filtherton

As I said, there have been a few randomized trials. Like this one: PLoS Medicine: Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial

In this particular study, the researchers recruited 3200+ male volunteers aged 18-24 from the general population and randomly placed them into control and treatment groups. The circumcised group had 60% fewer cases of HIV infection during the study period.

The CDC has a rationale for why circumcision might reduce HIV transmission.

Male Circumcision and Risk for HIV Transmission: Implications for the United States | Factsheets | CDC HIV/AIDS

Now, it should be noted that these are all speculative. I do find them more compelling than the counterarguments, which all seem to be variations on "nuhuh, nope."

The CDC link also has a pretty comprehensive look at what science actually says about circumcision. It is interesting to see that some of the folks here who reject standard epidemiological practice on this matter are the most stridently pro-epidemiology when it comes to vaccines and/or the existence of the g-spot.

ASU2003

I'll paraphrase what I remember saying before. You take 3200 men, divide them into two groups of 1600, STD test them all, circumcised half of them that want it, wait X number of weeks and STD test them all again (without knowing how much sex each group had with infected females or if the circumcised guys even were able to have sex), STD test them all again a second time (this time seeing that the circumcised group was catching up to the uncircumcised group), then stop the study early because 12 uncircumcised guys out of 1600 got sick versus 5 circumcised. Then run with the headline 60% reduction! 60% reduction! I bet if they would go back and check up it would be close to 50-50 because there are too many unchecked variables in that study.

The CDC is at least looking for valid scientific reasons, but why aren't STD rates a lot higher in the socialized healthcare countries where most people are uncircumcised? Are they having safer sex with condoms? Which group of men use condoms more often? Condoms and monogamy are the answers to STDs, not circumcision.

It isn't easy to come up with a study unless the researchers know too much going in. I think if they studied couples where the woman had an STD, but the man did not, they could see how many times each type of man would have to have sex before he was infected.

filtherton

Have you actually read the study? Because it seems like some of the finer points of it were left out of your critique.

Lindy

I noticed this as well, captain kirk. Some of the uncut seem to think that since they're not cut, nobody else should be either.

Lindy

MSD

I'm cut and vocally against it. I'm pissed off that 26 years ago, some doctor got a few hundred dollars out of my parents' insurance company for hacking off part of my dick.

ASU2003

It was a few years ago, but the overall premise of their study was flawed and cutting it short once the STD rates in the circumcised group were catching up seems like pushing an agenda not science.

filtherton

You know for a fact that they stopped the study because the STD rates in the circumcised group were catching up? Why would two other randomized trials come up with the same conclusion, namely that circumcision can have a negative effect on HIV transmission rates?

I have a more reasonable explanation. Pretty much all clinical trials require approval of Independent Review Boards in order to receive funding. IRBs are tasked with making sure that research subjects are treated ethically. They frequently require researchers to check the effectiveness of the treatments being tested (here the treatment is circumcision) throughout the data collection period. If there is sufficient evidence that the treatment either is or isn't working, and if the adverse effects associated with continuing the research in light of the effectiveness of the treatment are too severe, the research project is terminated. It's standard practice (as I understand it).

So what happened here is that the research showed that circumcision was so effective at reducing the prevalence of HIV in the treatment group that the IRB decided that it would be unethical to continue the study because it would unnecessarily expose the control group to increased risk of HIV.

lulu_mq

I prefer my man to be uncut. Not that being cut is a bad thing. I just enjoy the fact that it's all natural, it looks sexy!. My SO has had no problems with infections or hygiene. And im going to agree with Noodle on this, It is sooo incredibly hot to watch the head emerge within arousal!

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ASU2003

Because stopping the study would stop the control group from having risky sex in the future... Both groups will continue to have sex. They will both be exposed. And if you have played roulette, there can be streaks, but in the end everything will get closer to even.

And it seems unfair to have one group of people not having sex because they are healing and hyper-sensitive for a few weeks of the short study time. And who knows what the personalities of the people in each group was or how often they were having sex with new partners (or condom use). That is a big assumption they made right there.

filtherton

If you subjected your perspective to as much skepticism and scrutiny as you are the wealth of information counter to your perspective you might find that you don't really have a solid basis to believe what you believe.

Have you read the study yet? It seems pretty clear from the assumptions you've presented about the study that you haven't read it. What is the significance of the fact that you've conjured up all these different reasons why it is invalid even though you haven't read it? Has it occurred to you at all that the researchers may have shared your concerns and developed an experimental plan that would eliminate or reduce the potential for bias?

