LB - You have ignored the fact that it was claimed
that circumcision prevented AIDS and STDs. What
you state about sunspots would
be good evidence against a claim that the
Republican congress prevented sunspots! It is clear
that if circumcision has any prophylactic effect it
is swamped by other social and medical
factors or else some positive correlation would
be apparent. It simple logic to say that a
preventative measure should produce an obvious
result if it is sufficiently effective. If circumcision
was 100% effective there would be fewer
cases of STDs and AIDS in circumcising countries
than in non-circumcising countries. This does not
appear to be the case. It is up to the proponents
of routine infant circumcision to justify their
position. The facts quoted in the original message
remain unchallenged.

Best regards, Lindsay Berge
----------------
JP - Some random observations
------------------
Document 1117
 DOCN AD941117
 TI   "Circumcision as a Safer Sex Intervention?"
 DT   940500
 SO   Volunteer (05/94-06/94) P. 6
 AB   {*filter*}ly active, but uncircumcised gay men have a
two-fold risk ofHIV infection, according to a study by
researchers at the University of Washington.  
The scientists surveyed more than 500 {*filter*} men,
85 percent of whom were circumcised.  The findings
suggested that"the role of circumcision as an
intervention strategy to reduce {*filter*} transmission of
HIV warrants consideration."

DISTRIBUTED BY GENA/aegis (714.248.2836): Copyright
(c) 1994 -Information, Inc., Bethesda, MD.  This
information is provided by theCenters for Disease
Control & Prevention (CDC), National AIDSClearinghouse
as a public service. Noncommercial reproduction
encouraged.
-------------
Newsgroups: hiv.aids.data
Distribution: hivnet
Date: Tue, 16 Aug 94 10:22:40 +0100


Subject: CIRCUMCISION MAY PLAY IMPORTANT ROLE
IN SPR
Document 0030
 DOCN  YUPD9430
 TI    CIRCUMCISION MAY PLAY IMPORTANT ROLE IN
           SPREAD OF HIV
 DT    940808
 AU    Edward Stim
 SO    CONFERENCE NEWS: Published by The Organizing
Committee of the Tenth International Conference on
AIDS/International Conference on STD 1994 - Yokohama,
Japan; Distributed Electronicly by GENA/hivnet
Amsterdam ISSUE 2, Monday 8 august 1994

excerpt - The most convincing data came from his
14-month prospective study that started with
initially HIV-negative men. After 14 month, the
highest numbers of HIV-seroconverters were the
uncircumcised, {*filter*} ulcer patients (48%) and
the lowest, the circumcised,
non{*filter*} ulcer group(2.6%). In between in incidence
were the uncircumcised, no-ulcer group (26% ) and the
circumcised, ulcer group (12%). This highly significant
finding, implicating the foreskin as a major AIDS risk
factor is backed up by a meta-analysis of 28 studies,
26 of which suggest a strong correlation between HIV
seroconversion and an uncircumcised {*filter*}. According
to the combined data, the presence of a foreskin
increases the risk of HIV infection 3-fold, and, if one
includes aprospective 10-year period of usual exposure
to HIV, circumcision hasthe potential of reducing the
seroconversion rate of an at-riskpopulation from 15%
to 0.7% after 10 years.

Asked what might be the mechanism of circumcision's
protective effect, Prof. Ronald suggested that the
presence of a foreskin created a moist mucous
membrane on the {*filter*}, which is more receptive to
HIV transmission than the drier, thicker similarly
located skin area of the uncircumcised {*filter*}.

But he cautioned the audience about a premature
attempt to apply his data to large populations,
emphasizing that more prospective research should
be done to confirm what at present he considers a
very strong hypothesis on the transmission of AIDS
to the insertive partner. He suggested that Bombay
might be an ideal place to further test his hypothesis
because of the significant numbers of Hindus and
Muslimswho have many similar characteristics
from an STD-risk standpoint butwho differ on
attitudes toward circumcision.

In a very stimulating question and answer period, it
was pointed outthat the surprisingly low HIV
seroconversion incidence in the, Philippines
(compared to others wise similar uncircumcised
populations in Southeast Asia) could be explained
by the virtual 100% circumcision rate for Philippine men.

