Circumcision as a public health policy

At this point it has been established that circumcision reduces female-to-male HIV transmission rates by around 60%. Like it or not, the science is in. Now the question has shifted to being about why it reduces transmission, as well as how we can best introduce circumcision has a public health policy. On the first point, the general answer is that the foreskin is a relatively large surface area subject to tearing and softer (non-keratinized) skin. On the second point, though, I wasn’t aware of any actual policies in place to save the lives of men and women in regions particularly vulnerable to the spread of HIV. As it turns out, multiple sub-Saharan countries have undertaken measures to dramatically increase circumcision rates – though much work is still required:

Zambia is still 75 per cent short of its target of two million circumcisions by 2015. So is Uganda, having completed 1.5 million towards its 4.1 million target. Kenya has achieved its target in numbers – but not among the “right” men.

The donors who are pouring cash into male circumcision following the landmark 2006 study which showed that it reduced the risk of HIV infection by 60 per cent, have neglected a crucial factor – the attitude of women.

A man who gets circumcised is often viewed as a man who is looking to sleep around as much as possible. And, indeed, this has become something of a problem, as HIV rates in some areas have remained steady. This may also be due to men not waiting the necessary 6 week healing period – 40% of newly circumcised men had sex while still healing, actually resulting in an increase in their likelihood of contracting HIV. Furthermore, we may be seeing the problem of moral hazards at play. This is where risk is reduced for one thing or another, so people are less cautious in return. Some examples are playground materials and car safety. In playgrounds, children are often getting hurt as much if not more than in previous years because they’re playing on soft wood chips or rubber, leading them to believe they can fall harder and get hurt less. With cars, safety has greatly increased and deaths have fallen, but accidents remain steady or on the rise. People with seat belts are willing to speed more than those without them.

But the real problem in these sub-Saharan nations is a lack of education and peer support:

Carol Musimami, one of 30 “technical advisers” who counsel the men, said: “You will see the older ones come after dark. They don’t want to be with the youth. We are targeting the 25 to 35-year-olds –they are the ones with the money, they buy the women, they are exposing themselves [to infection]. But they are hard to get. They don’t want others to know,” she says.

Leadership is key. In Kenya, the circumcision programme in Nyanza province in the west – one of the three centres in the landmark 2006 trial that proved its effectiveness – was faltering when Raila Odinga, the Prime Minister and a member of the non-circumcising Luo tribe, responded to protests from tribal elders fearing the loss of their identity by declaring: “We don’t lead with our foreskins, we lead with other faculties. This is a medical issue.”

The speech, in 2008, proved a pivotal moment and more than 500,000 Luos have since been circumcised.

This is a major issue in global health. Science can find all sorts of answers to major problems, but that doesn’t mean it’s all just a matter of policy implementation after that. For instance, Jimmy Carter and WHO launched a campaign to eradicate Guinea worm disease in 20 African nations in the 1980’s. The primary approach to this was to make sure people had clean drinking water. With funding, wells were built and larvacide was added. However, one of the biggest pushes was to get people to drink clean water was to give them simple cloth filters. Unfortunately, this came with two problems. One was simply logistical: the filters clogged. The other was that the cloth material was too aesthetically pleasing, so people would often use them as decorative items. When the Carter Center, Precision Fabrics, and DuPont worked together to distribute plain nylon cloth filters (and education), the problem quickly shrank. There were 3.5 million cases of Guinea worm disease in 1986. As of 2005, the number had dropped to 11,000. This underlines the need for cultural understanding in addition to the simple cold science of the matter. Greater peer interaction and promotion of circumcision may be the key in getting places like Zambia to that 2 million goal.

At any rate, I’m very pleased to hear about these ongoing efforts to spread circumcision in developing nations in order to curb the spread of HIV. This is a triumph of common sense, global health initiatives, science, and basic humanity.

