AFRICA: Botwsana to Implement Controversial Infant Circumcision Devices

Circumcisionist Ambitions Realised
As if calling circumcision an HIV prevention method, and implementing "mass circumcision campaigns" in the so-called name of HIV prevention weren't controversial enough, Botswana is one of those countries whose medical authorities have been convinced to take it a step further, and start campaigns to circumcise newborn boys. Perhaps they see this as the next step, seeing as adult men aren't falling for the propaganda, and some countries, such as Japan, have begun to stop funding adult male circumcision programs?

It should be no surprise that babies are finally being targeted for circumcision under the pretext of HIV prevention. The justification of male infant circumcision is what circumcision "researchers" have been aiming for all along. Circumcision is not this medical "solution" that "researchers" supposedly "discovered" merely 30 years ago; the fight to justify male infant circumcision has been raging on since Greco-Roman rule.

Circumcision, particularly male infant circumcision, is a cherished tradition in Judaism, and it's a money-maker for American physicians. The goal isn't to stop HIV in Africa; the goal is, and has always been, to justify male infant circumcision in the US, and elsewhere. Circumcision "researchers" want for medical organizations, such as the AAP, to point to Africa and say "Male infant circumcision prevents HIV in Africa, therefore we recommend infant circumcision for American babies." Is it any wonder that much of the funding for "mass medical male circumcision," or any similar variant, happens to be American money?

Implementation of Controversial Infant Circumcision Devices
Circumcising male infants should be controversial enough, as amputative surgery in healthy, non-consenting minors is unethical. There goes the "voluntary" part of the so-called "Voluntary Medical Male Circumcision" slogan...

The plot should thicken when, not only are baby boys being circumcised, but they're being circumcised with controversial devices.

According to StarAfrica, the Botswana Ministry of Health has adopted the Mogen clamp and AccuCirc device, to be administered to healthy, non-consenting, non-sexually-active children. National coordinator Conrad Ntsuape told state-run Radio Botswana that the two devices were the best that Botswana opted for.

The following passage is disconcerting:

"Ntsuape noted that the entire procedure would be bloodless, requiring no anaesthesia, suturing or a sterile setting."

It sounds very similar to the lines of a certain Neil Pollock.

Of course there is no such thing as a "bloodless" circumcision, requiring no anaesthesia, nor a sterile setting. Even the latest AAP statement features a lengthy passage on adequate pain management for infants undergoing circumcision. A sterile setting is necessary to avoid infections, such as those with MRSA.

Let's continue further:

"Ntsuape said the decision to adopt the two devices followed a lengthy consultation process that focused on acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts that was conducted by Botswana and the United States through Harvard Institute in 2008."

Instead of the acceptability of male infant circumcision, shouldn't it have focused on other things? Like, for example, whether or not male infant circumcision is effective in reducing HIV? (There are no studies that exist on this subject, and world data shows that it does not.) Shouldn't there have been an actual evaluation of the risks involved, especially given the devices being considered?

"Ntsuape said the results of the survey indicated that 96 per cent of mothers in Botswana accepted early infant circumcision while the remaining four per cent were undecided or not interested."

Before considering what mothers have to say in a survey after being told that circumcision would prevent HIV in their sons, where is the proof that infant circumcision reduces HIV transmission? Were the risks of circumcision discussed with these mothers? Were the risks of each device disclosed to these mothers? Was the fact that circumcision cannot prevent HIV transmission, and therefore even circumcised men have to wear condoms discussed with the mothers?


What Botswana Circumcision Advocates May Not Tell Parents

The Mogen device being marketed here has a terrible track record for circumcision mishaps, including glans amputations. So infamous is the Mogen clamp for circumcision mishaps that numerous million-dollar lawsuits put the company out of business.

Common Mogen Problem: The circumciser is blind to the condition of the child's glans. Some or all of the glans is pulled up along with the foreskin, resulting in partial or full glans amputations.

What mothers have to say about circumcision has no bearing on the fact that there is no scientific evidence that circumcising newborns will prevent HIV transmission, but would the women in this survey answer the same, if they were given this information?

The AccuCirc device is a recent invention that doesn't have much of a history, not that it needs any, as we know its intended purpose of cutting off part of a healthy child's penis.

