriate.

RESULTS: Of the 499 men studied, 201 (40.3%) had been circumcised by age 3 years. The circumcised and uncircumcised groups differed little in socioeconomic characteristics and sexual behavior. Overall, up to age 32 years, the incidence rates for all STIs were not statistically significantly different - 23.4 and 24.4 per 1000 person-years for the uncircumcised and circumcised men, respectively. This was not affected by adjusting for any of the socioeconomic or sexual behavior characteristics.

CONCLUSIONS: These findings are consistent with recent population-based cross-sectional studies in developed countries [unlike the widely publicised Fergusson study], which found that early childhood circumcision does not markedly reduce the risk of the common STIs in the general population in such countries. [In this case, not even "markedly" - does not reduce it at all, and could increase it.]

Evening Times (Glasgow)
February 18, 2008

City children face illegal circumcision

By Tristan Stewart-Robertson

YOUNG girls in Glasgow are at risk of being taken out of the UK to be circumcised illegally, Strathclyde Police said today.

The force now wants to introduce training for staff in the next three months - nearly two years after legislation came into effect in Scotland to strengthen existing laws against female genital mutilation.

And the children's commissioner, Kathleen Marshall, said the laws could be further tightened to allow local authorities to remove kids from families to prevent them being taken out of the country for the "procedure".

Detective Superintendent David Leitch of Strathclyde Police admitted there were people at risk of FGM in the West of Scotland - including girls in asylum and refugee communities in Glasgow.

He said: "We have potentially a number of women who have gone through this or feel there is a risk to them, or someone close to them, of this happening.

"I want to give them the comfort that we are aware of this issue, and if people approach us or other agencies there is increasing understanding."

FGM is usually carried out [in the girls' home countries] by an older woman with no medical training, rarely using anaesthetic and antiseptic, and often with basic tools such as knives and scissors.

Girls are generally subjected to it between the ages of five and seven.

Ms Marshall said: "A lot more needs to be done to raise awareness.

"Councils in Scotland are not allowed to apply for an interdict forbidding removal of a child from the country. The equivalent order is available in England and Wales."

A Scottish Government spokesman said: "FGM is a horrific and unnecessary practice. If a girl survives the procedure, she faces long-term medical problems including major complications during childbirth.

"We want to eradicate it and protect girls."

New Times (Rwanda)
February 13, 2008

Nothing can fight HIV/Aids better than discipline

BY DAVID GUSONGOIRYE

Following government advice that circumcision lessened chances of contracting HIV/Aids, many young men formed very long lines outside health centres to have their foreskins chopped off. State minister in charge of HIV/Aids and other Infectious Diseases Innocent Nyaruhirira had just given the nod to circumcision when he acknowledged that men who are circumcised are 60% more likely to be protected against HIV during sexual intercourse. [even though HIV is more prevalent among circumcised men in Rwanda than intact men....]

The response to the circumcision programme was so vigorous, so spontaneous, that it got me worried, instead of exciting me. It gnawed at my heart, not quite knowing how to express what it was that worried me specifically, until I happened upon a freshly circumcised fellow. I found him lolling upon a mat, dressed in a loose garment tied toga-style – regular clothing was out of the question at this time of healing – and we fell to conversing about his new condition.

"Mister, these Aids people have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one. Don’t have sex, don’t do this, don’t do that. Eh, man, how can a young man such as I forfeit sex, eh? And the condoms – where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!"

I came from that young man’s side a very humbled person, and doubly afraid for the future as far as the hydra known as HIV is concerned, and its potential to wreak more havoc against a young population that loves and values fun more than security of life.

I should also state that this assertive young man had got the benefit of a good education and therefore far above being called an ignoramus. There it was in black and white: whatever sensitisation that had been done about ways of protecting oneself against HIV infection were going to be thrown to the wind, because circumcision would now provide full coverage!

It is appalling, to say the least. That explained the long circumcision lines in front of the health centres – young men and women were now going to indulge in all the sex they wanted without any inhibitions, any fears about HIV infection.

Anything that will give a person a chance to escape HIV infection is gladly welcome. This fight is not any different from any other physical conventional wars – you don’t win any by using only direct frontal attack; you have to employ various stratagems in order to make headway.

I strongly urge the government, the entire public and in our own homes to step up the campaign against HIV/Aids, but by taking counseling to another level. Who knows that the World Health Organisation and Unaids’ statistics might not have taken every single factor into consideration?

It is counseling that will help those young men who are rushing to get circumcised in order to ‘enjoy’ their sex unhindered, to get informed that there are many things to consider before they place their unprotected peckers in the mouth of infected vessels, placing all their faith in their circumcision armour.

It is not the place of this column to criticize circumcision, lest I am read wrongly. [Why ever not?] The column is actually endorsing it, and advising that as in previous campaigns, it is also not infection-proof. Therefore, it should be used as a mere fall-back position, not as the entire and only shield.

As in tectonic forces, HIV also follows the line of least resistance. Fighting HIV needs discipline, and so an undisciplined person will not manage to walk within the strictures of Abstinence, Faithfulness, Condoms, and Circumcision – all of which give high chances, but only when one sticks to them religiously.

And look now; there is another group that has grown into maturity and is infected, but without ever having had sexual contact with any member of the opposite sex – or of the same sex. There are many unfortunate children who were just born with the HIV virus. The level of resistance of these people and many others is quite different from yours and mine, just as it is different in a general sense. So, it is always a danger to indulge in the kind of sex that the young men want – wild and unprotected – when it is your resistance that is weak and therefore your life is put in uncalled for danger.

Let us all campaign for a high sense of discipline in our daily undertakings, be it in our health, financial, or political affairs.

Contact dgusongoirye@newtimes.co.rw

The Times
February 10, 2008

SA men 'not snipped properly

BOBBY JORDAN

UP TO half of circumcised South African men did not undergo the procedure “properly”, leaving them more at risk of contracting HIV [...if they have unprotected sex...] than men who went under the scalpel in a clinical setting.

This was one of several findings presented to an international conference in the US this week, attended by the world’s top HIV/Aids researchers.

Recent research worldwide has shown that male circumcision may decrease the chance of contracting HIV, which [...according to one small study of foreskins from the cadavers of old men...] targets cells in the foreskin.

The World Health Organisation last year recommended circumcision as an effective intervention in the fight against Aids.

French researcher Dr Bertran Auvert of Versailles University suggested this week that 40% to 50% of circumcisions in Southern Africa were only “ritual” or “partial” circumcisions — where the foreskin was not completely removed.

HIV trials conducted in South Africa [by Prof. Auvert], Kenya and Uganda showed that only clinical circumcision [...no, they didn't compare it with any other kind...] could reduce the risk of males getting HIV, said Auvert.

