Foreskin cells more susceptible to HIV

[star-warrior]

Ok, I have a foreskin, as do quite a number of you, however, it is surprising to find this out, and it is a finding that WHO (World Health Organisation) have announced on. I think the director of HIV/AIDS at the World Health Organization has a rather fitting name "Kevin De Cock "!


http://news.bbc.co.uk/1/hi/health/6502855.stm

WHO agrees HIV circumcision plan

Foreskin cells are thought to be more vulnerable to HIV infection

International experts have backed the use of male circumcision in the prevention of HIV.
The World Health Organization and UNAIDS said circumcision should be added to current interventions to reduce the spread of HIV.
Three African trials have shown that circumcision halved the rate of HIV infection in heterosexual men.
The recommendations largely apply to countries where rates of heterosexual transmission is high.
Experts warned that greater use of circumcision would not replace the need for other prevention methods, such as condoms.
But modelling studies have shown that if male circumcision was more widely available, millions of lives, particularly in sub-Saharan Africa would be saved.
WHO and UNAIDS said access to the procedure should be urgently scaled up in areas with high rates of heterosexual infection and low rates of male circumcision.
But warned that it was an additional intervention and would not replace programmes providing HIV testing, or prevention or treatment for sexually infected infections.
Men and their partners must also be given counselling to prevent them developing a false sense of security, they said.
Training and monitoring must be done to check circumcision is being done by appropriate health professionals in a sanitary environment with proper equipment.
And they stressed there was no evidence yet as to whether circumcision has any impact on the risk of infection for the woman or on the risk among men who have sex with other men.
Significant step
Kevin De Cock, director of HIV/AIDS at the World Health Organization said: "The recommendations represent a significant step forward in HIV prevention."
"Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men."
However, he said it would be years before the impact on the epidemic would be apparent.
Catherine Hankins, UNAIDS, said: "Being able to recommend an additional HIV prevention method is a significant step towards getting ahead of this epidemic.
"However, we must be clear: male circumcision does not provide complete protection against HIV.
"Men and women who consider male circumcision as an HIV preventive method must continue to use other forms of protection such as male and female condoms, delaying sexual debut and reducing the number of sexual partners."
All three African trials were stopped early because the results were so dramatic - with reduced rates of new HIV infections of 48-60%.
There are several reasons why circumcision may protect against HIV infection.
Specific cells in the foreskin may be potential targets for HIV infection and also the skin under the foreskin becomes less sensitive and is less likely to bleed reducing risk of infection following circumcision.
When Aids first began to emerge in Africa, researchers noted that men who were circumcised seemed to be less at risk of infection but it was unclear whether this was due to differences in sexual behaviour.
Deborah Jack, chief executive of the National AIDS Trust, said: "These recommendations address many of the benefits of including male circumcision in a comprehensive HIV prevention package.
She added: "Additional research to determine the health impact for women and men who have sex with men is vital, as is ensuring that adequate resources are provided to fund existing prevention methods, as well as continue research into new technologies such as microbicides and vaccines."

 

[runner]

Rubbish. Circumcision will not prevent aids.

 

[3nipples]

Reduce by how much?

Does the US have a significantly lower rate of infection than Europe?

As long as you still need to wear a condom to be safer, you might as well just keep your foreskin.

 

[chimere]

The evidence right now is contradictory - the "specific cells" they refer to in the article (yet don't dare name?)are Langherans' cells; it is the leading theory on why circumcision reduces HIV transmission - link

However, there is new, contradictory evidence to this theory: link

There is also premature findings that it might even increase the HIV risk for women: link. Given De Cock's comments in the article, it is fair to say he is basing the policy on two of the American-funded randomized trials.

So if it's not Langherans' cells, then why is it that circumcision reduces HIV risks? One possible answer, also a weak point in the American studies: hygiene. In all of the American studies, hygiene was an unaccounted factor in the study - which is quite significant, given that these studies are all carried in third world African nations. link

For the UN to make a widespread policy such as this based on two longitudual studies that suffered from the same limitations is quite poor - I think it's the desperation from the effects of HIV/AIDS that's making the organization putting out rash policies in so little time. I mean how can you honestly tell nations to start circumcising their males when you can't even know, case-by-case, the reason why HIV infection rates are reduced. This seems to play into a big AIDS panic.