I hate discussing the better or worse of two evils, and discussing what is the "better" male infant circumcision method is no different than discussing which is the "better" female infant circumcision method. There simply isn't a "right" way to mutilate a perfectly healthy, non-consenting child. However, there is a good critique on why the AccuCirc is particularly terrible here.

Conflict of Interest

David R. Tomlinson

"Chief Expert on Circumcision," WHO

Inventor of AccuCirc

The citizens of Botswana may be interested to know that the inventor of the AccuCirc device also happens to be "chief expert on circumcision" at the World Health Organization. He develops, implements and evaluates male circumcision training programs in Africa, and he wrote the WHO's manual for male infant circumcision. (Reference here.) Is it any wonder that the AccuCirc device is included in many African "surveys?"

To Close
Adopting a device known to cause problems is not very wise, not to mention circumcising healthy, non-consenting newborns who are at zero risk for HIV transmission is ethically repugnant no matter what methods employed. Botswana is complicit in implementing what is effectively male infant genital mutilation, under the deceptive guise of HIV prevention.

Related Posts:

Circumcision Botches and the Elephant in the Room

The Ghost of Mogen

CINCINNATI: Intactivists Protest Circumcision "Experiment" at Good Samaritan Hospital

EUROPE: Israeli MK Lectures PACE on the Medical Virtues of Ritual Circumcision

In the latest plea for the Council of Europe to reject their resolution, MK Meir Sheetrit tries argue that resolution is "medically unjustified." This is certainly a different tune than what Shimon Peres sent to Council of Europe Secretary General Thorbjorn Jagland, arguing that infant circumcision is of "great importance" in Jewish and Muslim religious tradition, that it is a "fundamental element and obligation of Jewish tradition" that has been practiced by Jewish communities "for thousands of years."

The fact that Meir Sheetrit is choosing to argue "medical benefits" in lieu of "religious freedom" is interesting to say the least.


Is the argument for "religious freedom" so weak that it has to be propped up by a sudden interest in public health?

I will analyze excerpts of the Jerusalem Post article conveying this news:

"The committee said that circumcision is dangerous because 1.5 percent of children get infected," Sheetrit told The Jerualem Post Wednesday evening, "but infections can be taken care of."

...and completely unconscionable considering that they are caused by a needless operation on healthy, non-consenting children.

"Circumcised males are 60% less susceptible to HIV and it lowers the risk of penile and prostate cancer. Those are fatal diseases, as opposed to a passing infection."

Preventing HIV is not the reason Jews circumcise their children, is it?

Newborns are already at zero risk for sexually transmitted disease. Additionally, circumcision FAILS to prevent HIV, which is why even the most enthusiastic circumcision purporter in Africa cannot overstate the use of condoms enough.

Here is what the American Cancer Society has to say regarding penile cancer:

In the past, circumcision has been suggested as a way to prevent penile cancer. This was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. But in many of those studies, the protective effect of circumcision was no longer seen after factors like smegma and phimosis were taken into account.

Most public health researchers believe that the risk of penile cancer is low among uncircumcised men without known risk factors living in the United States. Men who wish to lower their risk of penile cancer can do so by avoiding HPV infection and not smoking. Those who aren't circumcised can also lower their risk of penile cancer by practicing good hygiene. Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer.

80% of American males are circumcised from birth. Yet, according to the ACS, 1 in 6 US men will be diagnosed with prostate cancer. If circumcision is supposed to prevent prostate cancer, I'm afraid it is not very effective.

"Opponents of circumcision raised the claim that the child should have autonomy.

However, there are two other ethical arguments for circumcision.

The first is that of "community and divinity," which fits with freedom of religion arguments, Sheetrit told the committee, citing University of Chicago cultural anthropologist Richard Shweder."

Does this include communities who believe it a religious rite to circumcise their daughters?

"The second is the "best interests standard," cited by Dr. Caroline McGee Jones of the University of Texas Health Science Center, explaining that it is ethical for parents to circumcise their son if they believe it will benefit him and his well-being."

What if parents believe female circumcision will benefit their daughter and her well-being?

It must be asked, what other non-medical procedure are doctors obliged to perform on children at their parents request, because they, the parents, believe it is "beneficial?"

"According to Sheetrit, PACE members from several countries approached him after the meeting to say he changed their mind, but Rupperecht remained unconvinced."

HAH!

Sure they did.

The fact is that the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world recommends circumcision for infants. All of them, including the AAP in their latest statement, state that the "benefits" are not great enough.