[But the trials in South Africa and Kenya used the forceps-guided method, where the foreskin is pulled forward and chopped - very similar to tribal circumcision - while the one in Uganda used the sleeve resection method, which removes more of the mucosa - and all three trials gave about the same amount of "protection".]

“What I know is that not all who say that they call themselves ‘circumcised’ are clinically circumcised,” he said. “In fact their penises are completely intact.”

Of the estimated 165 million men in Sub-Saharan Africa, about 54 million (33%) were uncircumcised, Auvert said.

He detailed a plan for a massive circumcision roll-out in sub-Saharan Africa.

[If this is so, then it makes nonsense of all the cross-sectional studies that claimed to find circumcised men are less likely to contract HIV than intact men - because we don't know if the "circumcised" men were circumcised "enough".]

Cameroon Tribune (Yaoundé)
February 7, 2008

Cameroon: Zero Tolerance on Female Circumcision

Brenda Yufeh

Female Genital Mutilation (FGM) which is defined by the World Health Organization (WHO) as all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural or other non-therapeutic reasons is a barbaric act to womanhood.

The practice violates the basic rights of women and girls and seriously compromises their health, posing risks during childbirth, and leaving lasting physical and psychological scars. Estimated statistics from the United Nations reveal that 120 to 140 million women have been subjected to the practice and three million girls continue to be at risk each year. Approximately 6,000 new cases of FGM is experienced every day, five girls every minute.

International organisations have not folded their arms to the cruel act women undergo. That is why the United Nations designed yesterday as the International Day against Female Genital Mutilation to raise awareness amongst the general public about this cold-blooded act. The practice of FGM is still widespread in spite of a global commitment following the 2002 UN Special Session on Children to end FGM by 2010.

In Cameroon, experts from the Ministry of Women's Empowerment and the Family, say it is difficult to have statistics on the practice of FGM in the country since those who practice it do so in hiding while victims of FGM are usually ashamed and afraid to testify in public due to traditional treats from kinsmen.

However, a UN report estimates that about 20 per cent of women in Cameroon go through a form of FGM called infibulation which occurs in certain areas of the South West and Northern Provinces. This is why as Cameroon joined the international community to commemorate the first International Day against FGM, the Minister of Women's Empowerment and the Family, Suzanne Mbomback, used the occasion to condemn the practice.

She underscored government's commitment to respect and protect the rights of its citizens. As such, Minister Suzanne Mbomback urged all to join in the fight against FGM. In Yaounde, the day was characterised by debates and film projections against the practice of FGM.

Afcast
February 6, 2008

WEST REGION NEWS

Niger's Female circumcision rate drops

NIAMEY, February 06 -- The prevalence rate of female circumcision among women aged between 15 and 49 years has dropped by half (from 5% in 1998 to 2.2% in 2006), within a decade in Niger, according to UNICEF statistics released here Wednesday.

According to UNICEF, the practice is widely carried out among the Gourmantché and Peulh ethnic groups, which have 65.9% and 12.8% respectively of their women circumcised.

Female circumcision involves full or partial removal of a woman's external genitalia.
- pana

AFP
February 6, 2008

SLeone women step up pressure to eradicate female circumcision

FREETOWN (AFP) — Women's rights advocacy groups in Sierra Leone are piling up pressure on authorities for the speedy eradication of female circumcision prevalent in the country, one campaigner said on Wednesday.

Finda Fraser, coordinator of the Advocacy Network, said a coalition of 16 women organisations had launched a campaign to gather views on the harmful practice commonly referred to as female genital mutilation (FGM) "on how to forge ahead and advocate for its eradication from our community."

Herself a victim of FGM Fraser said, "It but it is against our human rights and should not be practised in Sierra Leone. It is an issue which the government and women's organisations should work to stop quickly."

Social Welfare Minister Haja Musu Kandeh on Monday expressed her government's commitment to ban the practice but did not state when it would take effect.

Sudanese-born Enshore Ahmed, a UN advisor on gender issues in the west African country, noted that Sierra Leone and Sudan top the list of countries in terms of prevalence of female genital mutilation in Africa.

"We have a lot to do to eradicate the practice. I am appealing to the government to engage in the process of having a law endorsed against the practice," she urged.

The country's gender and children's rights law passed by parliament last year does fall shy of explicit mention of the the practice.

An estimated between 35 and 40 percent of women in the country undergo circumcision, traditionally believed to control female sexuality and make girls more "marriageable."

Still carried out in 28 African countries according to the World Health Organisation (WHO), FGM often causes infection and sometimes death.

Overall, between 100-140 million girls and women have undergone female genital mutilation worldwide, the WHO reports. Some three million girls yearly are at risk of infection, the agency says.

Courier-Mail (Brisbane)
February 8, 2008

Circumcisions rate highly

Circumcision of baby boys is no longer offered routinely in many Australian public hospitals, forcing parents to have the procedure done privately. [Only if they're absolutely determinedto have it done. Nobody's forcing them, they're forcing it on their baby.]

The Royal Australasian College of Physicians, which includes pediatricians, is rewriting its policy on circumcision after renewed medical debate on the practice.

Recent studies have found that men who have had their foreskins removed are [slightly] less likely to acquire sexually transmitted diseases.

But RACP policy director Gary Disher suggested yesterday the college would maintain an opposition to circumcising baby boys as standard practice.

"The debate around circumcision at the moment . . . focuses on the prevention of sexually transmitted diseases," he said.

"New parents with a new baby boy in their arms are not thinking about the sexual activity of that boy 20 years on.

"As pediatricians, that baby boy and his parents are our client group. The evidence suggests there is no medical reason for circumcision at that point.

"Our new policy, I'm sure, will keep that as a headline."

...

Herald Sun (Melbourne)
February 8, 2008

Circumcision still trendy

CIRCUMCISION may have been outlawed in Victoria's public health system, but it is still popular in private hospitals.

The controversial operation was the 10th-most common hospital procedure claimed for children last year, according to figures from Medibank Private.

There were 376 circumcision claims lodged in the 2006-07 financial year, despite the operation being banned in public hospitals for non-medical reasons since September, following the lead of NSW, Western Australia and Tasmania. [Fewer than one a day is "popular"?]

Almost 5000 hospital claims were made by Medibank members aged under 17 for dental extractions and restorations. [If 376 circumcisions is "trendy", 5000 dental extractions and restorations is a landslide of popular approval.]

The one million-plus ancillary dental claims meant it was the top out-of-hospital procedure for young members.

Tonsillectomy (3275 claims), grommet insertion (1676) and ear nose and throat procedures (691) were also common hospital claims by young members. [So circumcision is not just tenth, but a distant tenth, comprising less than 3.5% of the top ten procedures.]