In response to other questions, Prof. Ronald
emphasized that even ifhis circumcision-HIV
hypothesis is confirmed, the response should not
be mass circumcision of at-risk populations. Instead,
the 4 C,s of HIVprevention - {*filter*}s, Compliance,
Counseling & Contact Tracing should be supplemented
by a 5th:

Circumcision in high-risk populations based on
informed voluntary choice. He also concurred with
an audience questioner that the most effective
AIDS prevention was responsible monogamous
{*filter*} behaviorand, when that could not be assured,
{*filter*} availability and good use.

       DISTRIBUTED BY GENA/hivnet
--------------.
TI: {*filter*} behavior, {*filter*}ly transmitted diseases,
male circumcision and risk of HIV infection among
women in Nairobi, Kenya.
AU: Hunter-DJ; Maggwa-BN; Mati-JK; Tukei-PM;
Mbugua-S
AD: Department of Epidemiology, Harvard School of
Public Health, Boston, MA 02115.
SO: AIDS. 1994 Jan; 8(1): 93-9
AB: ------ Women whose husband or usual sex
partner was uncircumcised had a threefold increase
in risk of HIV, and this risk was present in almost
all strata of potential confounding factors.-----
----------------
TI: AIDS in sub-Saharan Africa: the epidemiology of
hetero{*filter*} transmission and the prospects for
prevention.
AU: Hunter-DJ
AD: Department of Epidemiology, Harvard School of
Public Health, Boston, MA 02115.
SO: Epidemiology. 1993 Jan; 4(1): 63-72
AB: --- Other {*filter*}ly transmitted diseases and
lack of male circumcision may increase the
probability of transmission of HIV during {*filter*}
{*filter*} and probably are partially responsible
for the rapid diffusion of HIV in Africa.--

-------------
HIV (AIDS virus) is more prevalent in uncircumcised
males (New England Journal of Medicine
1988;319:274-78; Lancet 1989;2:403-407; Int J
Epidemiology 1990;19:693-97).
--------------
HIV is much more common in females with
uncircumcised partners
(AIDS 1994;8:93-99).
---------------
Following circumcision, the surface epithelia of
the glans develops a protective keratin layer and
acts as a form of natural {*filter*} (New England
J of Medicine 1987;316:1546-47).

If this is true, why doesn't the CDC recommend circumcision
as a preventave measure for AIDS?

If this is true, then why does the United States, with a
circumcision rate of {*filter*}ly active males at 70%+ have one
of the highest rates of AIDS in the world? Why do countries,
particularly European countries where the vast majority of men are
normal (intact), have a much lower rate of AIDS *and* STD's?

Can you answer these questions? You posted similiar 'studies'
about a year or so ago. You couldn't explain last year why the
United States has the highest rate of routine infant circumcision
yet still had one of the highest rates of AIDS in the world.
Can you answer it this year....or are you just fearmongering,
seeking to pursade mothers to mutilate their children's {*filter*}s?

All the major medical organizations in the United States
recognize routine infant circumcision as a "social" custom
only.

Sorry you took so much time to type out these reports. Sorry also
you failed to present the studies which indicate circumcision may
actually be a factor in promoting AIDS.

What's on your schedule Mr. or Mrs. Pichard? Well, let me guess.
In May we roll out the AIDS scare and blame it on the normal {*filter*} and
give it a month or two...then in July we roll out the {*filter*}
scare and give that a month or two...then in September we roll out the
cancer scare and give that a year or two...then when things get slow
remind C. Blow to fire up the UTI scare...then in November roll out
the "he'll be different" scare...(in December, in respect for the
Christans, post nothing)...then in January roll out the "clean"
scare...then in March pretend you were circumcised as an {*filter*}
(remember, last year you were fif{*filter*}, this year you were thirty)
and how much better sex is, etc.

Congratulations Pichard, you're right on schedule.

[ pro-circ abstracts deleted ]

There's more to the story than Pritchard would have us believe.
I believe it is dishonest to simply plaster abstracts all over the
place unless you have an understanding of the issues involved.

