NOCIRC of Michigan
Educating a New Generation

THE MICHIGAN CHAPTER OF

THE NATIONAL ORGANIZATION OF CIRCUMCISION INFORMATION RESOURCE CENTERS

About NOCIRC

The National Organization of Circumcision Information Resource Centers (NOCIRC) educates parents and health care providers about infant circumcision.

NOCIRC is internationally recognized as the center of expertise on circumcision. It is a non-profit organization of health activists and health care professionals.

Spreading AIDS by Circumcision:
How the United Nations Failed Africa and the World 

by Norm Cohen, Director, NOCIRC of Michigan

The United Nations’ AIDS-fighting agency admitted last November that it grossly overestimated both the size and the course of the AIDS epidemic.

The agency now believes that the number of new HIV infections probably peaked in the late 1990s at about 3 million per year.  New infections have been dropping since.[1]

Nevertheless, circumcision’s last stand in the medical world has come in the form of urgent calls for worldwide circumcisions to prevent the spread of AIDS.

Fools Rush In

The claim that circumcision reduces the HIV infections actually made Time Magazine’s list of “Top 10 Medical Breakthroughs of 2007”.[2]

The basis of these claims comes from three “randomized controlled trials” in Africa among men who wanted to be circumcised.  These short-term trials were not truly randomized, not representative of the general population, and not controlled for condom use and for other relevant behaviors.

Nevertheless, the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) wasted no time in recommending mass circumcisions worldwide in March 2007.[3]

The exaggerated claims about circumcision were quite extraordinary.  “At last, science has discovered an AIDS vaccine,” wrote Tina Rosenberg in the New York Times.[4]  Robert Bailey, professor of epidemiology at the University of Illinois at Chicago and a circumcision advocate said, “It is permanent and protects every time.”[5]

In fact, the three trials proved that circumcision did not protect the 64 men who became HIV positive within 2 years after being circumcised.[6]

A Common Lack of Common Sense

The researchers in the trials had to perform 56 circumcisions to prevent 1 HIV infection from occurring in less than 2 years time.[7]  The trials were stopped early, before the other circumcised men could ever get infected.

The claim that circumcision reduces the HIV infection rate by 60% was made erroneously on the basis of less than 2 years of study, not on the lifetime of a sexually active male.

Researchers never proved that circumcision prevented infection­–only that an infection lag was observed in some men who were circumcised.

Liar’s Dice

A 60% reduction in infection will decrease towards 0% reduction in subsequent years after repeated sexual contacts.  Therefore, a claim cannot honestly be made that circumcision prevents HIV infection by 60%.

Nevertheless, this 60% reduction in only 69 men was extended to the general population to predict that millions of infections throughout Africa could be prevented.

The behavior and risk-taking of the men in the studies were different before and after their circumcisions.  The circumcised men were reported to have decreased their number of sexual partners and increased their use of condoms, but a reduction in HIV infections was attributed to their circumcision.[8]

Even if the results of the studies were true and all adult men could be circumcised in 10 years, new infections in sub-Saharan Africa would only be reduced by 8%.[9]

The Politics of Circumcision

So as not to be upstaged by the UN, the US Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) are now considering their own policy statements on newborn circumcision.[10]

However, a study published last year by the CDC found that black and Latino men in the US were just as likely to become infected whether or not they were circumcised.[11]

The ethnic group with the highest circumcision rate is African Americans and the group with the highest rate of heterosexually transmitted HIV is also African Americans.[12]

African Americans are infected with AIDS 8 times more frequently than whites.[13]  However, in order not to appear racist in their policy, medical organizations would have to recommend circumcision for all boys.

At the current HIV infection rate, over 1,500 white males in the US would have to be circumcised to prevent one heterosexually transmitted infection.[14]

Parents Will Say No

An official recommendation for newborn circumcision from the AAP and the CDC to prevent subsequent cases of AIDS will be a tough pill for new parents to swallow.  Circumcision and AIDS are both already well-known to Americans.  It’s too late for most of us to accept that one prevents the other.

Those who would circumcise anyway will continue to do so with a new excuse that they may claim but didn’t really need, and those who would not circumcise still will not.

AIDS never became widespread in the United States.  There is no AIDS crisis here, and there never will be.  In the minds of the American public, AIDS comes from bad behavior.