...

Twin Cities
February 6, 2008

Court: Mom Can't Sue Over Circumcision

ST. PAUL (AP) — The Minnesota Court of Appeals has ruled that a mother who didn't [consent or ]like the way her baby's circumcision looked cannot sue a Fridley hospital for medical malpractice.

Dawn Nelson sued Unity Hospital and Dr. Steven Berestka, claiming the doctor removed "the most erogenous tissue" after the boy was born on Jan. 21, 2000 — without consulting either parent. Nelson and the boy's father, David Nelson, were unhappy with the result.

But the Appeals Court noted in its Tuesday decision that the mother indicated on a prenatal form that the baby should be circumcised.

Attorney Zenas Baer, who is representing the mother and son, said he was disappointed with the court ruling.

He said federal regulations say there has to be a signed informed consent form before any surgery — and he argued that a checked-off box on a form regarding circumcision [that wasn't seen by or known to the circumcising doctor] is beside the point, saying "isn't the mom allowed to change her mind?"

Baer said his client plans to appeal.

Dawn Nelson initially sued the doctor, alleging assault and battery and negligence. That claim was settled separately. The claims against Unity Hospital and its parent company, Allina Health System, went forward.

Nelson claimed the hospital had a duty to verify that the doctor obtained informed consent and she claimed the hospital had been deceptive or misleading in its informed consent policy.

A Hennepin County judge disagreed and dismissed the case. The appellate court affirmed the lower court decision.

As for the child, another surgeon "performed a revision for cosmetic purposes" shortly after the initial circumcision, the ruling said.

Mark Whitmore, an Allina attorney, said the company was pleased with the ruling.

According to Baer's Web site, he "contributes substantial amounts of time to ending the barbaric practice of routine infant male circumcision worldwide, insuring genital integrity for all citizens of the world." [This seems to have been put in to mock Baer. In context, it comes at the end of a long list of other admirable activities. The story would have done better to focus on Dr Beretksa and his offhand way of doing circumcisions.]

Aidsmap
February 6, 2008

CROI: AIDS vaccine: additional infection risk restricted to uncircumcised men

Gus Cairns

The Merck ad5 candidate AIDS vaccine, which appears to have increased the HIV infection risk of some trial participants (see this report), may have done so because it specifically increased the vulnerability of uncircumcised men to infection through insertive anal sex, the Fifteenth Conference on Retrovirues and Opportunistic Infections was told today in Boston.

This implies that the vaccine may have abrogated an immune response that was protective to uncircumcised men. This may (or may not) have been related to pre-existing immunity to the ad5 adenovirus, which was the vaccine’s ‘delivery vehicle’.

...

The STEP trial
In the STEP Trial, 1,500 volunteers at high risk of HIV in the Americas and Australia were originally recruited, starting in December 2004. They were largely gay men and female sex workers. Sixty-two per cent were male and the average age was 29. They were at high risk of infection, with 25% of men and 50% of women having had at least 20 sex partners in the previous six months.

...

The trial was stopped in September 2007 when its data and safety monitoring board realised that the vaccine conferred neither a protective effect against HIV infection nor any effect on the subsequent course of infection.

However analyses of the trial data revealed a more alarming fact: there were more infections in the vaccine recipients than the placebo recipients – 49 versus 33, to be exact.

...

Adenovirus immunity increased infection risk in vaccine group
This suggested that the vaccine may either have generated an immune activation response that, perhaps by stimulating HIV-receptor cells, made people more vulnerable to HIV, or it removed an immune defence against HIV that was somehow conferred by pre-existing ad5 immunity.

...

Uncircumcised men at greater risk
There was one more important risk factor for HIV acquisition in vaccine recipients when compared to the placeo group: circumcision, or rather, the lack of it.

Uncircumcised vaccine recipients were, in univariate and multivariate analyses, four times more likely to become infected with HIV if they received vaccine than if they received placebo. In contrast there was no difference at all in infection rates between circumcised vaccine versus placebo recipients.

In questions after the presentation, Buchbinder commented that the risk to uncircumcised men was greater than the risk to men with high ad5 immunity, and that the latter may be a passive marker for the former. This was because the men with high ad5 immunity, who were largely recruited in the second wave, also tended to come from countries and communities with lower rates of circumcision; they were younger and more likely to come from Latin America, for instance.

She also commented that preliminary data hinted that the enhancement of infection risk was specifically seen in uncircumcised gay men who largely or exclusively had insertive anal sex. This would imply that the vaccine was abrogating some immune mechanism that normally protected uncircumcised ‘tops’ from infection through the mucosa of the foreskin.

However, this would not explain in itself why placebo recipients were less likely to get HIV if they had high ad5 immunity, so the two effects may be synergistic.

...

References

Robertson M, Buchbinder S et al. Efficacy results from the STEP Study (Merck V520 protocol 023/HVTN 502): a phase II test-of-concept trial of the MRKad5 HIV-1 gag/pol/nef trivalent vaccine. Fifteenth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 88LB, 2008.

...

TownHall.com
February 7, 2008

SAfrica Questions Circumcision Advice

By CLARE NULLIS

South Africa's health minister took another controversial foray into the AIDS debate Thursday by questioning international medical studies that say circumcision helps reduce HIV infections in men.

Manto Tshabalala-Msimang, who frequently clashes with foreign experts on how to deal with this nation's world-worst AIDS epidemic, said there wasn't "enough information" to justify the government running roughshod over some local communities whose traditions frown on circumcision.

In this July 2006 file photo a young unidentified initiate, with his face caked in white lime clay, eats rice from his blanket during his rite of transformation from a boy to manhood near Port St, John's, South Africa. [Nearly 40 youths died from circumcision each year 2000-5 in Eastern Cape Province.] South Africa is not ready to follow U.N. advice and use male circumcision as a weapon against the spread of HIV/AIDS, the country's health minister said Thursday, Feb. 7, 2008, warning that international studies are inconclusive and run roughshod over African cultural traditions.

Her comments were the latest in a string of positions that have earned Tshabalala-Msimang sharp criticism from AIDS activists, leading one expert to say the statement showed she is "addicted to folly."

Tshabalala-Msimang voiced doubts about the circumcision studies on the sidelines of a meeting of South African traditional leaders. Many of those leaders portrayed the advice on circumcision as a Western attempt to force foreign values and solutions on Africans. [And there's a lot to be said for that.]

South Africa has an estimated 5.4 million people infected with the AIDS virus - the most of any nation.

The United Nations says there is compelling evidence circumcision reduces the risk of men contracting the AIDS virus by up to 60 percent. The World Health Organization and UNAIDS last March endorsed male circumcision as an "additional important intervention."

