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Even If Circumcision Helps Prevent HIV Transmission, Good Luck Finding American Guys It Could Benefit

While studies in African countries showed circumcising heterosexual men could reduce HIV transmission rates by 50- 60 percent, snipping away the foreskin would have little to no effect for gay Americans.

Earlier this year results from a meta-study of other research concluded circumcision likely wouldn’t effect gay or bisexual men in the Western world. Now a study conducted in 2008 in San Francisco, whose results were released last week in Vienna at the International AIDS Conference, says the theory is almost certainly bunk — if only because many of these men are already circumcised, AIDS Meds notes.

Whether or not circumcision of adult males in the United States, notably men who have sex with men, will influence the incidence of HIV in this country remains a matter of debate. As recently as March, an analysis of data collected in the United States and other Western countries indicated that circumcision will not necessarily prevent transmission among MSM.

To explore this further, Jonathan Fuchs, MD, MPH, of the San Francisco Department of Health and his colleagues conducted a survey of MSM in San Francisco measuring HIV prevalence, circumcision status, condom use with insertive and receptive anal intercourse, and willingness to be circumcised.

Of the 521 MSM surveyed, 115 (21.1 percent) were HIV positive and 327 (62.7 percent) were already circumcised, leaving 69 (13.2 percent) for whom circumcision may have an additional preventive benefit. Among those for whom circumcision may confer a protective effect—those who predominantly engaged in insertive anal intercourse (21.7 percent reported “topping” at least 80 percent of the time, without condoms, with their five most recent partners)—only three (0.5 percent) were willing to participate in an MSM circumcision trial. What’s more, only four (0.7 percent) were willing to get circumcised, even if it proved to be a safe method that did reduce the risk of HIV transmission.

Extrapolating these findings to the entire MSM population of San Francisco—an estimated 65,700 people, Fuchs indicated—only 500 men would potentially benefit from circumcision.

Then again, maybe it’s missed opportunity if these 500 men will probably sleep with each other at some point in the future.

By:           Ryan Tedder
On:           Jul 26, 2010
Tagged: , , , , ,

  • 29 Comments
    • peteNsfo
      peteNsfo

      Circumcision is genital mutilation…

      Safe sex & knowing your status prevent transmission.

      There’s an undocumented cultural component to all these ‘studies’ starting w/ USA’s fear of sex & the penis in general.

      The most outrageous part of this whole idiocy is that boy’s are mutilated as infants without the ability to decide for themselves; it’s absurd.

      Jul 26, 2010 at 9:48 am · @ReplyReply to this comment ·
    • Zach
      Zach

      Even if circumcision did confer preventative benefits for gay men, how many are actually going to have part of their penis cut off, when they’re already not willing to use condoms?

      And witness the problems with circumcised males in Africa – many think they become immune to HIV and engage in even more unprotected sex.

      Jul 26, 2010 at 11:18 am · @ReplyReply to this comment ·
    • Mr. Enemabag Jones
      Mr. Enemabag Jones

      Black males in America are almost on par with white males when it comes to neonatal circumcision. Yet straight black males have a high rate of HIV incidence. If circumcised American black males are still suceptable to HIV, why do researxchers believe circumcison will help black males in sub-Saharan Africa?

      This is a band-aid solution and is going to end very badly for Africa.

      Jul 26, 2010 at 1:20 pm · @ReplyReply to this comment ·
    • Mike L.
      Mike L.

      I personally think circumcision is wrong, unless it’s for religious reasons, family custom or medical reasons like phimosis. Other than that I think it’s really unnecessary, and the only sure way to prevent HIV regardless of sexual partner.

      Jul 26, 2010 at 1:25 pm · @ReplyReply to this comment ·
    • Larry
      Larry

      I was really disappointed a while back when the SF Chronicle simply took the older circumcision study and uncritically published an editorial recommending routine circumcision for all men. It was terrible journalism back then and, in light of this study, even worse journalism now.

      I’ll admit to being biased: I’m uncut myself and have a moral opposition to circumcision. However, even controlling for that, I still was never convinced of these studies, and like Mr. Enemabag Jones, I also consider it to be a band-aid solution that could have disastrous effects in the long run.

      Instead, I would suggest a time-honored practice that has been proven to reduce HIV transmission in cut and uncut men alike: It’s called a “condom.”

      Jul 26, 2010 at 1:34 pm · @ReplyReply to this comment ·
    • Jimmy
      Jimmy

      Mike L, why do “religious reasons, family custom” get a pass if you think it is wrong. Religion is a choice, as is custom, that an infant cannot make. The way you qualify your personal position is perplexing.