The study says what it says and it seems to agree with several other studies. You don't have to believe it and you don't have to convoluticate justifications to me for why you don't believe it. I'm just saying that science isn't on your side, for whatever that's worth.

Daniel_

There is some slight evidence that RECENTLY circumcised men are infected slightly less often than uncircumcised men. I am not aware of a logitudinal study that looks at lifetime infection rates for man circumcised as infants.

As has been pointed out above, if you look at national infection rates they totally fail to corelate with national circumcision rates. The US has a significantly higher proportion of circumcised men than similarly developed countries in Europe and Asia, and yet has a very similar infection rate.

I think that the best that can be said currently is that in some cases having a foreskin may allow a route to infection that is less likely in men without foreskins, however it must also be stated that the size of this effect is orders of magnitude lower than can be achieved by programmes of education, barrier contraception, and routinely available free at point of use HIV testing.

What seems clear to me is that prophylactically circumcising adult men will lead to many people sticking partially healed wounds into infected partners, which will without doubt be a vector for significant INCREASES in STI transmission.

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filtherton

I'm not either, and it's possible the reduction disappear in the long run. But right now evidence from multiple studies suggests that there is an effect associated with circumcision.

Unless you're also adjusting the national infection rates for confounding factors, comparing national infection rates doesn't really mean anything.

This is kind of exactly what I said above.

Do you have a longitudinal study to back this up?


I am fully ready to accept the notion that it is possible that circumcision provides no long term effect on HIV transmission rates.

Daniel_

Likewise, I am prepared to accept that circumcision could reduce transmission rates, I'm just not of the opinion that it's been proved yet (either way). I just reject the arguments people place as if everything is known either way.

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And everthing is Green and Submarine
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filtherton

Well, there are several studies which already show that there is a statistically significant effect. There are also plausible biological explanations for why there might be an effect. I'm fairly certain that the magnitude of effect seen is greater than the magnitude of effect required for the approval of new drugs. However, if you're waiting for conclusive proof in matters of public health, you'll be waiting forever. There are always doubts.

What I find questionable is the seemingly reflexive opposition to the idea that circumcision can affect HIV transmission rates. I don't think it has a bit to do with the science, and I think that the reactions that pop up- where people criticize the science without understanding it, or even taking the time to read it- support this assertion. There are ethical and emotional considerations that have nothing to do with the science, and these considerations are perfectly natural. I just think it's folly to attempt to hide these concerns behind half-baked criticisms of scientific fact.

I'm agnostic about circumcision. As far as I'm concerned it doesn't matter. I've got a son coming in a few months and we aren't planning on having him circumcised. There are better ways to avoid HIV than circumcision and my family is lucky enough to live in a place where those better ways are socially accepted and encouraged.

However, it is important to acknowledge, at least hypothetically, that there are places where safer sex isn't encouraged. Where certain Popes have made ridiculous claims about condoms. In places like this, assuming that an effect actually exists, it might makes sense to encourage people to get circumcised, because in situations where people aren't going to use condoms and aren't going to stop having sex, circumcision would be better than nothing.

Daniel_

I agree totally.

"There are better ways to avoid HIV than circumcision and my family is lucky enough to live in a place where those better ways are socially accepted and encouraged. "

__________________

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Overhead, the Albatross hangs motionless upon the air,
And deep beneath the rolling waves,
In labyrinths of Coral Caves,
The Echo of a distant time
Comes willowing across the sand;
And everthing is Green and Submarine
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ASU2003

I criticize the science because their methods are flawed and they went looking for a certain result and stopped the study early when they got it.

I'll read the stupid study again, but it won't change anything. There should be other people who make sure scientists are actually doing science and not statistics.

Why would they offer to circumcise the control group before they even started if they were impartial and trying to determine if circumcision had any effects or not. It sounds like they expected a result from the start to me.

And how much sex will a newly circumcised guy have in the three months following the surgery?

So, they didn't want to give it another 9 months (which is still too short of a time in my opinion) to see the numbers get closer together...

But it looks like they actually did collect the data. It's just that 60% after one year sounds better than 38% after 2 years. Is it going to be 20% after 3 years? It should hold true year after year if they want to make a claim.

I was a little mistaken above, they did collect behavior data in this study. Yet I'm still not convinced that one group didn't by chance happen to sleep with more HIV infected people.

So, do they know how many times each person in each group slept with an infected individual?

(Their graph says it is 7 vs 15 after 12 months. They need to check to make sure things correspond to one another. I also like how it is 2 vs 9 after 3 months (when the circumcised group wasn't supposed to or couldn't have sex for 6 weeks...) At the end they wrote it off as an insignificant amount of time during the 21 month trial, yet it's like starting a baseball game already down. It was only a 5 vs 6 infection rate for the next 9 months.)