The advice was issued following three extensive trials in South Africa, Kenya and Uganda that showed circumcision dramatically reduced men's susceptibility to HIV infection because the cells in the foreskin of the penis are especially vulnerable to the virus. [The studies only showed that few circumcised men than intact men contracted HIV in a given period - they did not study cells in the foreskin.]

One study [by the same people who carried out the non-blinded random clinical tests] projected that in the next decade, male circumcision could prevent 2 million AIDS infections and 300,000 deaths.

Tshabalala-Msimang said she was not convinced, noting South Africa's Xhosa ethnic communities suffer high AIDS infection rates even though nearly all Xhosa men are circumcised. However, the infection rate is even higher for Zulus, for whom circumcision is taboo. [So the reporter is doing her own AIDS research, assuming that circumcision is the only difference between Xhosa and Zulu.]

The health minister also said male circumcision offers no protection for women, who bear the brunt of the AIDS infections in sub-Saharan Africa. [- and the most recent study suggests circumcision may put women at greater risk.]

"I can't say to people they must get circumcised when the process (of research) is ongoing," she said. "I can't go and say things to people which I can't guarantee."

Stephen Lewis, the former U.N. AIDS envoy for Africa and a strong critic of Tshabalala-Msimang, said the comments were typical of an official who has espoused garlic and lemon as a remedy for AIDS and openly mistrusts anti-retroviral medicines used to treat infections.

"She remains a minister who is addicted to folly," Lewis said in an interview from Canada. "There is overwhelming scientific evidence that male circumcision is one of the important ways of preventing transmission of the virus. This is proven beyond a shadow of a doubt."

Rwanda, Uganda, Zambia and Swaziland are among the African countries incorporating male circumcision as part of government AIDS prevention strategies. The United States and big donors like the Bill and Melinda Gates Foundation have said they are willing to fund such programs.

Swaziland, where an estimated one-third of the population is infected, has set up a circumcision task force even though Swazi culture is similar to that of Zulus, who fear circumcision will undermine their warrior traditions.

Twelve Swazi doctors, a tenth of the country's total, are being trained to perform the operation. The country's rate of circumcisions has increased from a couple a week to more than 10 a day, said Inon Schenker, head of an Israeli training mission in Swaziland. [diverting vital health care away from the rest of the people]

"I meet almost everyone who comes into the operating room," Schenker said in a telephone interview. "I ask them, `Why did you come?' and 90-plus percent say, `This is going to allow us to be healthy.'" [And their opinion is worth...?]

He said every Swazi man who undergoes circumcision is counseled that the medical procedure alone does not offer complete protection against the AIDS virus and continued condom use is essential. They are also told they must wait until the wound heals before having sex. [So were the men in the trial in which women were more likely to became infected after their men were circumcised.]

Cape Argus
February 8, 2008

Manto dips toe into circumcision debate

... Chief Langa Mavuso, HIV and Aids co-ordinator in the House of Traditional Leaders in the Eastern Cape and programme director, on Thursday said South Africa would not be dictated to "by countries like Geneva".

Later, Dr Sibusiso Sifunda, of the SA Medical Research Council's (MRC) health promotion, research and development unit, told the meeting the South African circumcision study, in Orange Farm in Gauteng, was not representative of a typical South African neighbourhood. The socio-cultural issues had also been completely ignored.

A study in the Eastern Cape, which would provide an in-depth understanding of the "meaning and processes" of initiation in that province, was under way.

Professor Anthony Mbewu, MRC head, said the randomised trial data on circumcision was important, but that much more understanding of the South African context was required.

A South African solution was required.

paper
, 2008

Headline

South Africa: Minister Breaks Bad News About Aids Prevention Business Day (Johannesburg) Email This Page Print This Page Comment on this article Business Day (Johannesburg) 8 February 2008 Posted to the web 8 February 2008 Tamar Kahn Cape Town Health Minister Manto Tshabalala-Msimang expressed doubts yesterday about the merits of male circumcision in preventing HIV transmission, saying new research suggested the procedure might make women more vulnerable to the disease. Last year the World Health Organisation (WHO) recommended that countries hard-hit by HIV/AIDS encourage male circumcision, after three large studies showed it could halve the risk of men getting the virus from infected women. "I've just had very shocking news this morning," the minister told traditional leaders gathered in Cape Town to debate male circumcision ahead of a WHO meeting in Brazzaville in April. She told reporters later she had been informed by local scientists Gavin Churchyard and Glenda Gray of new research indicating that women who had sex with circumcised HIV-positive men appeared to be at greater risk of infection than women who had sex with uncircumcised men. Prof Churchyard, who heads the Aurum Institute for Health Research, said that research presented at the 15th Conference on Retroviruses and Opportunistic Infections in Boston this week indicated circumcising HIV-positive men might increase the chance of harm to women. There were "incredibly high" rates of HIV transmission in the first six months after circumcision, probably because the men were having sex before their wounds had healed, he said. The research had important public health implications, as it meant a mass circumcision programme would have to be coupled with HIV testing, said Churchyard. "Circumcision reduces the risks for uninfected men, so it would have an overall effect on the population, and women could still benefit indirectly." The study presented at the conference was carried out in Uganda and funded by the Bill and Melinda Gates Foundation. It compared the annual HIV incidence in the wives of men who had been circumcised to wives of men who had not. According to media reports and a video recording of the presentation, the annual HIV rate in the wives of the men who had been circumcised was 14,4% over two years, compared to 9,1% among the women whose husbands had not been circumcised. The researchers emphasised that the results could have been due to chance, as the findings were not statistically significant. Relevant Links Southern Africa HIV-Aids and STDs Health and Medicine International Organizations and Africa South Africa AIDSmap reported the study's principal investigator, Maria Wawer of Johns Hopkins University, as saying the results were "unexpected and somewhat disappointing". If the results were not due to chance, they might be due to men having sex before their circumcision wound had healed. Both groups reported the same level of condom use. Wawer said the results posed a challenge to the mass roll-out of male circumcision in Africa. The results were "not good, not good at all," said the health department's HIV/AIDS head, Nomonde Xundu. The president of the Southern African HIV Clinicians Society, Dr Francois Venter, said the minister was "right to be concerned ". .

Holy Moly
February 6, 2008

Christina Aguilera welcomes her newly circumcised son home with penis balloons

Ooh, that crazy Christina Aguilera likes a laugh doesn't she? This time it's at the expense of her newborn son, Max Liron, whom she welcomed home after his circumcision [- or according to other stories, held the bris at home] by decorating her house with penis balloons.