Does MK Meir Sheetrit intend to take an unfounded position against the most respected medical organizations in the west?

Is he seriously suggesting he knows more than the ombudsmen who signed the resolution?

Related Posts: 

COUNCIL OF EUROPE: Non-Medical Circumcision a Human Rights Violation

COUNCIL OF EUROPE: When Israel Says "Jump," Secretary General Says "How High?"

ISRAEL: The Emperor's New Foreskin

Politically Correct Research: When Science, Morals and Political Agendas Collide

Intactivism Isn't Making Anyone Rich

There is no money in trying to convince people to do nothing.

It'd be nice if I could leave the job I do every day and live off of trying to convince people that cutting children is wrong.

The sad reality is that while circumcision promoters get cuts (pun absolutely intended) in the form of grants, foreign aid, and getting paid for performing circumcision itself, intactivists have to sacrifice a lot of their time and money to get our message across.

Circumcising a child pays; allowing him to go home whole does not.

Yet I have read here and there, on Facebook, on parenting forums etc., accusations to the effect that intactivists are being "funded by millionaires."

I have never heard of a more ignorant straw-man, ad-hominem accusation.

While intactivists take time out of their busy schedule, not to mention precious time they could be spending with their family and loved ones, not to mention time they could be spending for themselves (e.g. going to school, improving their skills, another job, etc.), there are circumcision promoters whose sole source of income is the promotion of circumcision, if not performing circumcision itself.

The ignorant accusation that "intactivists are being funded by millionaires" stems from the fact that at one point, an intactivist organization, Intact America, got a kick-start grant of a million dollars from a single donor.

 Click Here to visit the Intact America website

While this is irrefutable fact, it's a stretch to say that we're being "funded by millionaires."

Intact America is only ONE organization who got paid one million dollars, one time, by one donor, but that was a long time ago, and that money is gone now. No other intactivist organization has gotten a donation anywhere close to that amount. Intact America now survives on donations it can muster from willing intactivists.

But while circumcision advocates point their fingers and accuse intactivists of being involved in a money-making scam, they either seem oblivious to what's happening in their own camp, or they're deliberately trying to draw attention away from it.

Yes, at one point, Intact America got a million dollar grant from a generous donor.

But how much money do circumcision promoters get?

How much money are circumcision "researchers" like Maria Wawer, Ronald Gray, Robert Bailey, Daniel Halperin, etc., etc., getting for their work in the way of grants and scholarships?

How much money is PEPFAR handing over to PrePex and other organizations to circumcise 20 million Africans?

"Funded by millionaires?"

It would sure be nice if we could get someone like Bill Gates to donate to us the amount of money he's paying circumcision promoters in Africa.

It'd sure be nice if we could get money from the World Bank, UNAids, WHO, PEPFAR etc. to promote HIV prevention to those who don't want to get circumcised.

It'd sure be nice if the NIH, Johns Hopkins, etc. would give grants to researchers who want to find ways to prevent HIV WITHOUT circumcision.

It'd be nice if intactivists were given money to ready information packages, fly to Africa and educate the people of Africa on STD prevention, hygiene etc.

It'd be nice if we could pay artists to write songs about intactivism and speak out against male genital mutilation at HIV/AIDS conferences.

But we just don't have that kind of money.

Circumcisers get cash for their work. For many, this is their sole occupation.

It's intactivists who have to scrounge around for cash, when and if time and circumstances allow, and only after their own obligations and commitments.

When you look at just how much money is being pumped into circumcision promotion and facilitation, it's kind of ridiculous, not to mention dishonest and insulting, to hear a circumcision advocate try and discredit us by accusing us of being "funded by millionaires."

Ad lazarum, ad hominem and projection all rolled into one.

Related Posts:

PEPFAR To Blow Millions on PrePex

External Links:

Bill Gates helps fund mass circumcision programme

The 'Circumcision Song' Hits Airwaves Across Africa Thanks to Bill Gates' Funding

PEPFAR To Blow Millions on PrePex

PrePex had been running paid ads on high-end news outlets bidding for the WHO approval that would allow them to cash in on the African HIV/circumcision pie. They had a video on BBC, and ran dedicated articles on the Washington Post and the New York Times, as well as others.

Well, it looks like PrePex entrepreneurs have finally gotten their wish. According to the New York Times, the WHO has finally given their approval for the PrePex device, and PEPFAR leader Eric Goosby has already pledged to buy PrePex devices to circumcise as much as 20 million boys and men in Africa by 2015, under the ostensible pretense of "reducing HIV."