And there are a bunch of other numbers thrown around like 72/74 were HIV positive at the beginning (how many others had recently contracted it, but the HIV test missed it), and there were uncircumcised men in the intervention group, and circumcised men in the control group at about a 8% level for some reason.

Condoms are much better at preventing STDs. Fixing the 1.8% marriage rate would improve things. Producing a quick at home HIV/STD test would help things. They are spreading false beliefs that all they need to do is get circumcised and they can fuck anyone and stay disease free.

filtherton

Your assumptions are incorrect. Institutional Review Boards and the peer review process are set up to make sure scientists are actually doing science (statistics are a vital part of science).


How would offering to circumcise the control group affect anything? They circumcised them after the study was finished.

I don't know. How long does it take a circumcision to heal?


You keep saying that the numbers would have gotten closer, but I suspect you have absolutely no reason- beyond your own personal expectations- to suspect that they would get closer. Why do your expectations have more credibility than the folks involved with this study?

You're confusing risk ratios (RR) with protection. Protection = 1-RR, so that the protective effect was actually greater as time progressed (62%).

I don't think you could be convinced. You seem too hopelessly committed to your own expert opinion. One group probably did get more exposed to HIV, but which one? The size of the group should ensure that any difference was insignificant.

Probably not. Just like trials involving the efficacy of flu vaccines can't take into account how frequently participants were exposed to the flu. The random nature of the study design should reduce the effect of this type of bias.

These are perhaps valid complaints. I don't care to refute them. That's why this study has been done multiple times. Each time, a similar result was seen.

You're delusional if you think that this is what "they" are "spreading". Seriously. You should stop and think about why you really have such a big problem with these studies. Here's a hint: it has nothing to do with the vagaries of scientific inquiry.

ASU2003

Using their numbers in between check-up #1 and #2 (when they 'stopped'), it was 5 vs 6 new cases out of ~1500 in each group. I would like to see them go back now 5 years later and see what the numbers are.

And the national trends don't show a drastic reduction in the speed of infection rates between countries that have similar sexual habits but different circumcision practices.

It seems to me that they already assumed the result would be positive in favor of circumcision at the start.

It's probably 6 weeks of limited or no sexual activity. And for some reason they thought that they didn't need to start after this. Let alone look at the cost to perform all of the operations, follow-up care when a few of them had problems, and the risk of vaginal tears during sex, it doesn't seem like it is effective as condoms and changing the culture of sex.

filtherton

Me too, but that doesn't invalidate the statistically significant results that they did find.

They don't? Where are you getting this information? Which countries did you compare?

Or they offered people a free circumcision as part of recruitment for the study and thought it unethical to deny people who were placed in the control group the opportunity.

According to this Circumcisioncenter.com | The Circumcision Center it's four weeks. Why are you so pedantic when it comes to this study but so lackadaisical when it comes to finding supporting information for your own assumptions?

And no one is saying that circumcision is better than condoms at reducing HIV prevalence. You keep refuting that point as if it is a point anyone has made ever. I think the problem here isn't the study, and because of that I don't really feel like going through each little thing that happened in the study with you to refute your misconceptions- it isn't my project and it's clear your concerns are less with the study then that its results will be perceived as an excuse to not use condoms.

ASU2003

Maybe they should have circumcised all of them and then looked at if the trend they could have predicted with their graph came true. There were some ethical ways they could have continued this study, but I'm still not buying that they didn't want the result they got when they started it.


https://www.cia.gov/library/publicat.../2155rank.html
Canada, US, Brazil, Israel, Sweden, UK.... But there may be drug users included in those numbers and they don't break it down based on how many were circumcised or not. Plus there are a lot of other factors that go into that number. My main problem with this study is that they are claiming that since it might have stopped a few cases that US health insurance should cover it for all babies and it's 'the right' thing to do. When unless you think your boy will engage in risky sex during a trip to Africa, AIDS prevention shouldn't be high on their list of reasons. Even on a national scale it doesn't seem to be cost effective and in 10 years it might not be a concern.

They should use the money they could save by not circumcising the entire sub-Saharan continent (and the US) and work on finding a real cure for HIV/AIDS (and be able to fund it's roll-out). Or push real methods that we know have a better than a debatable 60% chance of stopping the transmission.
HIV gene treatment
Bold Efforts to Find a Cure for HIV AIDS and New Prevention Tools Are Urgently Needed, Says NIAID Head
Local physician: HIV/AIDS cure getting little publicity - Baldwin County NOW - A Gulf Coast Information Source for South Alabama

Spiritsoar

I'm cut, and I like it. My aesthetic preference for circumcision could therefore be biased.