Now, we know that pop stars like to live a bit differently but isn't this just a bit cruel? It's a bit like suggesting a nice game of Monopoly to someone who's just lost their fortune on the housing market or having a welcome home bonfire for a burns victim, isn't it? [It certainly underlines the point made by Leonard Glick in "Marked In Your Flesh" that there is less and less religion in an American Bris.]

Christina, who was born a Catholic but converted to Judaism to marry her husband Jordan Bratman [? - converting to Judaism is not easy, and converting in order to marry a Jew is specifically forbidden.], said:

  "I'm not Jewish, my husband's Jewish... I never really knew a lot of Jewish people growing up either, so I really had no idea [and clearly, still has] about the bris [circumcision rite] and all the Jewish holidays. It's all a learning process for me.

"It was a very sweet experience; we had a lot of close friends come over and experience the bris with us."

Poor little Max, don't be surprised if he starts manifesting some psychological scarring in about 16 years time. Although 'The Oedipus of Beverly Hills' would no doubt sell a few newspapers...

Shall we expect the elevator pouring blood scene from 'The Shining' to be on loop to mark her future daughter's first menstruation? Poor little lambs.

In another inteview, she comments that she chose a caesarian section because she 'had heard horror stories about tearing' ...

WBTV
February 6, 2008

Gaston County Father Charged with Child Abuse, Circumcision

A Gaston County man, who is the father of a dozen kids by two different women, is now facing even more child abuse charges in Caldwell County.

Last week, Johnny Marlowe pleaded no contest to assaulting his wife and neglecting all 12 kids.

WBTV's Michael Handy found out the latest charges came after Marlowe was accused of circumcising two of his sons.

Johnny Marlowe remains in the Gaston County jail tonight, but he could be released within the next few weeks. Either way, his legal troubles are far from over now that he's facing felony child abuse charges in Caldwell County.

"Instead of doing this, could we just give me the maximum and let it go," asked Marlowe's at his most recent court appearance.

He pleaded no contest to more than a dozen counts of child neglect and one count of assaulting his wife. "I'd rather just take the maximum and let it go," he said to the judge.

Marlowe made it clear he wanted the whole mess behind him as quickly as possible and his wife Amber was barely able to speak.

She [tried] to tell the judge that her husband was married to another women at the same time and they all lived together in a very small house.

It is hard to imagine three adults and 12 kids living in the house, but police say that's nothing compared to what happened in Caldwell County.

Marlowe and his two wives lived in Lenoir for several years and during that time Amber says he delivered and then circumcised two of his youngest sons.

Police reports indicate that Marlowe used a utility knife and one of the boys even bled extensively.

The question everyone is asking is, what could motivate a father to deliver and circumcise his own sons?

Well Marlowe says it all started back in 2004 at a Pennsylvania hospital. Doctors there tried to force Amber to have a C-section and that's something Marlowe says he strongly opposes. [Believes in all things natural, does he?]

Doctors at that Pennsylvania hospital even went to court to try and get legal guardianship of the Marlowe's unborn daughter.

It made national news, but the Marlowe's won the case. Amber gave birth naturally and without complications at another hospital.

Story Updated: Feb 6, 2008 at 5:26 PM EST

[A lawyer writes: Circumcision does not by law require any medical training whatsoever in any state I know of, and while anesthesia is required by federal US law for procedures on veterinary and lab animals, it is not required for children. So it is hard to see the nature of the legal offense except in "Yuuchh!" factor terms, and antisepsis.]

Aidsmap
January 30, 2008

Swiss experts say individuals with undetectable viral load and no STI cannot transmit HIV during sex

Edwin J. Bernard

Swiss HIV experts have produced the first-ever consensus statement to say that HIV-positive individuals on effective antiretroviral therapy and without sexually transmitted infections (STIs) are sexually non-infectious. The statement is published in this week’s Bulletin of Swiss Medicine (Bulletin des médecins suisses). The statement also discusses the implications for doctors; for HIV-positive people; for HIV prevention; and the legal system.

The statement, on behalf of the Swiss Federal Commission for HIV / AIDS was authored by four of Switzerland’s foremost HIV experts: Prof Pietro Vernazza, of the Cantonal Hospital in St. Gallen, and President of the Swiss Federal Commission for HIV / AIDS; Prof Bernard Hirschel from Geneva University Hospital; Dr Enos Bernasconi of the Lugano Regional Hospital; and Dr Markus Flepp, president of the Swiss Federal Office of Public Health’s Sub-committee on the clincal and therapeutic aspects of HIV / AIDS.

The statement’s headline statement says that “after review of the medical literature and extensive discussion,” the Swiss Federal Commission for HIV / AIDS resolves that, “An HIV-infected person on antiretroviral therapy with completely suppressed viraemia (“effective ART”) is not sexually infectious, i.e. cannot transmit HIV through sexual contact.”

It goes on to say that this statement is valid as long as:

• the person adheres to antiretroviral therapy, the effects of which must be evaluated regularly by the treating physician, and
• the viral load has been suppressed (< 40 copies/ml) for at least six months, and
• there are no other sexually transmitted infections.

The article begins by stating that the Commission “realises that medical and biologic data available today do not permit proof that HIV-infection during effective antiretroviral therapy is impossible, because the non-occurrence of an improbable event cannot be proven. ... ”

...

They add, however, several exceptions and caveats ... :

• After a few days or weeks of discontinuation of antiretroviral therapy, plasma viral load rises rapidly. There is at least one case report of transmission during this rebound.
• In patients not on treatment, STIs such as urethritis or genital ulcer disease increase the genital viral load; it falls again after the STI is treated.
• In a patient with urethritis, sperm viral load can rise slightly even while the patient is receiving effective treatment. This rise is small, however, much smaller that the rise observed in patients not on treatment.

...

Implications for the legal system
Finally, the Commission says that courts will have to take into account the fact that HIV-positive people on antiretroviral treatment and without an STI cannot transmit HIV sexually in criminal HIV exposure and transmission cases.

...

Reference
Vernazza P et al. Les personnes séropositives ne souffrant d’aucune autre MST et suivant un traitment antirétroviral efficace ne transmettent pas le VIH par voie sexuelle. Bulletin des médecins suisses 89 (5), 2008.

This got a quick response:

Centers for Disease Control
February 1, 2008

CDC Underscores Current Recommendation for Preventing HIV Transmission

CDC Statement
For Immediate Release
February 1, 2008
Contact: CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention 404-639-8895

An article recently published by Switzerland’s Federal Commission for HIV/AIDS states that HIV-positive individuals on effective antiretroviral therapy are not at risk for transmitting HIV to their sexual partners under certain circumstances. The Commission acknowledges that there are no scientific data that the risk of transmission in these circumstances is zero. The Centers for Disease Control and Prevention (CDC) underscores its recommendation that people living with HIV who are sexually active use condoms consistently and correctly with all sex partners.