Advertisements

52 Responses

  1. My background is in Social Science. Hence by most scientist, I can hardly be labeled a true scientist. I do not doubt that circumcision prevents certain types of disease …including HIV. But, so doesn’t washing your hands after cutting raw chicken ward off E Coli or brushing your teeth prevent serious gum disease.

    The foreskin, as in the case say of healthy tonsils, serves a purpose. Among these are sexual benefits, prevention of diseases in babies, and protection of the shaft in adult males. To my limited knowledge, all male mammals have foreskins.

    Tonsils should be removed if infected as well as foreskins if they impede genital functioning. But with proper care, nature intended us to have a foreskin.

    I say education and not mutilation is the answer.

  2. […] Circumcision as a public health policy […]

  3. http://www.doctorsopposingcircumcision.org/info/HIVStatement.html

    All three studies found that non-circumcised males contract HIV infection more quickly than circumcised males.11-13 This may be because the circumcised males required a period of abstinence after their circumcision. All three studies were terminated early, before the incidence of infection in circumcised males caught up with the incidence of infection in the non-circumcised males. If the studies had continued for their scheduled time, it is probable that there would have been little difference between the circumcised group and the non-circumcised group. Mills & Siegfried point out that early termination of such studies cause the benefits to be exaggerated.16 Dowsett & Couch (2007), even after publication of the RCTs, found insufficient evidence exists to support a program of circumcision to prevent HIV infection.17

    ^^^^^^^^

    Have you actually read the studies you are talking about in this post. The link I posted above is a critique by doctors.

  4. Sources are important here. Aside from the insane bias of that site, following their links doesn’t end up well for them. (I found the same thing here when I looked at another site.) In following their claims on the specific section you posted, I found they linked directly to one of the papers in question. From the paper:

    To analyze the impact of the 6-wk period of abstinence, the analysis was repeated with the duration of the period M1–M3 reduced by 42 d in the intervention group. Forty-two days was the median (IQR = 28–56) interval between MC and first sexual contact reported by sexually experienced participants of the intervention group.

    The rates came out greatly in favor of the circumcised group. The basis for claiming the numbers would even out not only is bold, it’s without merit.

    On citation 17, that paper raises questions mostly about the effectiveness of implementing circumcision. Clearly there are challenges to such a health policy, but that’s not reason to deny the science of the matter.

  5. The science is hardly in. The laundry list of flaws with these “studies” is disgusting.
    1. They were not registered with the WHO until the results were already reported which by the WHO’s own standards makes them invalid.
    2. The men in the study who volunteered for circumcision were provided with condoms and told not to have sex for 1-2 months. The “control” men were not afforded the same.
    3. The studies were then truncated while some of the circumcised men were still in their healing period and as such could not have had sex in order to contract HIV.
    4.The populations involved have little in common with a western world including hygiene, access to protective measures, and even the strain of HIV being transmitted.
    5. Studies done in industrialized countries including the USA have shown no protection from circumcision.
    6. the results of these studies have never been seen in a real work population. The countries with the highest circumcision rates continue to have the highest HIV rates.
    7. Countries in Africa were Millions have been spent circumcising men continue to see HIV rates increase. perhaps because…
    8. Circumcised men are less likely to wear condoms. Reports have even indicated that in the african countries involved prostitutes are not requiring men who are circumcised to use condoms. Men who have lost 20000 nerves and fine touch muscle seem to not like losing more sensation by wrapping it up.