Grinning like a french poodle

In the New York Times, PrePex CEO Tzameret Fuerst said that the estimated price for each PrePex device would be an estimated $15 to $20 range. If PEPFAR pays for 20 million devices, that's a minimum of $300,000,000 a maximum of $400,000,000 American tax dollars that the program would spend on a dubious practice with speculative benefits, a waste of money considering that there are cheaper, less invasive, more effective ways of preventing HIV transmission.

No Demonstrable Scientific Proof Circumcision Prevents HIV
The sound bite that "circumcision reduces HIV 60%" is repeated over and over like a mantra, the WHO has given their blessing, and interested programs and manufacturers are promising to circumcise millions for foreign aid, but there is actually no scientifically demonstrable proof that circumcision does anything to prevent HIV transmission.

Close scrutiny of the so-called "research," however, reveals that there is actually no demonstrable scientific proof that circumcision does anything to prevent, or even "reduce the risk" of HIV at all, let alone by "60%." Circumcision promoters brush past this fact by distracting their listeners with the less-than impressive "60%" figure, and by mentioning how many men are "lining up to get circumcised." They need the money now, now, now.

There have been recent attempts to posit yet another hypothesis that attempts to explain "how circumcision prevents HIV," but they miss the mark, instead arriving at irrelevant conclusions, and not coming anywhere closer to furnishing the causal link for the so-called "effect" the much talked about "studies" were supposed to measure in the first place. Without a causal link, the "studies" are nothing more than statistics embellished with correlation hypothesis, and the efforts to circumcise millions in Africa are myth-based, not evidence-based.

African Men Not Buying into Circumcision for HIV Prevention
Despite the hyped up "mass circumcision" programs in Africa, it's been report after report of programs failing to meet their quota of circumcising boys and men in the past year.

Though they tried and tried, the much hyped Soka Unkobe program failed in Swaziland, where approximately 34,000 out of the expected 200,000 men (about 17%) were circumcised. Rather than abandon the strategy to mutilate the genitals of the men of Swaziland, American organizers are trying to figure out "what went wrong."Apparently, they feel they feel getting men to agree to have part of their penis cut off is simply a matter of "sending the right message." There is something wrong with an HIV prevention program that measures its progress by how many men they've circumcised, and not by how many they've educated about condoms and safe sex.

Three years into the 5 year program, only 80,000 of 1.2 million targeted men (about 6.7%) have been circumcised in Zimbabwe, and here too circumcision promoters are scratching their heads. Why aren't the men biting?

[There is no evidence that circumcising men in Zimbabwe has any effect against HIV.]


Click to enlarge
In Botswana, programs are also failing to convince men to cut off part of their genitals. One program circumcised only 685 out of an intended 10,000. In another program, promoters convinced only 360 out of 2560 men (approx. 14%) to get circumcised. Here too, promoters are dumbfounded and can't find the right people to blame. It couldn't possibly have anything to do with the fact that they're trying to convince men to undergo permanently altering surgery on their genitals, could it?

In Zambia, circumcision uptake has also been low.

In Kenya, Homabay district, only 11,000 men have been circumcised out of the estimated 42,000 since September 2008 when the program was initiated. Here too, circumcision uptake has been low, so coordinators are targeting children who are neither at risk for HIV, nor putting others at risk, not to mention the ethical dilemma of forcibly cutting off part of the genitals of healthy, non-consenting individuals. (So much for "Voluntary Medical Male Circumcision.")

The WHO may have given their coveted blessing to plunder African HIV funds to PrePex, and PEPFAR leader Eric Goosby may have pledged American money to pay for their devices, but it remains to be seen whether the devices will actually ever be used, or if they'll simply remain sitting in storage compartments unused.

While a failure to implementing PREPEX would be ironically heartening insofar as it shows that African men aren't buying into the circumcision propaganda, it remains disturbing that millions of dollars that could be providing more effective aid and advances in public health are being wasted and squandered by PEPFAR.

Real World Data Fails to Correlate with "Findings"
While the "60% reduction" claim is repeated, it fails to manifest itself in the real world.

It is interesting that PEPFAR is so eager to help circumcise millions of men in Africa, while circumcision has done America no favors in terms of HIV reduction.