If you are really interested in a complete understanding of the
HIV/AIDS vs. circumcision issue, as a start, you would do well to
read the 1994 survey article of de Vincenzi and Mertens of the World
Health Organization (available at the URL)

http://www.***.com/

They stated:

---

"Recent publications have reported an association between the lack
of male circumcision [sic] and {*filter*} transmission of HIV ...
In this article we review the evidence in support of the association
between the lack of circumcision and STD, including HIV infection,
and the possible biological explanations. we discuss implications
for public-health interventions and suggest areas and methods for
further research.
...
... relatively few studies have been carried out and those that
have, present conflicting results. The major criticism of most
of the studies preformed to date is the lack of attention given
to potential confounding factors, which could be related to both
circumcision status and risk of {*filter*}ly transmitted
infections, such as {*filter*} behaviour or differences in hygienic
practices, or differential use of specific health facilities. As
Poland [48] noted, "We must remember that circumcision is not
performed randomly."

Therefore, further efforts are still required to quantify the
relative risk associated with the lack of male circumcision...

As the safety, expected benefits, feasibility and acceptability of
mass circumcision are all questionable, neither public-health
interventions nor intervention studies appear to be defensible
options before there is stronger evidence from observational studies
in different settings that show lack of male circumcision may be
a genuinely independent risk factor for the transmission of HIV."

--

g.

--
   I conceal nothing. It is not enough not to lie. One should strive
   not to lie in a negative sense by remaining silent.  ---Leo Tolstoy

Leaving all the atributions in because I'm not sure who posted
the abstract.

Alyn
"Just the facts, ma'am"

says...

beth

AF - If this is true, then why does the United States,
with a circumcision rate of {*filter*}ly active males at
70%+ have one of the highest rates of AIDS in the world?
Why do countries, particularly European countries where
the vast majority of men are normal (intact), have a
much lower rate of AIDS *and* STD's?

Can you answer these questions? You posted similiar
'studies' about a year or so ago. You couldn't explain
last year why the United States has the highest rate
of routine infant circumcision yet still had one of the
highest rates of AIDS in the world. Can you answer it
this year....or are you just fearmongering,
seeking to pursade mothers to mutilate their
children's {*filter*}s?

JP - The hypothosis relates to transmission from
infected female to uninfected male. In fact, North
American white males, who are most likely to
be circumcised, have a  low rate of infection. In spite
of admittedly wide spread prevelence of HIV in the
society as a whole, the female to male transmission
rate remains very low. This is consistent with the
hypothesis. Referring to a safe simple medical
procedure as {*filter*} of childrens {*filter*}s sounds
a lot like fearmongering to me.  

AF - All the major medical organizations in the United
States recognize routine infant circumcision as a
"social" custom only.
JP - Potential medical benefits - but not necessarily
cost benefits - have been established. Do you want to
decide on what is best for your child on the advise of
a medical doctor or a health provider cost accountant?

AF - Sorry you took so much time to type out these
reports. Sorry also you failed to present the studies
which indicate circumcision may actually be a factor
in promoting AIDS.
JP - Your group had already done so. Why did you not
also present the alternate view and save me the
trouble?

AF - What's on your schedule Mr. or Mrs. Pichard? Well,
let me guess. In May we roll out the AIDS scare and
blame it on the normal {*filter*} andgive it a month or two
...then in July we roll out the {*filter*} scare and give
that a month or two...then in September we roll out the
cancer scare and give that a year or two...then when
things get slow remind C. Blow to fire up the UTI scare
...then in November roll out the "he'll be different" scare
...(in December, in respect for the Christans, post
nothing)...then in January roll out the "clean"scare...then
in March pretend you were circumcised as an {*filter*}
(remember, last year you were fif{*filter*}, this year you
were thirty) and how much better sex is, etc.

JP - Posting current information on the hypothesis
relating male circumcision and HIV, without editorial
comment, does not constitute a scare tactic.

I was age thirty and have never said otherwise.

I have never brought up UTI. When it has been brought
up by your side, I have referred the reader to C Biows
postings. I doubt C Biow appeciates the suggestion
that I have the ability to fire him up.