      Jul 26, 2010 at 2:33 pm · @ReplyReply to this comment ·
    • Toby
      Toby

      There is very strong evidence showing the reason that HIV didn’t become a Heterosexual epidemic in the US is because of circumcision.

      Comparing that to the gay community is like comparing apples to gay oranges.

      It doesn’t matter if you “top” 80% of the time…if you bareback bottom that other 20%…well…it changes the study completely.

      I mean YES, of course, circumcision will not prevent HIV infection if you bareback bottom 1 out of 5 guys you sleep with.

      But that doesn’t mean that circumcision is a public health bust.

      It just means that circumcision wont help you if you’re the one getting barebacked.

      Jul 26, 2010 at 2:56 pm · @ReplyReply to this comment ·
    • Michael
      Michael

      @Jimmy: Thanks for pointing that out. I think the biggest problem that pro-circ people have that they simply can’t overcome is that even if circumcision prevented infection rates 100% (which is silly to say even hypothetically because it’s so impossible and so far from the truth), there is still the lingering problem of a violation of proper ethics.

      I understand that many parents with a religion justify circumcision by that religion, but what if the child does not choose FOR THEMSELVES that particular religion or, if it is permitted within it, does not choose that particular practice of that religion or custom? Again, I know it’s tricky because those who believe in a religion generally believe it to be correct, but it is increasingly quite common for children to choose different religious beliefs (or no religion at all) than their parents in today’s world.

      In my opinion, and I could elaborate much more but won’t, that shoots down circumcision for religious or cultural reasons. (And of course, let’s not forget that Jewish circumcision originally removed only the tip of the foreskin, and that anti-Semitism made it more severe around the time of the Greeks!!! This can be read about in Billy Ray Boyd’s Circumcision: What It Does)

      Anyway, I think it’s important to remember for parents that religion (yes that means their particular one) is, to both them but especially to all others outside it, a culture. There are common practices within all cultures…but that doesn’t mean it makes logical sense to follow through with all the rites of that culture. In fact, one may entirely dismiss many facets of a culture and still remain fully functional in it. The dealings with culture and the choices made in regards to culture are psychological and deal with our tendencies as social beings, I believe. Many things that play a big enough role in defining a culture, like circumcision, violate ethics, violate common sense, etc., and so many choose not to do them. And there are groups of Jews, for example, who agree with this. Often, those who disagree with the norm come out stronger, more aware, more present, more fit, more prepared, and so on.

      Circs might also make sense (if the data clearly showed that circumcision helps…which it doesn’t) IF WE HAD NO OTHER METHOD of prevention. On the contrary, we have two big ones: Abstinence and Condoms.

      I’m certainly not entirely abstinent. Some may choose to be, but I limit myself to sex within relationships. I’m not hooking up with several guys. My average rate is about one to two guys a year. Is that boring? Not fun? I don’t know…I don’t think so. I’ve still got my hand. That’s all I really need to be honest. But it’s safe. And I’m usually using a condom even with my boyfriends. If I were to hook up with someone outside a relationship, it would absolutely be with a condom. But that doesn’t happen because I feel that it lowers myself.

      So how hard is that? Moderate abstinence and condoms.

      Lot less painful than circumcision. Circumcision is basically irreversible. Circumcision changes proper and natural function, feeling, and may even be linked to psychological changes when performed in infancy. Intact men are not “dirtier,” either.

      ??

      Still nothing pushing me toward going out and getting circ’d. And still nothing pushing me to suggest circumcisions for my friends or the children they may have. In fact, it all so clearly swings against circumcision, that THAT is indeed what I’d suggest to them: NO circumcisions.

      Read these particularly the first – especially if you are looking for more information about the procedure or are pro-circumcision:

      http://expansionofspace.blogspot.com/2010/06/study-finds-that-cutting-off-fingers.html

      http://expansionofspace.blogspot.com/2010/04/i-wrote-blurb-recently-here-about.html

      Damn I always end up writing so much on Queerty when I’m passionate about something…haha

      Jul 26, 2010 at 3:22 pm · @ReplyReply to this comment ·
    • Michael
      Michael

      Have you seen this??

      http://www.youtube.com/watch?v=OlsUg0sdAtE

      This video is of Dr. Edell who targets the African circumcision movement.

      Jul 26, 2010 at 3:57 pm · @ReplyReply to this comment ·
    • Nathan
      Nathan

      Yeah, I never got the idea behind recommending circumcision for all men, if at all. If I’m uncut and unwilling to use something as simple as a condom, why would I be willing to remove part of my genitals?