80% of America's male population is circumcised from birth, yet AIDS rates in some US Cities rival hotspots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda.

The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009, "[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." (Hader once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe)

According to a recent report:

"HIV/AIDS is the seventh leading cause of death in the United States among people age 15 to 24, and half of young people infected with HIV are not aware of it. An unbelievable 26 percent of all new HIV infections are among those 13 to 24."

According to HIV prevalence data in the CIA Factbook, and circumcision prevalence figures in Wikipedia, the United States, where 80% of the male population is circumcised from birth, has a higher HIV prevalence rate than 53 countries where circumcision is rare (e.g., falls below 20%).

Countries where circumcision falls below 20%, and HIV is less prevalent than the United States (By rank in HIV prevalence):
 

Colombia, Argentina, Uruguay, Cambodia, Peru, Nepal, Switzerland, Vietnam, Ecuador, France, Chile, Spain, Moldova, Mexico, Italy, India, Iceland, Costa Rica, Canada, Belarus, Austria, Paraguay, Netherlands, Ireland, Denmark, Bolivia, Bhutan, United Kingdom, Belgium, Nicaragua, Laos, Bulgaria, China, Cuba, Cyprus, Czech Republic, Finland, Georgia, Germany, Greece, Hong Kong, Hungary, Japan, Lithuania, Mongolia, New Zealand, Norway, Poland, Romania, Serbia, Slovakia, Sri Lanka, Sweden

There is a prevalence of European, South American and Asian countries. Countries where one might expect a higher HIV prevalence rate have a surprisingly low prevalence rate. One would expect a higher prevalence of HIV in these countries, but they fare better than the United States, where 80% of the men are circumcised, instead.

Before handing out millions to gold-mining circumcision device manufacturers, PEPFAR ought to address the question of why something that never prevented HIV in this country is suddenly going to start working miracles in Africa.

PrePex CEO Tzameret Fuerst Gloats
In the following video, Tzameret Fuerst can be seen gloating about securing billions from PEPFAR, one can almost see the dollar signs in her eyes, as if she actually cared about HIV prevention. She repeats the same old circumcision/HIV propaganda, touting circumcision as a "one-time intervention with the efficacy of a vaccine." Sharp viewers may note other thinly veiled interests.

It'd be interesting to see her credentials. She holds degrees in urology, surgery and epidemiology, and can explain to us the mechanism whereby circumcision immunizes a man against HIV I'm sure.





But all is not lost; this new device makes the argument that circumcision would be "more painful, more complicated and more traumatic as an adult" a moot point, if in fact, as Tzemeret tells us, her product is "virtually painless and simple to do."


Related Posts:

CIRCUMCISION: BBC Runs Paid PrePex Ad

CIRCUMCISION: The Washington Post Folds to the PrePex Ad Campaign

NYTimes Plugs PrePex, Consorts With Known Circumfetish Organization

Where Circumcision Doesn't Prevent HIV 

Where Circumcision Doesn't Prevent HIV II

CIRCUMCISION "RESEARCH": Rehashed Findings and Misleading Headlines

 

Politically Correct Research: When Science, Morals and Political Agendas Collide

CIRCUMCISION "RESEARCH": Rehashed Findings and Misleading Headlines

So I log on to Facebook and read my news feed to find that intactivists have their panties in a bunch because some "new study" is about to be published, which suggests that a causal link between circumcision and a reduced transmission in HIV may have finally been found.

"This I've got to see," I thought to myself.

So I follow the links, and sure enough, there it was.

(Original press release can be seen here.)

Some "researchers" claim to have made the discovery that circumcision exposes the glans and internal mucosa of the penis, drying it out, thereby changing its bacterial environment, or "microbiome," along with the hypothesis that this new finding "might" explain why "circumcision reduces HIV transmission."

(Readers should find it peculiar that 7 years after the famous African "trials" that prompted the WHO to endorse circumcision as HIV prevention in Africa, a demonstrable causal link between the foreskin and facilitated HIV transmission has yet to be established.)

But something told me I had seen this "microbiome/bacterial environment" mumbo-jumbo before, and after a quick Google search, I knew that I was right.

Back in 2010, the same group of "researchers" tried to push this "discovery" as a possible explanation for the supposed "results" in the African circumcision "trials."

(2010 PLOS ONE study can be seen here.) 