I originally posted the Ronald-Plummer-Piot
abstracts because they had not previously been
posted. Aside from that, in the overwhelming number
of posting, I have simply reacted to statements
which I believe to be inaccurate, incomplete or
comically outrageous.

AF - Congratulations Pichard, you're right on
schedule.
JP - Your boys set the agenda.

Newsgroups:
misc.kids,misc.kids.pregnancy,misc.kids.health,alt.mens-rights,soc.men,talk.politics.medicine,sci.med
Subject: Re: Circumcise warning to parents; etc
Date: 8 May 1996 18:23:57 GMT
Organization: .

Leaving all the atributions in because I'm not sure who
posted the abstract.

Alyn

JP - Thanks for your comment. In fact, the abstract
does not even mention neonatal circumcision.
Misc.kids is not a particularly appropriate place to
be discussing this matter. The report has been posted
in the past and I will be glad to e-mail the full report
on request.

Newsgroups:

[ pro-circ abstracts deleted ]

There's more to the story than Pritchard would have
us believe. I believe it is dishonest to simply plaster
abstracts all over the place unless you have an
understanding of the issues involved.

If you are really interested in a complete understanding
of the HIV/AIDS vs. circumcision issue, as a start, you
would do well to read the 1994 survey article of de
Vincenzi and Mertens of the World Health Organization
(available at the URL)

JP - I would have you believe nothing - information is
simply information. Interpret it as you will. Would I
be more honest to offer editorial comment as you do
with your postings? Or conceal the information? And
there is more to the story
than the de Vincenzi and Mertens report - it is not
the last word. If you would post both sides you would
save me the trouble. There is probably not a single
medical procedure for which there are not legitimate  
differences of opinion. Besides, mass circumcision,
as an intervention, has not been recommeded, to my
knowledge, by anyone.

Go to Lycos or Alta Vista and search the word -
circumcision - there you will see a real plaster job.

Your continual denigration of my honesty and
intelligence could give me a complex. M Novoa said
recently that you were a kind and considerate
fellow.

g.

I conceal nothing.
JP - What about the important information
discussed above?

It is not enough not to lie. One should strive not to
lie in a negative sense by remaining silent.  ---Leo
Tolstoy
JP - amen.

The news system ate the tail of this the first time;
here goes another try:

Sorry; balky news system.  One more try:

The article is long on methodological critique (which for some
reason appears to upset certain posters on this topic when I
apply it to their statements) and objections to insufficient
data (another *faux*pas* for some reason.)

Regarding Hunter, Maggwa, et. al. (AIDS 1994 Jan, V&M cite [17])
V&M note that the results *are* statistically significant for
subjects without active {*filter*} ulcers (hardly a surprising
qualification).  Other than that, the results stand as published.

All in all, objecting that "There's more to the story than Pritchard
would have us believe" and then claiming to offer a "complete
understanding" by means of a paper that covers only the older half of
his references (and them not thoroughly) is at best disingenuous.

--
D. C. Sessions

Looking at the history of circumcision research, it has always been
the pro-circ studies that got the most attention. The reason for this
is simple: There is a human need to find good in all things that we
do. Whether it is there or not.

All in all, the research (such as it is) does not support circumcision
as a prophylactic against HIV infection.

g.

--
   I conceal nothing. It is not enough not to lie. One should strive
   not to lie in a negative sense by remaining silent.  ---Leo Tolstoy

I did try to answer our e-mail but your address bounced.

1. was based on self-assessment of circumcision status, significantly
often wrong.

2. found a significant correlation between circumcision and IV drug
use:
alternate TI: "Penile non-intervention as a drug-prevention strategy"
?
alternate AB: "the role of leaving babies intact as a (passive)
intervention strategy to reduce IV drug use warrents consideration."

3. is subject to many of the same strictures as those critiqued by de
Vincenzi and Mertens

Circumcising to prevent HIV infection - and thereby encouraging
circumcised men not to bother about safe or safer sex - would be
*disastrously* counterproductive.
--
Hugh Young                            *************************
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                                      *************************