Uganda adopts circumcision, finds science works

This is no real surprise:

The growing uptake of medical male circumcision by men in the Rakai district of Uganda is leading to a substantial reduction in HIV incidence among men in one of the districts of the country worst affected by HIV, Xiangrong Kong of Johns Hopkins Bloomberg School of Public Health told the Conference on Retroviruses and Opportunistic Infections (CROI 2015) in Seattle, USA, on Thursday…

The study found that circumcision coverage in non-Muslim men increased from 9% during the Rakai circumcision study to 26% by 2011, four years after the trial concluded. Every 10% increase in circumcision coverage was associated with a 12% reduction in HIV incidence (0.88, 95% confidence interval 0.80-0.96).

HIV incidence reduction in women lags behind but is expected to catch up in coming years.

We’ve known for the better part of the past decade that circumcision literally saves lives by acting as a high efficacy vaccine that reduces female-to-male HIV transmission by 60% (which is better than the flu vaccine most years). That we’re seeing the positive results of implementing it as a policy isn’t surprising. Science just works.

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14 Responses

  1. The site you linked to is an untrusted connection, so I’m not able to view it. But the part you included may be enough to debunk it.

    “Every 10% increase in circumcision coverage was associated with a 12% reduction in HIV incidence”

    If they are talking about percentages, then an increase from 9% to 26% is an increase of about 190%. That would make the decrease about 230%, which is of course not possible. So that’s not what they meant.

    If they are talking about percentage points (and they should have said so) then an increase from 9% to 26% is an increase of 17%. That would make the decrease about 20% (e.g. from 50% to 30%). This would be a spectacular result. To obtain a reduction of 100% then, all you need to do is cut the genitals of 83% more men over the original 9%, giving 92%.

    We don’t need to cut the men for this, because they’ve already had it done to them in some places. The following African countries have at least 92% men’s genitals cut, and therefore should not have significant HIV prevalence: Gabon (5.0%), Cameroon (4.6%), Côte d’Ivoire (3.0%), Togo (3.4%).

    In contrast, look who is doing even better:
    Burundi (only 2% of men’s genitals cut) (1.3% HIV prevalence)
    Rwanda (10% cut) (2.9% HIV prevalence)

    By the way, how do they explain Finland? It is simply by the magic of not being in Africa that they can have a near-zero male cutting rate, and a tiny HIV prevalance at the same time? Maybe they don’t have sex. That must be it. African men have a right to know.

    (All stats from Wikipedia)

  2. To be clear, my point above was not that 92% cutting would eliminate HIV prevalence in places that already had HIV, but that in places which already culturally had cutting, from before HIV spread, there never would have been an HIV epidemic in those places. I’m aware that incidence is not prevalence, but I needed to find a way to work with the numbers available to me.

  3. Nothing but bad information based on junk science.

  4. Here is the entire article for anyone who can’t click the link:

    The growing uptake of medical male circumcision by men in the Rakai district of Uganda is leading to a substantial reduction in HIV incidence among men in one of the districts of the country worst affected by HIV, Xiangrong Kong of Johns Hopkins Bloomberg School of Public Health told the Conference on Retroviruses and Opportunistic Infections (CROI 2015) in Seattle, USA, on Thursday.

    Three large clinical trials in sub-Saharan Africa, including one conducted in the Rakai district, have shown that medical male circumcision reduces the risk of acquiring HIV by between 50% and 60%. These findings have led to the scale up of services offering medical circumcision to men, especially to adolescents and young men.

    However, until now, the only evidence of an impact of medical male circumcision on HIV incidence in the communities where it is offered has come from a cross-sectional study in the Orange Farm community in South Africa, where another of the clinical trials showing efficacy took place. That study showed that the roll out of circumcision had reduced HIV incidence by between 57% and 61%.

    The study conducted in Rakai set out to assess the impact of scaling up circumcision in Rakai district since 2007, through analysis of annual cross-sectional surveys of adults aged 15-49 carried out by the Rakai Community Cohort Study. The analysis excluded Muslim men who would have been circumcised in any case, and sought to assess the impact of circumcision as an HIV prevention intervention. The analysis also assessed and controlled for the level of antiretroviral coverage over time in women, since increased antiretroviral coverage would be expected to reduce HIV transmission to men, regardless of the level of circumcision.