In other words, the so-called "researchers" aren't presenting anything "new;" they're merely re-hashing an old "discovery" and trying to present it as if they've only just "found" it yesterday.

But then, this wouldn't be the first time circumcision advocates have tried to re-hash old crap to make it appear as if it were "new" and "innovative"; they're trying to modernize a religious ritual that dates back millennia for crying out loud.

The press release has spawned news articles with ridiculously misleading titles.

Reads one CNN article:

"Why circumcision lowers risk of HIV"

The title isn't substantiated by the body of the article.

Yes, "researchers" have found that circumcision changes the bacterial environment. (Douching does the same in women, in some cases causing PROBLEMS.) No, they are not anywhere closer to presenting a causal link between circumcision and a reduction in HIV transmission.

That a change in the bacterial environment causes a decrease in HIV transmission is an unproven hypotheses, but the title leads readers to believe that scientists have reached a final conclusion.

(Why is nobody "researching" to see if changing the bacterial environment in the female vulva "reduces" HIV or other STD infections? Answer: Because such research is deemed politically incorrect, especially if the findings are positive.)

Why are they rehashing this "finding?"

Is it that nobody cared the first time?

The Missing Causal Link
In 2006, three "studies" that claimed male circumcision "reduced the risk of HIV transmission by 60%" were published. They were instrumental in getting the WHO to endorse male circumcision as HIV prevention in high-risk areas in Africa. The WHO endorsement, along with the "research" that was used to author it, has been bandied about by circumcision proponents to promote *infant* circumcision in America, of all places. 

Most people don't know this, but while they are paraded around as being "the gold standard," well-known African circumcision "trials" are horrendously flawed. One of their biggest flaws, perhaps their biggest, is the fact that they are missing a vital, core component; a scientifically demonstrable causal link.

If one examines the wording of the so-called "trials" in Africa, they all say that their purpose is to "measure the effect of circumcision in reducing HIV," an "effect" that has never actually been demonstrated to be true; it has only ever been *assumed* apriori, without any demonstrable proof whatsoever, that a causal relationship exists, without question.

Trying to measure a phenomenon without a causal link is logically fallacious. It is like trying to run a computer without a processor, a time machine without a flux capacitor.

Indeed, the (carefully selected) data presented in the African "studies" show that there may be a (far-fetched) correlation between circumcision and a (very slight) reduction of HIV, but correlation does not equal causation; just because two things are correlated does not mean that one causes the other.

A correlation simply means that a relationship exists between two factors, but it tells you nothing about the direction of that relationship; the relationship could very well exist by mere virtue that biased observers decided to juxtapose them. Westboro Baptist Church draws a correlation between the presence of homosexuals and natural disasters, for example.

Without a demonstrable causal link, one could claim that an absence of vampires in the vicinity of garlic is "proof" that garlic keeps them away, that countless sightings "prove" UFOs exist, or that dead exsanguinated cows are "proof" that the chupacabras exists, without ever actually showing you a vampire, UFO or chupacabras.

Without a causal link, the African "trials" are meaningless statistics embellished with correlation hypothesis. Circumcision "researchers" merely juxtapose carefully chosen statistics and assume a causal relationship exists as a matter of fact, perhaps hoping nobody will notice.

So far, it has worked, because few people have bothered to notice that, despite the claims that "circumcision reduces the risk of HIV transmission by 60%," and assertions that this is a foregone conclusion "beyond reasonable doubt," the "researchers" who authored those "studies" never did present a scientifically demonstrable causal link.

Like a car without a motor, the African trials, and all work based on them are simply worthless junk, and all of what is happening in Africa, the AAP's latest attempt to endorse infant circumcision in America, etc. is not evidence-based, but myth-based medicine, which is why intactivists are keeping a close watch on circumcision "research" and claims of finally discovering the fabled causal link between circumcision and HIV transmission "reduction."

A Brief History of the Circumcision/HIV "Correlation" 
The African "studies" may have been published 7 years ago, but few people are aware that circumcision "researchers" had been groping for a causal link between circumcision and a reduced likelihood of HIV transmission, since the idea was first promoted in 1986 by a man named, Aaron J. Fink, who was distressed at the overall falling popularity of infant circumcision, hoping to reverse the trend.

During the 1980s, some physicians were condemning circumcision as "barbaric and unnecessary," and only "advocated by the uninformed." In 1986, Blue Shield providers in several states decided to discontinue coverage of neonatal circumcision. In reaction to this, Fink sent a manifesto entitled "In Defense of Circumcision" to the New York Times and the San Francisco Chronicle, repeating antiquated claims of benefits; many of which weren't even published.