      Jul 26, 2010 at 8:24 pm · @ReplyReply to this comment ·
    • Lee
      Lee

      Honestly, I don’t know why people care about this so much, and I don’t know why people hate something that doesn’t hurt so much. To me, if you’re uncut, that’s fine. If you’re cut, that’s fine too. I won’t judge you on it and it isn’t a big deal to me. I don’t consider it “mutilation” in the same why that I don’t consider piercings “mutilation”.

      Jul 26, 2010 at 8:32 pm · @ReplyReply to this comment ·
    • Pip
      Pip

      @Nathan: hit the nail on the head. encouraging circumcision to avoid HIV is approaching the problem backwards. there are dozens of forms of contraception that are more effective.

      Jul 26, 2010 at 9:48 pm · @ReplyReply to this comment ·
    • Mark Lyndon
      Mark Lyndon

      Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they’ve been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn’t happen. We now have people calling circumcision a “vaccine” or “invisible condom”, and viewing circumcision as an alternative to condoms. The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.

      The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw. This is not the first time that HIV in women has been linked with circumcision in men.

      ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

      Jul 26, 2010 at 10:37 pm · @ReplyReply to this comment ·
    • Pat
      Pat

      Anyone promoting circumcision to prevent HIV is only promoting ignorance of how the virus is really transmitted. As the studies proved, even straight circumcised men can get it – even if they were supposedly 60% less likely to have gotten it.

      Jul 26, 2010 at 11:00 pm · @ReplyReply to this comment ·
    • Nate
      Nate

      @Lee: Circumcisions are one of the most painful operations performed on children especially when no pain killers are used, I would like to point out local pain killers don’t remove all the pain and that infants are more sensitive to everything especially pain, if you don’t believe me watch a circumcision for yourself and the say that it doesn’t hurt http://www.youtube.com/watch?v=XmX6RdRNoqk

      Jul 27, 2010 at 1:47 am · @ReplyReply to this comment ·
    • Nathan
      Nathan

      @Lee:

      I don’t know about anybody else, but I’m not judging anybody for being cut. Most of the guys I’ve dated have been cut (an oddity, since it has become comparatively rare where I live). I do think most of the medical reasons are hogwash, and it’s primarily a case of culture dictating what men’s penises should look like.

      If I did bareback, and someone then came up to me and said: “You can either wear this sheath over your penis that will be highly effective, or we can lop off part of your penis, which might be somewhat effective” – then I know which I’m going to do. I’m sure there are some guys out there who would get cut if it meant being able to safely bareback, but there won’t be that many. I’d rather keep it wrapped up.

      Jul 27, 2010 at 11:50 am · @ReplyReply to this comment ·
    • Giovannidude
      Giovannidude

      The WHO/UNAIDS is desperate to come up with some magical treatment for AIDS in Africa because it needs to show that it is being proactive in the face of the AIDS epidemic disaster there. The donors and financial backers are said to be growing restless.

      Circumcision for men (using phony studies) and gel for women (only partly successful) was the best they could come up with. Their recommendations could not include condoms, because that is old hat and many African men don’t want to use them anyway.

      The WHO may also have a guilty conscience, because it unknowingly spread AIDS in Africa in 1975 by using tainted smallpox vaccine that had been laced with AIDS, probably made in U.S. laboratories.

      Has anyone ever wondered if the distribution of hepatitis vaccine to gay men in New York City in 1978 might have been similarly tainted? After all, when official warnings about AIDS went out in the 1980s, it was focused only on those who had had gay sex “after 1977″.

      Jul 27, 2010 at 12:23 pm · @ReplyReply to this comment ·
    • Joseph4GI
      Joseph4GI

      @Toby

      Just what is this “strong” evidence? Links please? What “strong” evidence exists besides the horribly biased studies written by interested “researchers” who rigged the studies and cherry-picked the evidence?

      You do know that these “studies” were written by people who already had a previous interest in trying to find some sort of solid rationale for circumcision right? Look up Bailey and Halperin. Bailey’s had a hard-on for genital mutilation since 1995, BEFORE any “studies” in HIV. Halperin’s on record saying he wants to spread his grandfather’s legacy (his grandfather was a mohel).

      The men who were circumcised in the “study” were told to abstain from sexual activity for 6 months following their circumcisions, not to mention they were thoroughly instructed in the use of condoms. Then the studies were ended early because it would be “unethical” to continue? Right.

      Stats from 6 African countries where HIV was prevalent among the CIRCUMCISED were omitted. (Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland.) WHY did they do this?