    The study found that circumcision coverage in non-Muslim men increased from 9% during the Rakai circumcision study to 26% by 2011, four years after the trial concluded. Every 10% increase in circumcision coverage was associated with a 12% reduction in HIV incidence (0.88, 95% confidence interval 0.80-0.96).

    However, there was no evidence of a reduction of incidence in women as a consequence of the reduction in HIV prevalence in men due to circumcision. Dr Xiangrong Kong said that previous modelling studies suggested it may take up to a decade for medical male circumcision to have an impact on HIV incidence in women.

    Preliminary data for 2013-14 show that the proportion of non-Muslim men who have undergone medical circumcision in the Rakai Community Cohort has increased to 49%.

    Here is a link to the paper’s abstract:

    http://www.croiconference.org/sessions/impact-male-circumcision-scale-community-level-hiv-incidence-rakai-uganda

    This is pretty straight forward. Three studies independently found the same numbers when looking at circumcision. Circumcision was then instituted as a policy in a number of places. One of those places has already shown a significant decrease in HIV rates. The only really surprising thing about this is how quickly the HIV incident rate has fallen.

  5. Then why is the U.S. have one of the highest rates of circumcision and one of the highest rates of HIV? Doesn’t work.

  6. The US rate of HIV is comparable to that of Europe. Moreover, the difference between the US and much of Europe is the same as the difference between Europe and Japan. Yet much of Europe and Japan have similar circumcision rates. Clearly circumcision is not the predominant factor in HIV prevalence. It would be silly, however, to therefore conclude that circumcision doesn’t protect against HIV. It does. We know it does.

    This is a classic fallacy of the anti-circumcision crowd. You’ve taken correlation and called it causation. You’re wrong to do this. HIV in the United States is concentrated amongst the gay male community and needle using drug communities. Circumcision has only been shown to reduce female-to-male HIV transmission. This is likely due to 1) the foreskin having particular cells to which HIV is attracted, 2) microtears that occur in the foreskin, opening up entry for viruses, and 3) the foreskin being an ideal residence for bacteria and viruses.

    If you’re going to be one of those loony “intactivists”, you ought to do some basic research about this issue. Otherwise you aren’t going to stand out in the anti-circumcision crowd at all.

  7. If all that you say is true then why are all males born with a foreskin? You are the one that is misinformed. Yet you call me Loony. Sad that you are ok with a non fully function penis.

  8. The best going hypothesis why we have foreskins is that they serve an in utero purpose across all mammals. This is supported by the fact that all mammals have foreskins except for monotremes. Monotremes are a class of mammal that lays eggs rather than give live birth. They have no need for foreskins, and so they have naturally lost them over time. Human and other mammals, however, have to deal with fetuses (and in the case of marsupials, a relatively poorly developed fetus that is exposed to environmental factors very early). The foreskin may protect the penis during in utero development.

    Of course, your argument wouldn’t be a good one even if monotremes didn’t exist. Being born with something doesn’t mean it’s useful or good or bad or anything in particular. Most humans are born with wisdom teeth. Virtually all are born with tonsils, appendices, and noncoding DNA. Some of these things don’t make a difference in most people. Some make a huge difference. Some make a difference in a minority of people. The fact that there is so much variation in whether or not these things are good, neutral, or bad should tell you that declaring something as natural does not mean it is [insert adjective].

  9. You obviously do not know or care to know the functions and purpose of the foreskin. It is not a vestigial organ.

  10. I didn’t say it was vestigial, nor did I say it serves no function or purpose. What I said was, the best going evidence is that it serves an in utero function and probably nothing more.

  11. In the U.S. there is a lot of anal sex without condoms going on in the prison system. In Europe, vaginal sex is more likely on average to involve a circumcised male, as Muslim men have sex with non-Muslim wonen, but hardly the other wat around.

  12. Either way the point is circumcision does not protect you against aids. Condoms do.

  13. Circumcision and condoms both protect against HIV transmission. We have very solid evidence for this. Furthermore, this is not a zero sum game. We ought to be using every means at our disposal in order to combat this disease and save lives – particularly when there is literally no physical or ethical downside.

  14. Did you ever bother to jack off wearing a condom? Then you know your loss of pleasure caused by condoms.

    “B..b…b.. but wearing condoms isn’t slicing off a body part!”

    True, but then don’t use the pleasure card.

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