[How very different this instant and total denial is from the reaction to the claim that circumcision reduces HIV transmission to very much more than zero!]

Aidsmap
February 3, 2008

CROI: Circumcising HIV positive men may increase HIV infections in female partners, but fewer STIs seen

Gus Cairns

There was a trend towards higher HIV incidence in the wives of HIV positive men who were circumcised compared with wives of men left uncircumcised, in the latest prevention study conducted in Rakai province, Uganda, investigators revealed at a press conference on the opening day of the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

In 2006, a randomised trial of circumcision in Rakai reported that circumcision led to an almost 50% reduction in a man’s risk of acquiring HIV through heterosexual sex. The impact of male circumcision on transmission of HIV to the female partner remains unknown, and the study reported today set out to examine the effects.

In the Gates Foundation-funded study, 1015 HIV positive men were randomised either to immediate circumcision or circumcision delayed by two years. Of these 770 were married and were asked to invite their wives into the study; 566 wives enrolled of whom 245 (43%) were HIV-negative and therefore in a serodiscordant relationship.

The annual HIV incidence rate in the wives of the men who were circumcised was 14.4% over two years of follow-up compared with 9.1% in women whose partners remained uncircumcised. This result may be due to chance as it was not statistically significant, but was described as “unexpected and somewhat disappointing” by lead investigator Maria Wawer of Johns Hopkins University, Baltimore. It was not due to behavioural disinhibition; condom use was the same in both arms.

[It's "somewhat disappointing" that they may have been the cause of 13 women contracting HIV who otherwise might not have. No doubt the women were also "somewhat disappointed". Did Wawer et al. proceed to circumcise the other HIV-positive men? In the three non-blinded randomised clinical trials, there were ethical concerns about failing to tell men that they were HIV-positive. Here the men were known to be HIV-positive, and were watched to see whether they would infect their partners. There is something Mengele-like about this, or like the Tuskagee experiment, in which a group of black men with syphilis were left untreated to see how the disease would develop.]

Wawer said that these results were an additional challenge to the rolling-out of mass circumcision programmes in Africa, which are expected following the positive results from three randomised controlled trials of circumcision in HIV negative men, one of them conducted within the Rakai community [by Ms Wawer, among others].

She said: “It is inevitable that some HIV positive men will seek circumcision. It is the only HIV prevention modality that leaves a mark, and no one wants to be the only guy in the village who is uncircumcised if it becomes regarded as a mark of HIV.” [But if HIV-postitive men preferentially seek circumcision, then it is circumcision that will become the real mark of HIV - and what will that do to the infection rate?]

If the increased incidence in the partners of circumcised HIV-positive men is real and not due to chance, it may largely have been due to men resuming sex before their circumcision wound was certified as having healed, Wawer added. [This is called blaming the victim. Another explanatin is that circumcision increases the rate of transmission ... for example, by the keratinised (hardened) glans abrading the vaginal walls.] Five out of 18 wives of men who resumed sex more than five days prior to certified wound healing (28.8%) became HIV-positive themselves. In contrast six out of 63 wives of men who resumed sex no earlier than five days prior to certified wound healing were infected (9.5%) and this was statistically equivalent to six out of 68 wives of men who remained uncircumcised (8.8%). [This figure of five days appears to have been plucked out of thin air - massaging of statistics to give the desired result, perhaps?]

After six months, HIV incidence declined to 5.7% a year in partners of circumcised men and 4.1% in wives of uncircumcised men, which was also not statistically significant.

The results may be partly due to HIV-positive men tending to heal more slowly from circumcision than HIV negative men. Seventy-one per cent of HIV positive men had healed completely by 30 days after circumcision, compared with 83.2% of HIV negative men.

Wawer said: “It is imperative people don’t resume sex in the post-operative period, and because of this slightly longer healing time we are saying don’t resume sex until six to eight weeks after the operation.”

She added that even in the RCT in HIV negative men, the benefit from circumcision did not start to appear until more than six months after the operation. [The figures are far too low to indulge in that kind of fine-tuning, but if this were true it would suggest that the foreskin is no "AIDS magnet" and any effect is really due to keratinisation (hardening) of the glans.]

Effect of circumcision on STIs
There was better news from this and another study of the effect of circumcision on sexually transmitted infections (STIs). In the Rakai study, the circumcised HIV-positive men had a third less genital ulcer disease (GUD) than those who remained uncircumcised (10.1% versus 15.8%) and this was statistically significant (p = 0.002). However rates of all STIs and of bacterial vaginosis were the same in wives of circumcised and uncircumcised men.

Another study presented by Aaron Tobian of the same team investigated the effect of circumcision on the acquisition of genital herpes (HSV-2) in HIV-negative men, and on the incidence of GUD, bacterial vaginosis and trichomonas in their wives.

There was a 25% reduction in HSV-2 acquisition in the circumcised men, and a 25% reduction in GUD, a 20% reduction in bacterial vaginosis, and a 50% reduction in trichomonas in their wives. Severe bacterial vaginosis fell by 60% (two per cent in wives of circumcised men versus 6.5% in wives of uncircumcised). All these results were statistically significant. [- but notice the big difference between the Relative Risk Reduction (RRR) of 60% and the Absolute Risk Reduction of 4.5%]

Among 62 men who became HIV-positive during the trial, 38 (61%) either had HSV-2 before the trial (47%) or seroconverted simultaneously to HIV and HSV-2 (14%).

“All the STIs observed are cofactors of HIV,” Tobian commented. “These effects may influence the positive effect of circumcision on HIV acquisition.”

References
Wawer M et al. Trial of circumcision in HIV+ men in Rakai, Uganda: effects in HIV+ men and women partners. Fifteenth Conference on Retroviruses and Opportunistic Infections, Boston. Abstract 33LB. 2008.

Tobian A et al. Trial of male circumcision: prevention of HSV-2 in men and vaginal infections in female partners, Rakai, Uganda. Fifteenth Conference on Retroviruses and Opportunistic Infections, Boston. Abstract 28LB. 2008.

ABC
January 31, 2008

The Pulse Circumcision: back on the table

by Peter Lavelle

Male circumcision has fallen out of fashion, leaving men vulnerable to infections and other health problems. [That's why the men of Europe, Scandinavia, South America and Asia are all falling down from infections and other health problems - not.]

If you could go back in time and could roam the African savanna a million years ago, you'd soon spot the hominids - the ancestors of modern-day humans. They'd be the ones standing up.

You'd also notice that just like the other animals, the pre-humans were stark naked. Not only that, none of the males were circumcised.

In those days, a foreskin was important to a man and conferred an evolutionary advantage. It protected the tip of his penis - the exposed glans penis - from dust, sand, insects, and infections.