  6. 1. That doesn’t invalidate the studies.
    2. Counseling sessions of 15-20 minutes were provided to all participants at given intervals. They were directed to a facility which provided condoms. The circumcised group was told to wait for healing (~6 weeks), but this was taken into account in the final analysis. This tiresome objection is one of the weakest.
    3. The study was truncated due to the ethics of the matter. The results were excellent, and so to not tell the control group about them would be a disservice; the control group had been told the effects of circumcision on HIV transmission was unknown, so it was necessary to report the new findings.
    4. From the study: “This study has some limitations. It was conducted in one area in sub-Saharan Africa and, therefore, may not be generalizable to other places. Nevertheless, because of the similar route of transmission of HIV in sub-Saharan Africa and because observational studies from various areas of sub-Saharan Africa have shown an association between HIV status and MC, the result of this trial is applicable to all of sub-Saharan Africa with some degree of confidence.”
    5. What studies? I can recall reading one paper that included a diverse selection of individuals from multiple countries, one of them being the US. It showed positive results for circumcision.
    6. I get the feeling it’s the tactic of the anti-circumcision crowd to intentionally conflate correlation with causation. There are multiple factors at work in HIV prevalence. As I’ve pointed out elsewhere, Europe and Japan have similar circumcision rates, but Japan has a much lower rate of HIV. The reason is cultural, just as it largely is across Africa. Stigma, unavailable treatments and testing, and low education levels play the biggest roles.
    7. If you read the article and followed the relevant links you would see that the stats on HIV rates date to time frame entirely or mostly predating the implementation of circumcision policies. And even where there is overlap, the number of circumcised men was very low. This attempt at equating correlation with causation doesn’t work on any level.
    8. There are no studies which show there is any remotely conclusive difference in sexual pleasure between circumcised men and uncircumcised men, so your attempt to imply otherwise is plainly dishonest. Indeed, men circumcised as adults report no significant difference after the procedure. Furthermore, this is what’s known as a moral hazard. People perceive less risk in an activity, so they’re willing to push bounds. This is why seat belt laws have caused an uptick in accidents. However, fewer people are dying and getting seriously injured when buckled up. Just the same, circumcision has a moral hazard with it because, since it works, men and women alike can come to falsely believe that it is bullet proof. It isn’t, and that’s why it’s only one part in the fight. Education and condom use are still vital.

  7. This happens every time. The anti-circumcision crowd doesn’t have the science on its side. They should stick to the ethical side of the issue and that’s absolutely it.

  8. Peer reviewed study showing loss of sensitivity. There are also countess personal accounts out there of this loss. http://www.ncbi.nlm.nih.gov/pubmed/17378847

    Study showing no protection in US men
    http://www.reuters.com/article/2007/12/04/us-aids-circumcision-idUSN0345545120071204

    This one basically sums it us… You can wear a condom, or you can chop part of it off and wear a condom.
    http://www.journaids.org/index.php/essential_information/myths_and_misconceptions_about_hivaids/if_i_am_circumcised_i_cannot_contract_hiv_through_sex/

    There are more studies but I can’t spend any more time on this today. It’s obvious anyway that you choose to ignore any evidence that contradicts your points. I would suggest you look at the Circumcision/HIV statements of EVERY medical organization outside of those funded by the USA (WHO, AAP) and you will find zero support for circumcision to reduce HIV.

    So if condoms are nearly twice as effective and providing education and condoms is cheaper and more ethical then why are we spending millions pushing a fake cure. If the men involved are engaging in riskier behavior because they believe they are immune then those performing the procedures are not obtaining informed consent and will inevitably increase the AIDS prevalence.

  9. No one even mentions that foreskin is normal….it’s NOT a birth defect in need of amputation. This is a scientific fact. Being born without a foreskin is actually a birth defect….also a scientific fact. And when talking about third world countries…….I fail to see how that relates to the U.S.? We have the ability to address our personal hygiene…running water…..soap……everything we need to take care of our hygiene…….and the only proven method of avoiding sexually transmitted diseases is regular and proper use of condoms, NOT circumcision! They always say that condoms need to be used as well as circumcision….but common sense should tell you that if a condom is also necessary, what is the real purpose of circumcision in the first place? Why not just send a billion condoms over to Africa and give them some education? Instead our government along with Bill Gates is flooding Africa with propaganda and many Africans believe that a circumcision is an “invisible condom”……well there is a sure recipe for disaster!!!!