      In other countries, the “protection” remains to be seen as well. AIDS is a rising problem in Israel, where the majority of the male population is already circumcised. On July 7th, three weeks ago, Malaysian AIDS Council vice-president Datuk Zaman Khan announced that than 70% of the 87,710 HIV/AIDS sufferers in the country are Muslims (all Muslim men are circumcised). The Muslim population accounts for 70% of the incidence of HIV, but only 60% of the population, which would mean that HIV is spreading at a much higher rate in the Muslim population, where all men are circumcised.

      The studies have glaringly obvious flaws, they were written by people with flagrant conflicts of interest, the results were cherry-picked, and the numbers simply don’t add up in other countries where the majority of the male population is circumcised.

      AIDS cases can’t ALL be bottoming male homosexuals you know.

      Jul 27, 2010 at 12:49 pm · @ReplyReply to this comment ·
    • MikenStL
      MikenStL

      Amputating everyone’s penises would work even better. Why is no one suggesting this instead???

      The amount of adult skin missing due to infant circumcision is about the size of a 3X5 index card, maybe even more. I don’t know about most circumcised males, but I think I would really like to have all of that skin and nerve endings back. Additionally, If we weren’t supposed to have it, then why are we born with it? I’m sure it must serve a purpose…. Just my little rant.

      Jul 27, 2010 at 1:04 pm · @ReplyReply to this comment ·
    • Joseph4GI
      Joseph4GI

      Lee wrote:

      “Honestly, I don’t know why people care about this so much, and I don’t know why people hate something that doesn’t hurt so much. To me, if you’re uncut, that’s fine. If you’re cut, that’s fine too. I won’t judge you on it and it isn’t a big deal to me. I don’t consider it “mutilation” in the same why that I don’t consider piercings “mutilation”.”

      I don’t think anyone is discussing whether a cosmetic procedure is “mutilation” or not. Surely if a man wants to get circumcised, then it’s his prerogative what he wants to do with his body. Men do all kinds of things to themselves, including get tattoos, brow and lip rings, the works.

      Performing circumcision in healthy, non-consenting individuals is wrong for the same reason tattooing a healthy, non-consenting individual is wrong.

      But that’s not even the argument here:

      If the claim that circumcision protects you from HIV transmission is false, then men are being gypped. Doctors are making money from a procedure that does absolutely nothing for a man. Indeed, it does less than nothing, as now we have men thinking they don’t have to wear condoms anymore.

      I’m not sure WHAT it would be called to use dubious rationale to con people into letting doctors mutilate their children.

      Even IF studies were correct, why are people aready making the jump to plug infant circumcision, where infants are not having sex and are at zero risk?

      Shouldn’t whether a man wants to wear a condom or circumcise himself and take his chances bare-back be up to HIM ALONE TO MAKE?

      What, pray tell, is the point of circumcising ANYBODY if they’ll have to wear condoms anyway?

      This circumcision/HIV gravy train is STUPID.

      WHY can’t researchers seem to focus on anything else?

      Usually, research seeks to avoid surgical procedure, if not abolish it entirely. Here we have a group of “researchers” seeking preserve it. “Research.” To vilify a perfectly healthy, perfectly normal body part to legitimize its destruction. I mean, is that not the most backwards line of thinking you’ve ever heard of?

      What “research” is being done to displace circumcision? To eventually find an alternative solution to where men don’t have to consider mutilating themselves for protection? Is there any research being done on THAT?

      To use “research” and “studies” to endorse and promote a procedure whose “benefit” of “HIV risk reduction by 6is absolutely puerile.

      Jul 27, 2010 at 1:07 pm · @ReplyReply to this comment ·
    • Joseph4GI
      Joseph4GI

      Lee wrote:

      “Honestly, I don’t know why people care about this so much, and I don’t know why people hate something that doesn’t hurt so much. To me, if you’re uncut, that’s fine. If you’re cut, that’s fine too. I won’t judge you on it and it isn’t a big deal to me. I don’t consider it “mutilation” in the same why that I don’t consider piercings “mutilation”.”

      I don’t think anyone is discussing whether a cosmetic procedure is “mutilation” or not. Surely if a man wants to get circumcised, then it’s his prerogative what he wants to do with his body. Men do all kinds of things to themselves, including get tattoos, brow and lip rings, the works.

      Performing circumcision in healthy, non-consenting individuals is wrong for the same reason tattooing a healthy, non-consenting individual is wrong.

      But that’s not even the argument here:

      If the claim that circumcision protects you from HIV transmission is false, then men are being gypped. Doctors are making money from a procedure that does absolutely nothing for a man. Indeed, it does less than nothing, as now we have men thinking they don’t have to wear condoms anymore.