[Implying that's ALL it does.]

But it wasn't long before humans invented clothing, which gave comfort, safety and protection from the elements. The genitals were hidden away in stone-age versions of budgie smugglers.

So much for the foreskin - it wasn't needed.

[These paragraphs and the conclusion are paraphrased from a rant with no evidence by an early 20th century quack called Peter Remondino.]

Worse than that, it was actually a liability. Trapped inside clothes, themselves often dirty and sweaty, it became unhygienic. The fashion - especially in people living in hot places like Australia, the Pacific Islands, the Middle East, Indonesia, and the Americas - was to remove it.

[No, not the Americas. There is no evidence that this is the reason circumcision began anywhere.]

The practice of removing the foreskin, called circumcision, is now the most frequently performed surgical procedure in the world, says Brian Morris, Professor of Molecular Medical Sciences at the University of Sydney, writing in the journal BioEssays.

[The journal Bioessays admits writing by invitation only. Most of its articles are about molecular medicine. It is doubtful that Morris' article would have been accepted by a journal with any connection to its subject matter.]

The mucosa (the inner lining) of the foreskin is very thin, and doesn't have the defences against injury and infection that normal skin does, he says.

["Normal" skin? Interesting he tacitly admits the foreskin is not "just a flap of skin". The mucosa are similar to those of the vagina, anus and lips.]

A whitish residue of dead cells and other material, called 'smegma', collects under the foreskin and this attracts bacteria and other microorganisms.

[It does not of course "attract" anything.]

So statistically, men who haven't been circumcised are more prone to a wide range of infectious diseases, ranging from thrush, to human papilloma virus, syphilis, HIV, and urinary tract infections. And their female partners are much more likely to get genital herpes, chlamydia, pelvic inflammatory disease and infertility.

["Much" more likely? Infertility? Would this not reflect in the birthrates of different countries? This is a typical use of a high relative risk to inflate the importance of tiny absolute risks.]

Rates of cancer of the penis and prostate are higher in men who have intact foreskins, and rates of cancer of the cervix are higher in their female partners.

[Again, how much higher, and from what baseline? The second claim was disproved decades ago.]

A range of other conditions of the penis are more frequent, including inflammatory conditions of the skin, and phimosis, a narrowing of the opening the foreskin that prevents it being retracted and makes sex painful.

[All these can be treated non-surgically.]

There's a one-in-three chance of an uncircumcised man developing one or more of these conditions over his lifetime, says Morris.

[Morris actually refers to any condition at all, not just these frightening ones. What are the lifetime chances of developing some condition or other on ANY part of the body? About one in three.]

That's why circumcision is routine in infant boys in cultures all over the world (Hispanics, Europeans and Asians being a notable exception).

[On the contrary it is confined to about five cultures, the biggest of which, Muslims, do it in childhood, and for religious reasons and ritual cleanliness. The US and Israel are the only countries where a majority of babies are circumcised at birth.]

As with any surgical procedure there are risks. In one in 500 circumcisions there's some minor bleeding and in about 1 in 1000, the circumcision needs to be redone. Complications are fewest when it's done between birth and 4 months (though it can be done at any age). Serious complications requiring hospitalisation are rare. Mutilation or loss of the penis, and death, are practically unheard of if the surgeon is competent, says Morris. But the benefits of circumcision far outweigh the risks, he argues.

[These are all underestimates.]

Falling rates of circumcision

Nevertheless, rates of circumcision have fallen in many Western countries, especially the UK and Australia

In the US, circumcision rates are about 90 per cent;

[Way too high.]

Australia's circumcision rates reached 90 per cent in the 1950s and 1960s. But unlike the US, they began to fall away in the 1970s.

In the 1970s a belief emerged that circumcision was traumatic for the child.

[Because of course it is!]

It was painful for the child (anaesthetic wasn't routinely used in the 1970s) and the belief then (since discounted) was that it interfered with the parents bonding with the child. Circumcision rates fell to about 10 per cent in the 1980s.

[It's still painful even with anaesthetic. "Discounted" by whom?]

It's risen since then,

[Not so.]

driven by more widespread awareness of the benefits in preventing HIV and cervical cancer; today about 15 per cent, on average, of Australia male infants are circumcised at birth.

[The current rate is more like 13%, driven mainly by NSW and Queensland - much lower in the smaller states.]

The anti-circumcision lobby

But despite the volume of scientific evidence of its benefits and its increasing (but slow) reacceptance, there's still strong resistance to circumcision from lobby groups, and even from some sections of the health professions.

Anti-circumcision groups argue that it meddles with nature; and that the penis is more sensitive and sex is more pleasurable if the foreskin is left intact. Circumcision is traumatic, they say - it's a form of mutilation and children aren't able to give consent to it. As adults, men may regret having it, they argue.

There's no scientific evidence for any of this, says Morris.

[There is ample evidence that circumcision is traumatic, it's self-evident that children can't consent to it, and there is testimony from many adults who regret having it.]

Studies have shown for example that sex isn't any less pleasurable or the penis any less sensitive in circumcised men compared to uncircumcised men. Most women prefer a circumcised penis for appearance and hygiene.

["Studies" that didn't look at the foreskin. His claim about women is groundless - the only study to find this was of a small group of women who had circumcised their sons, and many of whom had never seen an intact penis.]

But the lobbyists have had an effect on the medical profession and the perceptions of the wider community, he says.

[Actually, the medical profession has shown very little sign of being influenced by Intactivists.]

Doctors' groups such as the AMA, and the Paediatrics & Child Health Division of the Royal Australasian College of Physicians, are equivocal at best about it, [Note the loaded words "at best", as though heartfelt recommendation was better.] recommending it only when the child has a medical condition obviously requiring it (a child with phimosis, for example)

[Phimosis can not be diagnosed until puberty, and then treated non- surgically, or by non-reductive surgery.]

, but not actively encouraging it as a routine elective procedure (although the Royal Australasian College of Physicians is currently revising its position).

State government health departments have followed suit. Public hospitals in all states except Queensland no longer offer elective circumcision for infants. What this means is that parents

[if they are DETERMINED to cut their sons]

have to find a surgeon and have it done in a private hospital or circumcision clinic, at a cost of several hundred dollars (which makes it too expensive for many financially disadvantaged parents).

Parents' choice

Like childhood vaccination, circumcision is an emotional, polarising issue.

[That's the ONLY thing they have in common.]

But parents aren't getting enough genuine information based on science to enable them to make a rational choice; when they do, studies indicate they're more likely to opt for circumcision.

[Or rather, studies show that they're very hard to dissuade, once they've got the circumcision bee in their bonnet.]

