Circumcision of HIV+ males increases risk to women

For quite a long time now there have been reports of studies that purport to show that male circumcision reduces transmission of HIV and Aids, leading some people to advocate universal male circumcision as a means of combating the pandemic.

There is a study that implies that this approach could be counterproductive. Circumcision of HIV men INCREASES risk to women. | ICGI - Genital Integrity:

A new study published in Lancet shows that women are 50% more likely to contract HIV if they are having sex with circumcised men. Most of the infections were from the time period when the couples began having sex before the wound healed, but the effect continued past that period, indicating that there is no benefit to women from male circumcision. Proponents of mass circumcision plans have long argued that women are protected when men are circumcised, but this study indicates the opposite. The study, like its predecessors, was stopped early.

Medical statisticians may believe that universal male circumcision will statistically reduce the rate of transmission of HIV, but one is dealing with people, not statitstics. The web site in the link is an advocacy site, and not disinterested in this matter, but The Lancet is a reputable medical journal.

The study referred to above shows what simple logic should have shown anyway -- that while circumcision may reduce a male's chance of being infected with HIV, one that male is infected, it does nothing to reduce the chance of his passing on the virus to women.

And the propaganda for universal male circumcision may be counterproductive, in that, human nature being what it is, it could lead circumcised males to believe that they are immune to infection (yes, weirder things have happened -- people are not statistics) and thus become more promiscuous.

HIV/AIDS Prevention and Sexed Bodies: Rethinking Abstinence in Light of the African AIDS Pandemic:| Theology and Sexuality

HIV/AIDS Prevention and Sexed Bodies: Rethinking Abstinence in Light of the African AIDS Pandemic: Theology and Sexuality:

As churches, non-profits, and governments look for solutions to end the African AIDS pandemic, abstinence has provided a seemingly quick and easy answer that is thought to carry moral weight. Yet abstinence, as it is preached and practiced, is often an immoral option because it does not first consider the full agency of women. In asking why abstinence has been so readily embraced as a response to the African pandemic, assumptions of black sexuality must be brought into question. The tendency to focus on sexual morality rather than on the economic, gender, and social inequalities that cause the spread of AIDS must also be questioned. Through employing a postcolonial critique of abstinence, I argue that when abstinence as morality and abstinence as prevention collapse into one another, there is no space for women to find agency in abstinence. Instead, abstinence must be defined as “space” rather than “prohibition” in order for it to contribute to human flourishing.

Hat-tip to Priestly Goth Blog: paper presentation on AIDS preventiong in Africa for the link.

Unfortunately, just as

so much communication about AIDS in Africa even that which attempts to offer treatment as well as programs of prevention follow colonial patterns of cultural imperialism and that even the language of AIDS is language imposed from others and not taken up from with in African cultural and linguistic matrices

so the pricing of the article follows colonial patterns of cultural imperialism and places it beyond the reach of any but the rich -- the cost of a single article being higher than that of a very substantial hard-cover book, so that most people in Africa who probably ought to read it will be unable to afford it.

But Larry Kamphausen provides more information about the paper than can be read in the abstract, and also describes some of the discussion that follows the reading of it, so if you are interested in the topic of HIV/Aids prevention in Africa, his blog post at Priestly Goth Blog: paper presentation on AIDS preventiong in Africa is worth a read.

Traditional healers, Western medicine and HIV/Aids

About 8 months ago I attended a conference on HIV/Aids (see Notes from underground: HIV, Aids etc). It was organised by the South African HIV Clinicians Society for religious leaders, and there were people from various religious backgrounds there -- Christian, Hindu, Muslim, Jewish, neopagan, paleopagan (the last also represented by a bloke who was trained in both traditional and Western medicine).

One of the problems mentioned by the speakers at the conference was that people with HIV/Aids sometimes consult religious healers who tell them that they have been cured. They do feel better, so they stop taking antiretroviral drugs, and then they begin to feel worse again. The speakers emphasised the point that doing this diminishes the effectiveness of antiretroviral drugs, not only for that patient, but for others as well, as the HI virus builds up resistance to the drugs.