  10. So how is it then, that when you look at real world statistics, this doesnt apply? The US – the most circumcision-happy nation in the developed world – has the HIGHEST rate of HIV. Just explain that one to me.

  11. Not to mention all the circumcised men who died of AIDS back in the eighties……if circumcision prevented HIV transmission all those circumcised men would still be alive .

  12. If you have to wear a condom after you’re circumcised, what’s the point? It is the CONDOM that is protecting them, not the circumcision.
    I wouldn’t be surprised to find out that the foreskins that are removed are being used sold to companies that buy this for cosmetic creams, etc. And even IF circumcision were to be a proven way to prevent STDs, I don’t believe it is ethical to force people to have them done, especially if they’re babies. SOME people actually want to wait until they get married to have sex and be faithful to their spouse because of personal and religious beliefs. Also, what ever happened to HIV testing? The position of this article’s writer is not only unethical, but unfounded. The science is NOT in, as the Africa studies were found to be flawed, in so many ways, well explained by the commenters before me. It’s outrageous that someone wants to force a policy to cut off part of a man’s healthy genital tissue. If he’s having sex with someone that has HIV or Aids, then it’s celibacy or condoms. Circumcision is NOT going to save him. Oh, and transfer of the AIDS virus is always a much bigger concern for the woman, as it is passed much more easily from man to woman than from woman to man. Should we also consider the milder forms of circumcision for women by removing the foreskin from their clitoris, too??

  13. Anna –

    1. I’ve addressed the fine-touch pressure study in another recent post. It works off the hypothesis that the number of nerve endings in the foreskin will translate to a difference in sexual pleasure. It sheds no light.

    2. This is the moral hazard which has already been discoursed. Moreover, circumcision is just one tool in the fight against HIV.

    3. Please stop with this anti-circumcision dishonesty. I really can’t stand this point about HIV rates in the US. HIV is primarily a problem amongst the male homosexual community. The large body of evidence pointing to protection during vaginal intercourse is not contradicted by what I now must refer to as your lies.

    4. At least 14 African nations have public health policies favoring circumcision. I’m fairly sure that counts as outside the US (not that it makes a difference in the science).

    Wild –

    1. Your wisdom teeth are also normal. How many people do you know who have had those removed? Arguing that something’s presence at birth means it ought to remain doesn’t fly.

    2. Condoms are highly effective, and more so than circumcision, but that doesn’t mean they are proven to stop STD transmission 100% of the time. Indeed, the only thing which will do that is abstinence, yet no one outside religious circles promotes that as a viable tool. Why? Because it doesn’t work. People are going to have sex. Just the same, people are going to have sex without condoms. Better we equip them with an added level of protection.

    Serene –

    Again, this is the common illogical attack of the anti-circumcision crowd that hasn’t looked at any of the science. HIV in the US is largely a problem of the homosexual community. Circumcision doesn’t offer the same protection during anal intercourse as it does during vaginal intercourse. But if you’re really bent on boiling down everything in global health issues to a single factor, as if that’s a legitimate approach, then ask yourself why Japan has so much lower rates of HIV than Europe despite having similar circumcision rates. Clearly circumcision isn’t the key factor there, so you’re left to only admit there are other cultural pressures at play.

    Wild again – Offering protection against HIV transmission does not translate to complete immunity. This might win the prize for the worst point made so far.

    Carolyn –

    1. The idyllic world of the anti-circumcision crowd where everyone does the exact best thing for their sexual health just isn’t a reality. People don’t always wear condoms, whether because they cost money or aren’t always available or the person just doesn’t like them. That’s reality. Circumcision will help to protect people when condoms aren’t used.

    2. Yes, foreskins are being sold. And 9/11 was an inside job, Obama was born in Kenya, and the shooter on the grassy knoll is still out there.