In 1986, Fink wrote a letter titled "A possible Explanation for Heterosexual Male Infection with AIDS," where he argued that the hard and toughened glans of the circumcised male resisted infection, while the soft and sensitive foreskin and glans mucosa of the intact male were ports of entry. Fink proposed in his letter: "I suspect that men in the United States, who, as compared with those in Africa and elsewhere, have had less acquisition of AIDS, have benefited from the high rate of newborn circumcision in the United States," regardless of the fact that the United States has one of the highest circumcision rates, and one of the highest HIV rates, in the western (industrialized) world (compare with European countries, Canada, and Australia).

Fink's proposal appeared in media throughout the US and Canada. Asked about his idea by a United Press reporter, Fink replied "This is nothing I can prove." This didn't stop other physicians from conducting "research" leading to a steady stream of widely publicized articles arguing that circumcised men were less likely to contract HIV--with the result that prevention of HIV infection has now surpassed even cancer prevention as the most popular claim of circumcision advocates.

"This is nothing I can prove."
~Aaron J. Fink

Fink abandoned the circumcision/HIV controversy in 1991, and he died in 1994, but he left behind an indelible legacy nonetheless; researchers and scientists continue efforts to establish a causal link between increased HIV infection and the presence of anatomically correct male genitals to this day.

The Quest for a Causal Link
Since Fink proposed that circumcision prevents HIV transmission in 1986, various hypotheses for a causal link have been suggested. They all either remain unproven, or have been completely debunked, however, and thus far, circumcision "research" claiming a decrease in HIV transmission remains unsubstantiated by a scientifically demonstrable causal link.

Hardened Skin Hypothesis
Perhaps the oldest hypothesis for a causal link between circumcision and HIV reduction was Fink's theory that the keratinized surface of the penis in circumcised male resists infection, while the mucosa of the glans and inner of the intact male are ports of entry.

Recent studies, however, disprove this hypothesis. One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why uncircumcised men are at higher risk for HIV infection." Another study found that "no difference can be clearly visualized between the inner and outer foreskin."

Be that as it may, some circumcision advocates continue to preach Fink's hypothesis as gospel, the last time that I talked about it on this blog was when news outlets were publishing paid ads for the PrePex device.

"A person living without shoes, they have very hard skin. They are walking on stone every day, without any wounds. So it's the same thing with the penis."

 
Langerhans Cell Hypothesis
Szabo and Short proposed that the Langerhans cells were the prime port of entry for the HIV virus. According to the hypothesis, circumcision was supposed to prevent HIV transmission by removing the Langerhans cells found in the inner mucosal lining of the foreskin.

deWitte et al. found that not only are Langerhans cells found all over the body and that their complete removal is virtually impossible, they also found that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact, acting as a natural barrier to HIV-1 transmission by Langerhans cells.

This theory would also apply to females, where the mucosa in the vulva is also laden in Langerhans cells, but for whatever reason, no circumcision "researcher" has suggested "circumcision trials" for women, to see if the removal of mucosal tissue would "reduce" the likelihood of HIV transmission. There are two studies that suggest a connection between female circumcision and a reduced likelihood of HIV transmission.  (See here and here.)

An interesting note, while Szabo and Short propose that the Langerhans cells are the prime port of entry for HIV, Weiss argues that there aren't *enough* Langerhans cells in the foreskin. Of course, both "studies" conclude that circumcision protects men against HIV and AIDS. 

Bacterial Environment Hypothesis
And here we are today.

Price et al. observe a difference in the bacterial microbiome on anatomically correct and circumcised penises, and propose the hypothesis that this change in the bacterial environment of the penis may be responsible for the reduction of female to male sexual HIV transmission.

Rather far-fetched, the argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflammation, a condition that facilitates the transmission of viruses. The chances for penile inflammation are reduced, thereby reducing the chances of sexually transmitted viruses, such as HIV.

Presenting this hypothesis presents a two-fold problem. First, it presents an irrelevant conclusion; the randomized control trials were measuring frequency in HIV transmission, not for frequency in penile bacterial inflammation, and whether said inflammation facilitated sexually transmitted HIV. And secondly, circumcision advocates give themselves the new burden of proving the newly introduced hypothesis, that a change in bacterial infection does indeed result in a significant reduction of HIV transmission. Were the men who acquired HIV sexually, suffering bacterial infections at the time? (Did they actually acquire HIV sexually?)