If the disease was cancer or some infection that was not sexually transmitted, then the circumcision promoters would have a chance at convincing parents.  With a guilt-laden, gay-linked disease like AIDS, they have no chance.  Parents are just not going to go there with their newborns, and they are not going to get their older boys circumcised so that they can have unprotected sex!

Parental noncompliance with a recommendation of circumcision will weaken the credibility of the original claim and cast doubt on the significance of the research.

Condom-ize, Don’t Circumcise

Promoting and funding circumcision is particularly appealing to those having religious beliefs in favor of ritual circumcision or in opposition to the distribution of condoms.

The recommendation is as meaningless as it is flawed.  Circumcision advocates propose to persuade men to be circumcised because it will protect them, and then afterwards tell them not to have unprotected sex because it won’t protect them.  They believe that men are stupid and reckless and will act so even if they are told to use condoms.

Circumcision is not a complementary strategy in the fight against AIDS, it is a competitive strategy.  What use is circumcision to a man who wears a condom when he has sex?  And what use is a condom to a man who has gone through all of the trouble of getting circumcised to prevent AIDS?

Researchers are trying to upstage condoms as the only practical way of preventing the spread of HIV.

Advocating circumcision to prevent AIDS contradicts and undermines 25 years of safe sex messages and leaves tens of millions of circumcised men and their partners at risk for a deadly infection.  Condoms are safer than circumcision, cheaper, and they protect women too.

Keeping Women at the Most Risk

Male circumcision reduces HIV infections in women by 0%.[15]  Women are the forgotten majority in AIDS suffering.  In Africa , HIV in young women is two or three times more prevalent as in young men.[16]  Sexually active women of childbearing age have the highest rates of AIDS.

Condoms protect both men and women from getting infected.  At best, circumcision would only prevent men from getting infected, but not from transmitting the disease to women.

Promoting the use of condoms would protect women far more than promoting circumcision ever will.  However, women weren’t factored in by the researchers, except as the ones who spread the disease to men.

Wasting Money Means Wasting Lives

Most circumcisions performed in Africa are done so under nonsterile conditions that spread infections, including HIV.[17]

The cost of one sterile circumcision in Africa is about $56 US[18], which would buy 1850 condoms for free distribution.[19]  That’s a condom a night for five years.  The annual per capita income in Africa is only $745 US.[20]

The estimated cost to circumcise the 120 million HIV-negative men in sub-Saharan Africa would be $6.7 billion dollars, not including the costs to treat complications.  A free condom distribution program for these men would cost $1.3 billion per year.

The inherent risks and complications of infant circumcision, and the costs of treating these complications, are never weighed against the supposed benefits.

Significant reductions in HIV transmission could occur in Africa by treating other sexually transmitted diseases that cause open genital sores.  Such an approach would cost much less than mass circumcisions.[21]

Persistent overestimates in widely quoted HIV/AIDS statistics have skewed funding decisions and obscured potential lessons about how to slow the spread of the disease.  UN and US bureaucrats overstated the extent of the epidemic so they could win political and financial support for their projects.

Problems like malnutrition, pneumonia, and malaria kill more children in Africa than AIDS.[22]

The Circumcision of Truth

The recent studies received funding because US agencies such as the National Institutes of Health liked the researchers’ idea of using circumcision to prevent AIDS.

The primary goal of these American researchers was to find a way to promote circumcision in North America because it has been in decline here.  By relying on the urgency of the AIDS epidemic, which we have now learned was exaggerated, they could keep their research money coming in and promote circumcision worldwide.

Meanwhile, circumcision advocates and the mainstream media like The New York Times cite only the research that promotes their viewpoint while ignoring or dismissing studies that contradict their viewpoint. 

The peer review committees for medical journals aid these advocates in this censoring process by publishing only the research that reaffirms their own viewpoint and the viewpoint of editors and publishers.

In the End, the Truth Triumphs

You can help to spread AIDS by circumcision if you believe the fantastical lie that circumcision protects you, your partner, and your children from AIDS. 

Or you can protect yourself, your children, and those you care about by discarding the hype and by using your own common sense.

For the PDF version of this article, go to: www.NOCIRCofMI.org/AIDS2.pdf

Norm Cohen
Director, NOCIRC of Michigan
NormCohen@NOCIRCofMI.org

References