2005/08/13 (last updated 2013/08/05) Remarkable Bias in Medical Journalism The cultural biases in scientific journalism are seldom more starkly apparent than in the recent coverage of the HIV conference in Rio. One could hardly open any newspaper in the country without seeing the headlines: "Male Circumcision Prevents HIV". Yet not a peep about the conference's other paper dealing with genital mutilation and HIV, which found a similar protective effect with FGM, as shown below. These two abstracts are presented on the conference website together and in the order shown, yet the first abstract seems to be invisible to the american medical press. Of course such findings are likely to be be corrupted by cultural cofactors for FGM, such as lower levels of sexual promiscuity in FGM'ing cultures, just as previous "definitive" MGM studies have been. But in general, since both male and female genitals originate from the same fetal tissue, any immunological cell phenotype found in male genitals (langerhans cells, in this case), will in all likelihood also be present in the female. In any case, contrasting the language and reaction of the researchers in the two GM studies quickly dispels any misconceptions about the objectivity of the medical researchers in this area. They are seeking "scientific" justifications for cultural norms. NOTE: In the second abstract below, the pool of volunteers consisted of men "wishing to be circumcised". There goes the random selection. Obviously there could be many reasons a man might want to be circumcised, one of which is that he's having some kind of sexual problems. According to the paper at http://www.cirp.org/library/anatomy/parkash/ "... most patients (were) unaware that the prepuce was retractable ..." This is an amazing demonstration of male sexual ignorance, medical neglect and cultural taboos. Be that as it may, it implies that atrophied and tight foreskins are a common problem (apparently initially caused by diaper irritation and certain soap chemicals) though readily treated using stretching techniques (http://www.cirp.org/library/treatment/phimosis/). Tight foreskins are correlated with micro-tears during intercourse, which would certainly increase HIV reception and skew the statistics. It would also account for the reports by some men who got circ'd as adults that there was no loss of feeling: their foreskins weren't retracting during sex! The e-letters in response to the MGM study provide a glimpse into the shortcomings and potential biases of the study, such as a lack of control for iatrogenic HIV infection despite evidence that it may have been the dominant mode of infection in the population! See: http://medicine.plosjournals.org/perlserv/?request=read-response&doi=10.1371/journal.pmed.0020298 Aside from the moral and ethical issues involved in involuntary genital mutilation (the overwhelmingly dominant form in practice), the fact is that neither of these studies demonstrates a net protective effect in a given population for either type of GM, because each deals only with the question of HIV transmission TO the genitally mutilated person, not FROM that person to their partner. There is good reason to believe ( http://www.math.missouri.edu/~rich/MGM/blog/epithelium.txt ) and empirical evidence for ( http://www.cirp.org/library/disease/HIV/chao/, http://www.circumstitions.com/HIV.html#hetero ) an INCREASED risk of HIV transmission from GM'd men to their partners due to increased abrasion during intercourse and possibly other factors such as MGM-related chlamydia infections, reduced use of condoms by GM'd men, and GM-related promiscuity. The net affect of MGM in a population may be evident in the large difference in HIV infection rates in the USA and europe, where MGM rates are much lower. Such data argue strongly against the use of MGM in HIV prevention. Wawer et al found a 50% increase in M->F HIV transmission from MGM. http://members.tranquility.net/~rwinkel/MGM/MGMandMtoFHIVTransmission.pdf One can understand western medicine's growing desperation to find a justification for involuntary MGM, but are they willing to risk helping to spread HIV in the process? Their reflexive denial of an iatrogenic component to the spread of HIV in africa ( http://www.rsm.ac.uk/new/pr126.htm ) brings their scentific objectivity into question. And putting this entire conundrum in the context of the evidence for an iatrogenic origin of the HIV virus itself raises the question of whether the human species can afford such self-absorbed "medicine" indefinitely. (see the movie documentary "The Origins of AIDS", which provides strong evidence that the main thesis of the book "The River" is correct. That thesis is that HIV was an accidental recombination of the SIV and human polio viruses which occurred in the kidneys of SIV-infected chimpanzees used to generate human polio vaccines. The movie interviewed witnesses who attested to the use of chimpanzees in the project, a central point of controversy surrounding the book. See: http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/AIDS/River/Economist.html http://www.hiv-knowledge.org/iasmaps/i10.htm 10.7 492 10.7 Sexual transmission Female Circumcision and HIV Infection in Tanzania: for Better or for Worse? 