And how did the circumcised men in the studies (64 out of 201) who acquired HIV, acquire HIV?

This hypothesis was first published in 2010, and it is now being published again as a "new discovery" in 2013.

An interesting note; co-authors include a list of usual suspects who have published other pro-circumcision "research," namely Aaron A.R. Tobian, David Serwadda, Godfrey Kigozi, Maria J. Wawer and Ronald H. Gray. (Surprise, surprise, Wawer and Gray are married; Gray authored one of the big three "trials" in Africa.)

Conclusion
Perhaps the biggest flaw in any "research" that tries to establish a "correlation" between anatomically correct male organs and an increased HIV transmission is that of a missing, scientifically demonstrable causal link.

It was missing when the idea that circumcision prevents HIV was first invented in 1986, and it continues to be missing today.

The original "studies" that the WHO used as a basis for their endorsement for circumcision as HIV prevention in Africa never did provide an established causal link; the researchers only asserted, and continue to assert, without demonstrable scientific proof, that one exists.

Circumcision "researchers" have presented a cart, but can't seem to produce the horse that pulls it.

Hypotheses of a possible causal link between circumcision and HIV reduction have been posited, but so far they have either been disproven or completely debunked.

This is the second time the "microbiome" hypothesis has been posited, and the "researchers" aren't anywhere closer to explaining how the presence of anatomically correct genitals increases the likelihood of HIV transmission, and how circumcision is supposed to reduce said transmission.

A scientifically demonstrable causal link remains elusive, like a unicorn or the Loch Ness Monster.

Without a demonstrable causal link, circumcision "research" attempting to link circumcision with a reduced transmission of HIV lacks scientific validity, and the efforts to promote mass circumcision in Africa and in the United states are all myth-based, not evidence-based.

The results of the so-called "research" have been accepted as bring "beyond reasonable doubt." The WHO has issued it's "recommendation" of what is essentially male genital mutilation as HIV "prevention." Entire "mass-circumcision campaigns" have been launched in Africa by the US government on the taxpayer's dime in the so-called name of "foreign aid," and AAP fellows salivate over the idea of endorsing routine infant circumcision in the US, but the fact that a causal link has yet to be established has somehow slipped by unnoticed.

Researchers grope desperately for causal link, before a critical mass gets wind of the fact that one doesn't actually exist, which is why we're going to keep seeing press-releases like these, boasting to have finally found it.

Even if
There are other problems with "research" that claims that circumcision reduces HIV transmission.

Another big problem, for example, is the fact that the data in the "research" simply fails to correlate with reality. In spite of having an adult circumcision prevalence rate of 80%, the USA has a higher HIV transmission rate than 53 countries where circumcision is rare (less than 20%), according to the CIA fact book.

The thing is, even *if* a scientifically demonstrable causal link between male circumcision and a reduction of HIV transmission could be established, there are ethical problems with promoting what is essentially genital mutilation in the name of disease prevention.

Does it not strike anyone else as odd that people are busy trying make surgery indispensable, as opposed to making it obsolete?

How would we react to similar "research" if the subjects were women?

The Langerhans cells hypothesis, if it were valid, could also apply to women, where Langerhans cells also line the mucosa of the female vulva. Women also have a bacterial environment which, if changed, may or may not reduce HIV transmission. For whatever reason, no plans for "circumcision trials" in women exist.

If a causal link could be established between a reduction in HIV transmission and the removal of labia from women, how would we look at "circumcision trials" that involved thousands of women?

What if the WHO endorsed female genital cutting as "HIV prevention," and it had the "research" to prove it?

How would we react to the AAP endorsing female genital cutting?

Well. We already know the answer to that question, don't we.

Would there ever be enough "scientific evidence" to vindicate female genital cutting as "tradition?"

Read the banner on my blog.

Genital mutilation, whether it be wrapped in culture, religion or “research” is still genital mutilation.

It is mistaken, the belief that the right amount of “science” can be used to legitimize the deliberate violation of basic human rights.

Related Posts:

Politically Correct Research: When Science, Morals and Political Agendas Collide

Where Circumcision Doesn't Prevent HIV

Where Circumcision Doesn't Prevent HIV II