I also believe that it's more hygienic. Yes, yes, I know we live in a world where hygiene should supposedly prevent those sorts of issues. But I can say that as a medical provider for soldiers, who don't always have ideal hygiene conditions, I have seen a good number of cases of balanoposthitis while serving in a deployed environment. Circumcision would have prevented these issues.

The simple fact that a simple procedure might reduce the chances for sexually transmitted diseases is enough reason for me personally to think it might not be a bad idea. In my mind the potential benefits outweigh the risks.

Also, though I know that there is a relatively low occurrence, circumcision prevents cases of phimosis and paraphimosis, reduces the chance of thrush, and has been shown to reduce the chances of urinary tract infections in infants.

I can say that I will have my children circumcised. I don't quite understand the people who argue about insurance coverage for this procedure. I pay for my insurance, and it covers the procedure I want. I don't see the problem.

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Daniel_

So would "not going to invade". Just saying...

__________________

╔═════════════════════════════════════════╗
Overhead, the Albatross hangs motionless upon the air,
And deep beneath the rolling waves,
In labyrinths of Coral Caves,
The Echo of a distant time
Comes willowing across the sand;
And everthing is Green and Submarine
╚═════════════════════════════════════════╝

raptor9k

deleted

Spiritsoar

Yea, you're right. The answer to the medical issues faced by soldiers in an austere environment is clearly to never deploy the soldiers.

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Fire

I do not understand shy so many people are so militant about it- I was having orgasm's long before circumcision, and am happily having them now ( well not right this instant) and there is not a loss of sensation, It is DIFFERENT, but not by any means less intense, or enjoyable- its kind of hard to explain, without a common frame of reference, how the circumcision changed what I felt, but trust me, I really dont feel robbed of anything, or like I was mutilated..... and if it gives me any advantage on not catching a fatal disease, even a small one, I will take it, especially since it cost me NOTHING.....

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ASU2003

Did you do it yourself? Did you have the insurance company pay it (and help raise our rates)? Did you get government assistance and increase our taxes? One person won't make that big of a difference, but it's the large numbers that add up. It's good that you had a choice, that's all.

Mister Coaster

You should have asked when we met up. Then again, I suppose the Pike St Market wasn't the best place for that.

Being an uncut child in the USA was cause for great ridicule once the "secret" was out. There was only one other boy with an uncut penis, we both were teased endlessly about it. That was pretty tough. As an adult, it's no big deal. I had always enjoyed being with women who obviously had not seen/played with one before. Always a fun and educational experience.

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Idyllic

Let me start by saying, I've had a very exciting life, and have enjoyed being a modern woman, nice way to say, I've enjoyed sex. I have mostly been with circumcised men, and at this point in my adult life would probably turn away a non-circumcised man, not just because I've been faithfully married to a wonderful circumcised man for the past 10 years, but because I remember sex with uncurcumcised men, and I am sorry it WAS NOT nearly as pleasurable, at all. For starters, I don't care how clean you may think you are, any fold on a human body retains heat and moisture, breeding grounds for infections, of all kinds, including yeast infections which DO have a tendency to linger in an uncircumcised penis. Yes, they LIVE in women, we are MADE of folds, but we grow up being taught about cleanliness and teased about our lovely SMELL. Uncircumcised men also carry a unique odor, just as women do. Second, men do not typically dry themselves after urination, as women do, and uncircumcised men dribble just as much as circumcised men do, that hood holds more moisture though, no bones about it….. Third, and this is the reason I prefer circumcised men, beyond the looks, the smell, the cleanliness, it is the way it feels. When an uncircumcised penis moves inside it moves inside its own skin or sheath more that it moves again the vaginal wall, there is less friction, and for me it is not as pleasurable. To me it is akin to what you men say it must feel like when you wear a condom, like an uncircumcised penis has a raincoat on and is moving within its’ own raincoat as opposed to moving within me. Part of the whole thrusting motion is completely lost, albeit, sometimes less fiction is less sore the next day, but there is a lot to be said about hurts so good. I will say, uncircumcised men are a lot easier to give hand jobs .

p.s. both my sons are circumcised, using a plastibell just after birth, no scissors, no crying, no issues.

And NO, I’M NOT, NOR HAVE I EVER BEEN “A PROFESSIONAL”. I’m just honest.