    3. Stick with the ethics argument. It’s all you’ve got. (I don’t buy it – I’d rather save lives than worry about an otherwise inconsequential procedure – but it’s the only basis for objection you have.)

    4. Female genital mutilation has not been shown to offer the same protections as male circumcision. Moreover, there are adverse effects to FGM whereas the same is untrue of circumcision.

  14. It always seems worth noting to me that the anti-circumcision crowd is the side with the dozens upon dozens of websites, yet the pro-circumcision crowd largely sticks to the scientific publications. It’s almost as if one side is just a very vocal minority with ulterior motives.

  15. Cutting part of a child’s healthy genial organ off has NOTHING to to with health and everything to do with CONTROL, IGNORANCE and SEXUAL REPRESSION.

    Every human male and female is born with a foreskin.

    Say NO to this atrocity euphemistically called “circumcision”. Do the research. Get informed. This is an issue of HUMAN RIGHTS. Protect children’s rights to their WHOLE BODIES.

  16. This is entirely about health, and there are no adverse sexual effects from circumcision. Please stick with the ethical side of the matter. It’s a problem when you people stray.

  17. To Michael: Tell that to the mother in Memphis whose perfectly healthy 3-month-old boy had his entire prick cut off when she brought him in for his circumcision. Or David Reimer….only you can’t tell HIM anything, he’s dead. You are a sick & twisted man who wants others to suffer as you have. I hate being circumcised & will until the day I die. Everything you say is the opposite of the truth, ALL the science is on the side of the antis, not the pro-circers. Africans aren’t as dumb as you seem to think they are, many of them are outraged over this racist, sexist, pseudo-scientific crusade.

  18. I was actually just thinking about the racism involved in this, Jon. People who say “Oh, just throw condoms and education at those Africans and they’ll be fine” seem to think that human behavior somehow doesn’t apply to people from that continent. Why, North American and European teenagers are often well educated and yet still don’t always use condoms, but those Africans just aren’t the same. Yes, those Africans just need to be told what to do and they’ll do it.

    Talk about racism.

  19. Among other things, Circumcision is the ultimate in Body-Shaming.
    Every man is born with one. Every man should therefore have one. Forced Infant Body Modification Surgery because of BODY SHAMING?

    To say the foreskin is gross is saying that men, in their natural state, are gross. For those that do: Way to bash an entire gender!

    This is an amputative surgery on the genitals.
    Why are men not allowed to keep their whole body, while women are (in my country, Title 18 USC, section 116) Protected until they are old enough to consent and it is called a “human rights violation”?
    Defending the point that FGM should be illegal, while male circumcision is OK means this: Forced Cutting on genitals is differently moral if they are different genders.

    That isn’t just body shaming, that is a claim that women are of inherently more moral value than men. Some would call that sexism.

    You may say it’s “For the Public Good”. Forcing body modification on people due to claimed benefit for others is a declaration that men’s bodies are not their own but are in fact, public domain, while women possess individual rights to their bodies.

    I deserve to have my whole body. I deserve to have my whole genitals. I deserve an equal level of Human Rights.

  20. Not really……that is in response to the constant news of how rampant HIV is in Africa and the farce of the U.S. and The Bill Gates Foundation that flood Africa with their funding of the circumcision cure for African men. The bottom line is this…..IF there truly is this problem in Africa, doesn’t it make more sense to tell them the truth by using accurate education and information……and IF you are going to attempt to assist them with this perceived problem of HIV….why not provide condoms too rather than cutting off a normal part of the men’s genitals with the crazy notion that circumcision is the answer to this problem.

  21. Oh really?????? No….cutting the normal genitals of males has many adverse side effects….But cutting babies is the ultimate violation of human rights! Did you just say this….”It’s a problem when you people stray.”??? YOU PEOPLE??? Really???