Who knows, perhaps in another million years, circumcision won't be necessary. A visitor to the future might find the foreskin has disappeared in the human male, dispensed with by natural selection.

[This won't happen if Morris has his way, because circumcision will thwart any evolutionary pressure on humans to be born without foreskins. If Morris wants the foreskin to evolve away, the best way is to leave it alone.]

Until then, parents will have to become more proactive to protect their sons' future health.

More info

* www.circinfo.net - Professor Brian Morris's website * NOCIRC - Anti-circumcision lobby group * Why circumcision is a biomedical imperative for the 21st century - BioEssays abstract * Short changed? The law and ethics of male circumcision (pdf) - International Journal of Children's Rights * Male circumcision halves HIV risk - Science Online 14/12/2006

Victorian Times Colonist (B.C.)
January 31, 2008

More parents choosing to skip circumcision

Majority of boys don't get surgery, but some doctors still doing it

Katherine Dedyna, Times Colonist

Victoria mother Kira Antinuk has a motto she wishes parents and doctors would adopt for the baby boys of B.C.: "May the foreskin be with you."

When she was pregnant with her son Dante, now four, she saw a video clip of a circumcision that changed her life -- galvanizing her into working against the removal of healthy tissue in normal babies.

Along with caring for Dante and newborn daughter, Kiana, Antinuk devotes up to three hours daily to posting on family-oriented websites based in the U.S., where the circumcision rate is higher than in Canada.

The majority of babies in B.C. are no longer routinely circumcised. The provincial health plan stopped paying for the procedure years ago, and Victoria hospitals provide only medically necessary circumcisions. In 2006, that totalled two babies at Victoria General Hospital.

But there are still three MDs performing circumcisions in Victoria. Two of them interviewed by the Times Colonist estimate they perform more than 300 circumcisions between them in a year while a third could not be reached for comment.

"That's hundreds too many," Antinuk, 27, says. Without religious or medical reasons "doctors should not be allowed to do it."

Dr. Catherine Stubbs of Oak Bay says by doing circumcisions, she's providing a service for parents who feel shamed by other parents, prenatal educators and even doctors in doing what they think is best for their sons. [But what service is she doing the sons? And what kind of reason is shame?]

"Doctors lie to patients right now," Stubbs says. [Circumcising doctors and nurses lie to their patients, telling them it didn't hurt and "he slept right through it."] "They tell them it's not available; they tell them it's going to cost them $500; they tell them it will scar their children for a lifetime [which of course it will]. There are many, many circumcised men in this world that are perfectly enjoying their penises, and their wives are." [And there are many, many who are not, and their wives aren't - and how is she to make sure she only circumcises the first kind?]

She performs one to four circumcisions per week. Retired physician Chorkie Chan says he has been circumcising about three infants a week, filling in for another physician on maternity leave. Both charge about $75 for the procedure.

University of Victoria medical ethics expert Eike Kluge agrees with Antinuk that circumcisions should stop, except when medically necessary.

"It's mutilation," says Kluge, a former director of ethics for the Canadian Medical Association. "For physicians to engage in this is, in fact, to act ethically inappropriately."

The College of Physicians and Surgeons of B.C., the regulatory body for doctors, is upfront about calling circumcision of baby boys a "medically unnecessary intervention" without therapeutic value, but would not comment on the allegation that circumcision is mutilation.

Registrar Dr. Morris VanAndel won't be pushing for a ban, saying "a degree of discretion" is appropriate for doctors. Moreover, because the majority of physicians, especially younger ones, want no part of circumcision, the practice will run its course without "thou shalt not" edicts, he expects.

Doctors are required to get informed consent, meaning parents must be made to understand all the drawbacks.

The college's 2005 position paper notes many ethical concerns and the possibility of babies bleeding to death -- the fate of Vernon infant Ryleigh McWillis in 2002.

The idea that doctors accede to parents who want their sons circumcised to "be like daddy" strikes Antinuk as a cruel deprivation of boys' rights to intact bodies.

But Stubbs maintains she will not circumcise a boy only for that reason. [So as long as they give some other reason, it's OK?] Both she and Chan say their most common request is from parents who knew of uncircumcised men who suffered urinary tract infections or tight foreskins. [i.e. the fallacy of the vivid instance - and an unwillingness to consider non-surgical options.]

Kluge says the research does not support the infection notion. "People come down with appendicitis. Are you therefore going to give an appendectomy to everybody?"

While religious arguments could trump security of the person provisions of the Charter of Rights [They could? What about when the babies are girls?], Kluge notes that the Jewish and Islamic religions, which require circumcision, have persons trained to do them, negating the need for physicians to be involved.

Trained mohels do "a better job," claims Victoria Rabbi Meir Kaplan, who disagrees that circumcision is mutilation.

Kaplan defends the infant practice, saying that Jewish males would not be happy undergoing a more painful procedure under general anesthetic in adulthood instead of a 10-second tradition at the age of eight days. [If it only takes 10 seconds, he's doing it too fast! And they're not particularly happy undergoing the 10-second procedure.]

Antinuk hopes a B.C. man will launch a lawsuit over his own infant circumcision -- a tough decision to take.

"You would have to bare your genitalia, symbolically, in public," Kluge says. That man would have to sue his parents for their decision.

The B.C. college has been approached by men circumcised as infants, but the complaints went nowhere because the doctors were retired or dead.

Female genital mutilation has been against the law in Canada since 1997 and Antinuk says the college should extend the same protection to boys.

Meanwhile, Stubbs has had only two circumcised baby boys who have had late bleeds in her 35 years of practice and once in a while, a baby requires a stitch or silver nitrite.

She uses both topical and local anesthetic. Many of the babies she circumcises nurse or even sleep [or rather, went into shock] during the procedure. "The majority of babies can be done totally pain-free."

CIRCUMCISION NUMBERS

AIDS LINK QUESTIONED
Last year, the World Health Organization hailed circumcision as a way to combat HIV in ravaged areas, citing evidence showing a 60 per cent drop in infection rates in circumcised men in South Africa, Uganda and Kenya. Circumcision removes specialized Langerhans cells in the foreskin that readily attach to viruses, including HIV. [This bit of speculation is becoming more and more of a factoid.]

But the U.S. Centers for Disease Control and Prevention recently concluded circumcision did not affect susceptibility among American black and Latino men, whose HIV rate is several times higher than for whites. In the U.S., men having sex with men is the major cause of HIV; in Africa it is male-female intercourse.

PROS AND CONS
According to the Canadian Pediatric Society, of every 1,000 circumcised boys:

- 20 to 30 will experience too much bleeding or infection

- two to three will have more serious complications such as too much skin removed or more serious bleeding

- 10 will need a second circumcision because of "poor result" in the first

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