But now other things amanzi: madness has posted on another aspect of the relationship between HIV and religious healers that was not mentioned at the conference -- the belief, propagated by some sangomas (witchdoctors) that sexual intercourse with a virgin will cure Aids, and notes that there seems to be a conspiracy of silence about this belief.

HIV, Aids etc

Yesterday I went to a day-long seminar on HIV and Aids.

It was organised by the HIV Clinicians Society, and it was intended for HIV clinicans and religious leaders, and there were a couple of hundred people there. I won't try to summarise the proceedings, but a few points might be worth mentioning.

The first speaker was Clem Sunter, who is a motivational goal-setting bloke, and had just returned from helping the Chinese to beef up their economy. So he was dealing with the question of why it was necessary to have such a seminar. One of the questions he asks in these exercises is "What has changed in the last 5-10 years, and what hasn't changed?" And in this case he noted the following:

• People are dying. The death rate, especially among people aged 25-35, has risen dramatically.
  
• More people are infected
  
• There are more players in the game, including the government
  
• There have been advances in drugs, including triple-drug therapy
  
• There is little change in prevention
  

Professor Des Martin spoke on transmission and testing, from the clinical point of view -- what is known about how HIV is transmitted, the progression of the disease, and advances in testing. Professor Rachel Jewkes spoke on transmission from an epidemiological point of view. Zackie Achmat, the flamboyant Aids activist, gave another motivational presentation from a somewhat different point of view. And so it went.

Speaking for myself, I found it useful to catch up. Some things had not changed -- there seems to be little known about transmission that was not known 5-10 years ago. What has changed quite dramatically is methods of treatment. Dr Leon Levin, a paediatrician, spoke on treatment of children with HIV/Aids. Most of the children with HIV infection would die in 4-8 years if untreated. Many people asked if there was therefore any point in treating such children, if they were going to die anyway. He said that in his clinical practice he had seen dramatic improvement in the health and quality of life of children after treatment.

All the medical speakers emphasised this point. There is no cure for Aids, just as there is no cure for diabetes, or high blood pressure or heart disease. Those who have the disease will have to continue treatment for life. If they stop their medication, the disease will return, and they will die. But the record of treatment for HIV/Aids is much better than that for other chronic diseases. It is more effective than the drugs used for treating heart disease, blood pressure etc.

I found the most useful part of the seminar the factual and scientific information given. When it got on to the role of religious groups, it tended to get fuzzy. Trying to say things that are acceptable or applicable or all religious groups tends to make those things vague and ineffectual. It might be better to disseminate the facts, and then let each religious group to work out for itself how it will interpret and apply the facts.

But there are some questions that one can ask about Aids and its social impact.

One was highlighted the very next day, when there was a news report about a doctor who was facing disciplinary action from a medical body for listing Aids as a cause of death on a death certificate, on the grounds that this was an invasion of the privacy of the patients, and threatened the confidentiality of the doctor-patient relationship.

That seems a strange kind of reasoning, as surely the same would apply to any other cause of death. If it is such a threat to privacy and patient confidentiality, then surely no causes of death should be recorded on any death certificates at all.

There are several good reasons for recording the cause of death on death certificates: to see if death was caused by foul play, to see what is statistically responsible for most deaths, which can guide efforts aimed at prevention or cure -- should we concentrate our efforts on reducing deaths from road accidents, or snake bites, for example. Which kills more people -- shark bites or mosquito bites?

The other thing is that at this Aids seminar, and in many other similar seminars, people have urged that the stigma must be removed from Aids. But surely keeping it off death certificates is one thing that perpetuates the stigma. When medical people speak with two voices, one urging the removal of the stigma, and the other urging its retention, to the extent of prosecuting those who list it as a cause of death, there will never be concerted action against this epidemic.