Is circumcision required in the age of condoms ?
Archiving and continuing a discussion from delhi freethinkers.
Excerpts from the discussion
Quote:Circumcision or no circumcision, you wanna stop the spread of infections and HIV, use a condom. Rest, leave it to the child, if he wants it circumcised or, not. Parents should have no role in it. And this is not just for jews and muslims, 60-70% of american no jewish and muslim males have had circumcisions done. It is much like how children acquire religion!

Quote:The condom- only approach u r advocating is, I am afraid, neither practical nor feasible from a public health perspective. Circumcision as a prevention measure agst HIV is not the result of lobbying by relgious nutters nor by some pro-circumcision support groups.It is the result of scientifically validated findings from multi centre trials across the world

Quote:80% of transmission is NOT through sex, majority of people who get infected by HIV are through blood transfusions, drug use among social groups using the same needle etc.

Quote:Nevertheless, sexual transmission is still the commonest mode of transmission for HIV in the world ..
I am not debating the religious reasons for circumcision nor am I advocating for any lobby groups working for circumcision... All that i am saying is that there are medical reasons that point towards beneficial effects from circumcision...
Let; s not consider religion first,
- Is circumcision necessary for every male? Like cutting of umbilical cord ?
- Will it decrease the pleasure of sex?
- Is it ethical to mutilate a healthy baby (kid) ?
- Is it ethical to deprive the partner of the circumcised person of sensual pleasure?
- What would be better, to circumcise a kid or to educate him about cleanliness of the moist area?
- what are the chances of getting STD of condom vs. circumcision?

The scientific studies are in-fact in place because the circumcision is so widespread throughout the history. If the alternatives are available then it is absolutely unethical to perform circumcision of a kid.
Indians today are governed by two different ideologies. Their political ideal set in the preamble of the Constitution affirms a life of liberty, equality and fraternity. Their social ideal embodied in their religion denies them. - Ambedkar
A very good article on the topic

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The answer depends on what group of people it is being recommended for
The variables are 1)age group 2)regional prevalence of HIV infection 3)They knowledge about sex, HIV, circumcision, etc of the parents or adult males who are being recommended circumcision

Who recommends circumcision? WHO does. Its first recommendation came out in 2007 and its revisions have been coming since then.

Whom does the WHO recommend it to?
For all male infants, adolescents, adults living in HIV endemic areas.

On what basis does it recommend it?
Based on clinical trials conducted in African nations (with high prevalence of HIV) to find out the effect of circumcision in HIV prevention. The output was 60% decrease in the rate of HIV transmission.

What are the reasons why people (including myself) think that the reliability of the WHO is compromised?
1) Firstly, this is science, which means no authority goes unquestioned. There is no final verdict. This should sweep away all the surprise reactions "u think u know more that the experts of WHO?

2) The clinical trials that were conducted did not represent the general male population, they were biased in including only those men who were interested in opting for "free circumcision". An uncircumcised male may ask himself, what kind of a male will opt for free circumcision. Does that group represent the males in general? Wont that group be dominated by men who have a lifestyle that is not monogamous? Why will a loyal husband opt for circumcision to prevent HIV? Why will someone prudent enough to use condoms care about circumcision? THE BASICS OF ANY GOOD TRIAL ARE THAT IT SHOULD REPRESENT THE POPULATION IN QUESTION

3) There was a drop out rate of 30% (attrition)

4) At the end of the trial, only heterosexual transmission was accounted for. There were no attempts to account for other modes of HIV transmission in those who ultimately got infected at the end of the trial. Why should even a non-medic personnel not reject this trial if it doesnt take this commonly known fact into account? Do we suspect that WHO "experts" didnt knew this? Of course that is out of the question to say that medically ignorant men are behind this. This leaves only one option. It was purposedly allowed to frame the trial in a way they desired.

5)As a continent, Africa has the highest circumcision rate. In kenya, 80% of the men are circumcised. So why is HIV still prevalent? The already high rate of circumcision should have controlled HIV by default.

6)WHO took sufficient care to point in an sentence that circumcision was not to be considered as alternative solution to other measures. Did WHO imagine those adult men who were ultimately going to be circumcised, were going to read every line in the recommendation to note that? Does WHO pretend that the target population will leave their health and social problems for the sake of reading it? Does it pretend that the local support groups or its own people will manage to teach them this fact and ensure that they follow it? Dont they have prevalent hunger and poverty to deal with it? I m not sure about this but arent those people entertaining superstitions like "sex with virgins treats HIV" Would u trust them into not thinking that they are more or else immune with circumcision, especially if they are intoxicated with alcohol prior to sex? Is it so hard not to expect that from such people?