26.7 | 10:35 | Manaus | 3138 Stallings R.Y.1, Karugendo E.2 1ORC Macro, Calverton Maryland, United States of America, 2National Bureau of Statistics, Dar es Salaam, United Republic of Tanzania Prevention | TuOa0401 | Rebecca Stallings Introduction: It has been postulated that female circumcision might increase the risk of HIV infection either directly, through the use of unsterile equipment, or indirectly, through an increase in genital lacerations or the substitution of anal intercourse. The authors sought to explain an unanticipated significant crude association of lower HIV risk among circumcised women [RR=0.51; 95% CI 0.38,0.70] in a recent survey by examining other factors which might confound this crude association. Methods: Capillary blood was collected onto filter paper cards from a nationally representative sample of women age 15 to 49 during the 2004 Tanzania Health Information Survey. Eighty-four percent of eligible women gave consent for their blood to be anonymously tested for HIV antibody. Interview data was linked via barcodes to final test results for 5753 women. The chi-square test of association was used to examine the bivariate relationships between potential HIV risk factors with both circumcision and HIV status. Restricting further analyses to the 5297 women who had ever had sexual intercourse, ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ (*) logistic regression models were then used to adjust circumcision status for other factors found to be significant. Results: By self-report, 17.7 percent of women were circumcised. Circumcision status varied significantly by region, household wealth, age, education, years resident, religion, years sexually active, union status, polygamy, number of recent and lifetime sex partners, recent injection or abnormal discharge, use of alcohol and ability to say no to sex. In the final logistic model, circumcision remained highly significant [OR=0.60; 95% CI 0.41,0.88] while adjusted for region, household wealth, age, lifetime partners, union status, and recent ulcer. Conclusions: A lowered risk of HIV infection among circumcised women was not attributable to confounding with another risk factor in these data. Anthropological insights on female circumcision as practiced in Tanzania may shed light on this conundrum. (*) HIV+ women who had never had intercourse? Is this another case of researchers systematically ignoring evidence of iatrogenic HIV infection via dirty needles? ********** 10.7 510 10.7 Sexual transmission Impact of male circumcision on the female-to-male transmission of HIV 26.7 | 10:50 | Manaus | 2675 Auvert B.1, Puren A.2, Taljaard D.3, Lagarde E.4, Sitta R.4, Tambekou J.4 1UVSQ - INSERM U687 - APHP, ST Maurice CEDEX, France, 2NICD, Johannesburg, South Africa, 3Progressus CC, Johannesburg, South Africa, 4INSERM U687, St Maurice, France Prevention | TuOa0402 | Bertran Auvert Introduction: Observational studies suggest that male circumcision could protect against HIV-1 acquisition. A randomized control intervention trial to test this hypothesis was performed in sub-Saharan Africa with a high prevalence of HIV and where the mode of transmission is through sexual contact. Methods: 3273 uncircumcised men, aged 18-24 and wishing to be circumcised, were randomized in a control and intervention group. Men were followed for 21 months with an inclusion visit and follow-up visits at month 3, 12 and 21. Male circumcision was offered to the intervention group just after randomization and to the control group at the end of 21 month follow-up visit. Male circumcisions were performed by medical doctors. At each visit, sexual behavior was assessed by a questionnaire and a blood sample was taken for HIV serology. These grouped censored data were analyzed in an "intention to prevent" univariate and multivariate analysis using the piecewise survival model, and relative risk (RR) of HIV infection with 95% confidence interval (95% CI) was determined. Results: Loss to follow-up was <11%; <1% of the intervention group were not circumcised and < 2% of the control group were circumcised during the follow-up. We observed 45 HIV infections in the control group and 15 in the intervention group, RR=2.77 (95% CI: 1.56 4.91; p=0.0005). When controlling for sexual behavior, including condom use and health seeking behavior, the RR was unchanged: RR=2.93 (p=0.0003). Conclusions: Male circumcision provides a high degree of protection against HIV infection acquisition. Male circumcision is equivalent to a vaccine with a 63% efficacy. The promotion of male circumcision in uncircumcised males will reduce HIV incidence among men and indirectly will protect females and children from HIV infection. Male circumcision must be recognized as an important means to fight the spread of HIV infection and the international community must mobilize to promote it.