      I’m not sure WHAT it would be called to use dubious rationale to con people into letting doctors mutilate their children.

      Even IF studies were correct, why are people aready making the jump to plug infant circumcision, where infants are not having sex and are at zero risk?

      Shouldn’t whether a man wants to wear a condom or circumcise himself and take his chances bare-back be up to HIM ALONE TO MAKE?

      What, pray tell, is the point of circumcising ANYBODY if they’ll have to wear condoms anyway?

      This circumcision/HIV gravy train is STUPID.

      WHY can’t researchers seem to focus on anything else?

      Usually, research seeks to avoid surgical procedure, if not abolish it entirely. Here we have a group of “researchers” seeking preserve it. “Research.” To vilify a perfectly healthy, perfectly normal body part to legitimize its destruction. I mean, is that not the most backwards line of thinking you’ve ever heard of?

      What “research” is being done to displace circumcision? To eventually find an alternative solution to where men don’t have to consider mutilating themselves for protection? Is there any research being done on THAT?

      To use “research” and “studies” to endorse and promote a procedure whose “benefit” of “HIV risk reduction by 60%” is completely supplanted by cheaper, more effective, less invasive, less mutilative prevention methods (condoms) is absolutely puerile.

      *Editor/Moderator: Please delete my previous comment. Computer was acting a little dodgy…

      Jul 27, 2010 at 1:11 pm · @ReplyReply to this comment ·
    • MikenStL
      MikenStL

      If you are relying on circumcision as your means of HIV infection prevention protection, I think you’ve got some serious problems, especially in the developed world were condoms are available everywhere.

      No foreskin does not “safer sex” make. If it did, then why do so many US circumcised (non-IV drug using) males have HIV?

      Jul 27, 2010 at 7:41 pm · @ReplyReply to this comment ·
    • David
      David

      Circumcision whether male or female is a fucking disgrace..

      The fact this bronze age bullshit still occurs is utterly disgusting..

      I’m furious with my parents for doing it to me as a child..

      Jul 28, 2010 at 1:56 pm · @ReplyReply to this comment ·
    • Whoddafunk?
      Whoddafunk?

      I agree with you David, circumcision is genital mutilation and I wish more people would talk openly about this. When I asked my parents why they circumcised me they didn’t want to talk about it and they said it was just what is done. I couldn’t believe they would just do something for that reason without thinking about it more deeply, and I couldn’t believe how nervous they got when it was brought up. That they would do something to their child that they can’t even talk about or justify without getting really nervous is crazy. Their reaction to me simply asking them about it made me feel as if I had stepped over some kind of boundary, like as if I said ‘hey mom and dad, why don’t we have a mutual masturbation session!’ or something crazy.

      Jul 28, 2010 at 2:10 pm · @ReplyReply to this comment ·
    • Shallow HAL
      Shallow HAL

      The reason why circumcision is so prevalent in the US is because it was promulgated fairly recently around 1900 as a cure for all kinds of venerial diseases, even syphilis. The true reason though was the belief that it would reduce ‘excessive venery’, or ability to act on sex drive. The idea was that men would be less able to masturbate and also find sex less pleasurable, and therefore make people do it less. Mr Kellogg of corn flake fame was also one of them, and also believed that bland foods would have a desirable anaphrodisiac property. As with circumcision, corn flakes didn’t do the trick, but it stuck as habit. Parents now continue the practice to not have their child singled out as different, also not necessarily knowing the origin of the practice in modern times.
      However, then as now the advocates of circumcision are veiling their anti-sex stance in a public health message. This being the result not of scientific evidence, or a wish to improve health, but to impose a religious view of sex for pleasure as sin.

      Jul 29, 2010 at 4:59 am · @ReplyReply to this comment ·
    • Jeffree
      Jeffree

      Shower in a gym in Northern Europe and you’ll see that most other guys are not circumcised. They will assume youre je-wish.

      Jul 29, 2010 at 5:36 am · @ReplyReply to this comment ·
    • Kiss Me I'm Queer
      Kiss Me I'm Queer

      That is the most pertinent explanation of the history behind circumcision that one can make.

      Jul 30, 2010 at 2:05 am · @ReplyReply to this comment ·
    • Kiss Me I'm Queer
      Kiss Me I'm Queer

      @Shallow HAL: That is the most pertinent explanation of the history behind circumcision that one can make.

      Jul 30, 2010 at 2:06 am · @ReplyReply to this comment ·
    • William
      William

      Does anybody who is sexually active hop to the doctor’s office for a circumcision to improve their odds of not getting HIV?

      Aug 2, 2010 at 5:33 am · @ReplyReply to this comment ·

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