 

[oz_doc]

There is definitely solid recent evidence that circumcision reduces the risk of HIV infection but i must say i think it is rather premature by the WHO to be recomending mass circumcision programs as a preventative measure. Not sure if people on here are familiar with the biostatistical concept of number needed to treat (NNT) which is the number of procedures or prescription of the therapy being investigated needed to prevent one outcome of interest, in this case how many circumcisions are needed to prevent one HIV infection. If I remember correctly the NNT here is around 60, i have yet to see any satisfactory evidence that the complication rate and other adverse effects of 60 circumcisions are lower than the effects of one infection. Therefore I still maintain that this is surgery that should be available for cultural, personal, religious and now HIV preventative reasons, but i think it wold be innapropriate to base a population health strategy recomending mass circumcision programs on the evidence as it currently stands.

 

[chimere]

Why such speed?

A critical perspective would be a good analysis of this policy: who benefits from the circumcising of millions of African males? The benefits of those males is already in question, given the uncertainty of the factors involved in heterosexual HIV transmission; but it's the millions of dollars that will be generated for the medical companies that will be carrying out the procedure. Ten dollars says it will be mostly American corporations and firms to do the job. After all, there is sceptism, both from the locals and foreigners alike, whether local doctors would have the hygeine and skill to carry out the procedure safely. Which is by contrast, sheer irony since the reports that touted the procedure and simple and life-saving to carry out. So this puts them further in the dependence of first-world countries. It's funny how both of the original studies on circumcision went first to the press, and second to the journals in reporting their findings.

An article many of you should read if you're interested about medicine in the third world from the BMJ: link

 

[chimere]

Reduce by how much?

Does the US have a significantly lower rate of infection than Europe?

The claim is that circumcision reduces HIV infection by "half", but that is completely misleading. link for info on the deception used in absolute vs relative risk in medicine; and of course, i'm not surprised by the mass media in perpetrating this.. after all, it's whatevere controversy they use to their advantage to gain viewers. a sad fact of misinformation, really.

There is further irony that the US has one of the highest infection rates in first-world countries. Japan has the lowest HIV infection rate in the world; and they're a country that doesn't circumcise. Likewise with many Nordic countries like Denmark, Sweden, etc.

 

[luminum]

If they decide it's for the best, then so be it. But fiscally, I find it impractical. It also doesn't work to address changing behaviors and attitudes toward unsafe sex.

It's not really a surprise for the medical findings about foreskin.

 

[jockboy01]

A critical perspective would be a good analysis of this policy: who benefits from the circumcising of millions of African males? The benefits of those males is already in question, given the uncertainty of the factors involved in heterosexual HIV transmission; but it's the millions of dollars that will be generated for the medical companies that will be carrying out the procedure. Ten dollars says it will be mostly American corporations and firms to do the job. After all, there is sceptism, both from the locals and foreigners alike, whether local doctors would have the hygeine and skill to carry out the procedure safely. Which is by contrast, sheer irony since the reports that touted the procedure and simple and life-saving to carry out. So this puts them further in the dependence of first-world countries. It's funny how both of the original studies on circumcision went first to the press, and second to the journals in reporting their findings.

I have to disagree with you here. Where would these medical companies be getting said millions of dollars? Definitely not from the citizens of these third world countries. There is no real money to be had in the medical communities of third world countries (okay, a little, but nothing like that to be made in the 1st world ones). So most of the work done there really is charitable.

As to the article, it reduces the risk. So what? So does condoms. I would be surprised if anybody pushed for circumcision of all males worldwide based on this. It would make no sense.

 

[chimere]

Well I don't know, third-world countries are generally exploited in terms of medicine. They're not getting access to generic drugs because of copyrights and patents by pharmaceutical giants, and there's a huge black market for drugs (many of which are dangerous 'knockoffs'). I do admit a conspiracy of American market domination to be a bit farfetched and that there aren't any real earnings in Africa, but there is a power inequality to be addressed. It seems to be centered on American interests rather than African ones; many of these African countries have been adamantly opposed to circumcision historically.

 

[3nipples]

Circumcisions have been performed in Africa for thousands of years. I doubt that they would have to resort to American or European surgeons.

 

[wonderfulelectric]

Ewww... This may be the way how cosmetic manufacturers get their stem cells and collagen from. I hear the ones form foreskins have the best quality.

 

[chimere]

Circumcisions have been performed in Africa for thousands of years. I doubt that they would have to resort to American or European surgeons.

Yes and no. It's highly regional - some have done it forever, some have never done it at all. Tradition means nothing, however; the case I'm arguing here is about safety and hygeine. There were cases in South Africa where many kids have died from circumcision procedures because of negligance and lack of medical training.

 

[hermanding]

there's always the condon
ding