[Why it is likely to happen....]

[How it happened.....]

7) It also mentioned that there wont be an immediately visible effect of circumcision in the HIV rates. But in the same recommendation, "infants" are also indicated along with adults and adolescents. This is beyond medical illogic, this is beyond common sense. If circumcising adults wasnt gonna take immediate effect, how would circumcising infants benefit in anytime earlier than a decade? Last time I heard, infants and children dont have sex!

To show how pathetic this reaction to "critical situation of HIV" is, Let us give the WHO benefit of worst future and predict a few very pessimistic outcomes of the HIV situation in the coming 10yrs like...
i) medical science doesnt come up with better preventive and treatment strategies by then. Actually condoms do a much better than that magical 60% thing with circumcision. But let us assume that they were unable to teach use of condoms in 10yrs
ii) the endemicity of those areas wont change cause the people remain poor and the government doesnt care.
iii) nobody cared to educated the infants of those areas about sex and STDs, as they grew up into adolescence
iv) circumcision will remain an important tool, as is now (Let us presume this was true, for the sake of the next point I am going to make)

So why not circumcise them at age 10 or 12? Why circumcise them as infants today? While u are already gettting circumcision Are they suggesting that they wont have time tomorrow? How does anyone get to prejudge someones sexual life when he is an infant?
How does any authority (or even parents) get to decide the reliability of someone's sexual activity and observance of safe sex strategies 10YRS IN ADVANCE?

Decreased risk of STD (sexually transmitted diseases), urinary tract infections, penile cancer, cervical cancer in partners, probably prostate cancer, are all related to one thing, penile cleanliness. If u regularly clean, the risk of circumcision clearly outweighs the benefits. Any consenting adult male who things he cant keep it clean or finds condoms boring and additionally imagines circumcision to provide him some sort of immunity, can have it, but its high time nations stop funding ways to promote infant circumcision, which is child rights violation, nothing else.

All the claims (including valid trials) made on the web or by people of the developed world (basically USA) are terribly self centred. There are a number of other factors in etiology of the so called "circumcision preventable diseases". Best example is prostate cancer, which thanks to their toilet habits is perhaps as easily attributable to circumcision as anything else. We should not forget that USA and somalia are the only two countries that havent signed the human rights. I see it because they put their national interests as priority, not the global health or global human rights.(though Obama expects to change that). Circumcision rates are already very high in USA, and the issue of infants who die due the practice of orthodox jews, a practice which can, at best be called MUTILATION, is actually a "controversy". What kind of developed nation will even allow a rabbi (not a certified and authorised doctor) to circumcise their male babies and then barbarically put the penis into their mouths and suck out the blood that comes out due to circumcison? That nation where 100+ children die every year of circumcision. I am putting USA as the main source of all the claims for which circumcision is thought to be a cure.

circumcision is as much a preventive health for balanitis and balanoposthitis is like saying cutting off a toe is prevention for toe gangrene of the toes). U can amputate the toe when gangrene sets in, just like u can circumcise when the foreskin poses a problem. Risk-benefit ratio doesnt justify everything as a preventive measure. I sometimes get a feeling that we dont remove appendices in infants because it is not there in scriptures, or else people would have figured out a way to justify its removal on preventive basis too.

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Came across this blog post:
When bad science kills, or how to spread AIDS
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Posting this here after the discussion on Chennai Freethinkers:
There is a very good deconstruction of the falsities and attacks used by Boyle and Hill to perpetuate the myth that not only is circumcision useless, but that it somehow will promote HIV/AIDS epidemic.
This is of course not as hard to call out, considering the adoption of circumcision over the last decade has shown a cumulative decrease in transmission rates of HIV/AIDS in most parts of Africa.

This write up also compares that critique to the much maligned Andrew Wakefield vaccine-autism link in terms of defying scientific consensus to promote an ideological view, rather than a scientifically proven and consistent result/critique:
It can be said that male circumcision is problematic in the light of consent issues, but in terms of health--there is definitive benefit (especially in developing regions where STI transmissions are on epidemic level).
Even if there are definite health benefits to circumcision, in terms of STD prevention, they are still lower than those of using condoms. More importantly, there was this groundbreaking anatomical study done in 1995 by a pathologist in Winnipeg, Manitoba:

The study by Dr. John Taylor clearly indicates large numbers of unique nerve endings exist in the male prepuce (foreskin). Thus, circumcision is likely to significantly reduce sexual pleasure. A far more recent study in Denmark corroborated this notion as well.

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