  22. You are exactly right!!!!!!!

  23. Just name us one country in Africa or anywhere else that reduced its HIV infection rate by 60% by circumcising its citizens. Just one, Mike. And do check this out: HIV enters through the urethra so only a condom can prevent this entry. Foreskin amputation does nothing but remove a healthy, highly enervated, functioning part of the penis. And is a human rights violation when perpetrated on a minor. http://www.news-medical.net/news/20130301/Macrophages-allow-entry-of-HIV-in-the-urethra.aspx

  24. You’re wrong…… And where is your scientific fact missing that foreskin is normal……. And are you actually trying to claim that condoms don’t work but foreskin amputation does????? How idiotic!

  25. John Owen – Your entire post is one big strawman.

    Wild – There isn’t a comment nesting function enabled, so you can’t reply directly to a comment.

    Jhon – The evidence shows that the protection offered is upwards of 60%. That’s the number, like it or not. Estimates for the effectiveness of circumcision on overall rates is different, coming in at 50% depending upon how many men get circumcised. Right now efforts are still underway, so we’ll have to wait on the results.

    On your urethra claim, this is exactly why the anti-circumcision crowd needs to stay away from the science of the matter. The study you cited not only overtly said that the urethra is a novel entry point, it premised its search for such an entry point on the fact that circumcision offers about a 60% protection rate:

    Clinical studies conducted in the 2000s showed that circumcision could reduce the risk of infection in men by 60% during sexual intercourse. Following this work, the Institut Cochin team demonstrated that the mucous membrane on the inner layer of the foreskin was one of the main entry sites for HIV. However, since circumcision does not provide complete protection, it remained to be determined what other mucous sites in the penis could facilitate HIV infection.

    In other words, circumcision offers about 60% protection, but since it isn’t 100%, there must be other points of entry in addition to the foreskin.

  26. The key statement in the original article was: “HIV rates in some areas have remained steady.” In other words, even after millions of circumcisions and hundreds of millions of dollars spent, HIV rates have NOT CHANGED!!!. Why? All of the pro-circumcision writers depend the average person not understanding the difference between RELATIVE RISK and ABSOLUTE RISK. What they are reporting in all of their (misleading) reports is the reduction in relative risk (60%) instead of the proper epidemiological standard of the reduction in absolute risk (1.37 %). All across Africa, everywhere where circumcision has been implemented, there has been observed a reduction in HIV infection rates of about 1.4%, as expected from the original experiments.

  27. http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2177677

    ^^female circumcision has been shown to prevent HIV

    As to HIV in American populations. the us navy did a study showing that circumcision has no effect on HIV transmission in us populations.

    Additionally the high and tight style of cut performed on these ADULT Africans cannot be carried out on an infant.

  28. Paul – The practice of circumcision as a policy is still very new. The results are not yet in. Furthermore, researchers estimate upwards of a 50% reduction in HIV in coming years because of increased circumcision.

    Amber – There are three issues needing to be addressed here. First is how science works. Second is what that study says. Third is what FGM means in a wider context.

    1. Science does not easily turn on one study or another. It builds (and, in particular, theory builds) on the cumulative effect of research. This is why I can find you a study contesting anthropomorphic global warming and it means absolutely nothing. You need to look at the body of evidence.

    2. The study simply found a correlation between lower rates of HIV and FGM. This is on par with the earliest studies from the 80’s regarding HIV and male circumcision. As you may have noticed, it has been until recent years that circumcision has been pushed as a public health policy. For the reason why, please see point #1.

    3. FGM mutilation is highly associated with decreased sexual pleasure, lubrication, and drive. While mutilating women are still able to orgasm (because, let’s be honest, the very next study you’re going to post is the one with that finding), their sexual lives are significantly altered. The same is not true of circumcised males.

  29. Are you serious? How many circumcised men died in the eighties of AIDS?????? Plenty. How does this not tell you that condoms are the only way to prevent STIs and HIV? There is no logic to cutting genitals to prevent disease. Personal hygiene and condoms…… Not cutting are the answers. And you clearly haven’t done your history checking on circumcision have you? Are you familiar with Dr. John Harvey Kellogg????? It doesn’t seem like it !

  30. That’s still the worst point anyone has made so far, wild. Circumcision is just one tool in this fight.

  31. One tool ? Don’t be ridiculous.

  32. Michael Hawkins
    Now get serious Mike: “the Institut Cochin team demonstrated that the mucous membrane on the inner layer of the foreskin was one of the main entry sites for HIV.” Where is this study? Please produce it! They demonstrated no such thing. But my patience is long especially in view of your fervor.

  33. I just read an article today about The Gates foundation……with Bill Gates himself STATING that money has been spent on HIV treatments and they have been successful in treating HIV. He also finally admits that condoms are preventive…….but then pushes the mass circumcision insanity! Smart money? Why not put it into education, health care, sanitation, nutrition, and successful HIV treatments along with availability of condoms? Mass circumcision efforts are ridiculous. It’s time to stop the propaganda that promotes the “invisible condom”!

  34. Jhon – That quote comes from the study you cited.

    Wild – Sigh. Yes, anti-retroviral treatments do treat HIV, preventing the onset of AIDS. Again, this is one part of the fight. Condoms are another part. Education is yet another part. This is a multifaceted fight that has to be tackled from many angles. The most crucial of those angles, though, is in stopping the spread of the disease. That’s where condoms and circumcision play a role. Bill Gates favors the use of both of these things (and more) as a pivotal health care policy. I agree with him.

  35. For anyone wondering, the article by Bill Gates can be found here.

  36. The study Mike. Show us the study. Sure the article mentioned the study. But they didn’t produce it. And you can’t either, you four flusher. Time to stop your bullshit, Mike-oh.

  37. So, Jhon, you’re dismissing the validity of the study YOU cited because it’s inconvenient (and you probably didn’t read it)? Come on. This is so transparent.
    As for the study, if you follow it, you’ll see it’s in French.

  38. Some men have such a fetish for genital cutting!!!!!!

  39. The link to the study mikey, you low level dodger. In French, no problem. Any language you want. What are you waiting for?

  40. Dude. Do you even know what we’re talking about here? The link in question is the one you provided. Here:

    http://www.news-medical.net/news/20130301/Macrophages-allow-entry-of-HIV-in-the-urethra.aspx

    The quote I provided came directly from that link. Again, the link you provided. You followed up my quote that you first provided by asking me for an original source. I’m not sure why you’re unable to re-click your link and find the original paper, but I guess you can’t. Let me give you some instructions for the future: Go to your link (provided in this comment above), actually read the link, scroll to the bottom (but above the comment section), and click the citation.

    Now, I’m going to provide you the citation, but I urge you to still follow my above instructions. This has all been very embarrassing for you, so learning how the Internet works might benefit you next time you take an incorrect position on something.

    http://www.anrs.fr/VIH-SIDA/Recherche-fondamentale/Actualites/Actualites-de-Conference-sur-les-retrovirus-et-les-infections-opportunistes-CROI-2011

    (In case I haven’t been clear, that is the link. You can find it by first clicking on the news-medical.net link I have reproduced above (taken from your post), scrolling to the bottom of that link, then clicking the citation. Here is it again: http://www.anrs.fr/VIH-SIDA/Recherche-fondamentale/Actualites/Actualites-de-Conference-sur-les-retrovirus-et-les-infections-opportunistes-CROI-2011)

  41. You need to take a few French lessons you stupid ass. These links do nothing more than announce press conferences at which HIV material was to be discussed. This is just more of your bullshit.
    The article makes the statement “Following this work, the Institut Cochin team demonstrated that the mucous membrane on the inner layer of the foreskin was one of the main entry sites for HIV.” Where is this demonstration? Produce it Milky. That’s what’s missing. Let’s have your link that will produce the missing study that demonstrates what they allege. Why do you need so much direction? You fucking dunce. This is your moment to make good. This demonstration will convert the infamous 3 African Studies from a huge correlation/causation fallacy into scientific certainty. Auvert, Wawer and Gray need you more than you know. Stop all the jerking off.

  42. So you retract your link?

    How embarrassing.

  43. I am not embarrassed at all that you can’t read French, but someone has to express the pain we all feel with your inability to understand plain English. Your use of scientific rhetoric in an attempt to cover up your lack of knowledge in order to try to win arguments is so puerile that it makes our teeth hurt.
    “He likes to spend his free time hiking and defending science, though not usually at the same time.” Time for your agent to give Leno a call, Milky. You’re a scream.

  44. Well, I for one stand by your link.

  45. Standing by: rock solid in granite ignorance last gasping your utter defeat as best your embryonic intelligence can grasp that concept.
    Accordingly your stunted concession sentence is relievedly noted by everyone. It’s a blessing when bad things come to an end.

  46. Nah. You posted a link to a study premised in pro-circumcision fact. Still seems a bit embarrassing for you, even with compensating linguistic flair on your silly, silly part.

    Also, your name is spelled wrong. So there’s that.

  47. Yeh. Now you show us your ignorance in yet another language. You need to consult any good book on Spanish orthography. Your stupidity will then astound you.
    Unless and until you or anyone else can demonstrate/describe how at the molecular level HIV enters the foreskin and passes on to the rest of the body, the three African studies must remain in the correlation status they correctly deserve. They show an absolute advantage of 1.3% in favor of the circumcised men. This advantage is statistically insignificant. When you or anyone else can show causality then the circumcision program to reduce HIV by 60-80% (Jesus!) will be shown to be something other than the very dangerous neocolonial medical fraud that it is.
    All those black circumcised men with their penile sensitivity drastically reduced…not to worry…here comes Big Pharma to the rescue. And so begins phase two of the fraud: http://www.marketwatch.com/story/innovus-pharma-announces-start-of-its-circumserumtm-commercial-phase-in-morocco-with-initial-order-of-10000-units-by-its-partner-ovation-pharma-2013-12-27
    Yeah we cut your dicks, but now we got some special snake oil that will make all the pain and heartache go away.
    Phase 3: Stick with us boys and in a few years when your ED kicks in we’ll have some watered down Viagra for under a dollar a pill to sell ya.
    What amazes all of us is that a low level provincial asshole like yourself is trying to help promote all this circumcision bullshit. Like some kind of a boy next door Brian Morris circumcision zealot. You Jewish? The silly icons you assign to those who disarm your ignorant and shallow arguments show just how desperate and defensive you really are. What you need now is to take a nice, long vacation… in Club Dead.

  48. You seem very angry, John. There’s no need really. Posting a link you later disavowed isn’t that big of a deal. A little embarrassing, sure, but not a huge deal. Don’t sweat it, man.

  49. All the negativity, all those comments calling you out. Try to get a grip old chap. The help you so desperately need can be immediately found here: 1-888-568-1112 . Don’t put it off any longer. We’re all pulling for you. You’re just a human being. Reach out.

  50. You know….. No one gives a shit about your opinion….. Honestly you are entitled to it. However if you are trying to use “science” to back up your pro circumcision stance when there are NO medical reasons to cut a normal baby with normal genitals…… Then you’re freaking crazy! That is all.

  51. I like the reflection, John.

    Sure there are, wild. For instance, I dislike the idea of people in developing nations needlessly dying of HIV. Since circumcision conveys a 60% protection rate (as the science says and as you and your on-the-level-of-birthers-and-9/11-truthers pals have failed to counter), it is one excellent tool in this fight. You, on the other hand, are a nuisance of a tool.

    Now stop spamming my site and go away.

Comments are closed.

%d bloggers like this: