Monday, July 25, 2011

Respone to David Wilton @mc_hiv

 This is a response to David Wilton's summary of his trip to UNAIDS Rome, where in the end he asks for responses from the intactivist community, my responses will be in bold, David Wilton's article has been reproduced in plain text:

I perceived our interaction with the delegates who chose to come by our booth as mostly positive. Excellent  A few wanted to argue. A few said they agreed with us, but felt powerless to oppose the juggernaut. Almost none knew anything about foreskin anatomy or the purpose of the foreskin. Thats our/your job to educate., and you educated, even though some did not want to listen.  Those who said they agreed with us were from non-circumcising countries, including Cambodia, Russia, Brazil, Colombia, Italy, South Africans descended from non-South African tribes, Australians, and really anyone who has had or experienced a foreskin outside of Africa.  You provided an alternative voice, as the circumcision promoters want to use this platform as a way of arguing for infant circumcision, and therefore your presence was strategically important.
The ones who know what a foreskin is and how it impacts comfort, health, and sexual pleasure were with us. Of Course its just common sense. Those who did not have this experience or knowledge where skeptical. I concluded somewhere through the middle of the four days of the conference that our message was not going to succeed on refuting the risk reduction impact of circumcision, but on informing about the benefits of the foreskin. Ignorant people, including Auvert, Piot, Fauci, Bailey, Westercamp, Gray, Weiss, and others, cannot be expected to provide informed consent in their circumcision consent generating interviews when they know little about the appendage they propose to cut off - and couldn't care less anyway. This is the ethical issue, that we must fight for and insist on, informed consent, of all the facts, including the anatomy and function of the foreskin, and the limitations of the protective effect of circumcision.
Worse still is the possibility that the information told to circumcision candidates is inaccurate or may trivialize foreskin anatomy and function. Truthful & Factual information is important in providing informed consent and ethical, this needs to be highlighted in peer review journals, that the ethics of this program need to be questioned. One argument that came up with a group of Ugandans was that a little bit of pleasure was worth losing for the benefit gained. They are entitled to take this position, as adults they can trade part of their functional anatomy for another gain.  Obviously they need to be fully informed about the limits of the gain, because if they are trading their foreskin for completet protection from HIV then that is a fraud.  So accurate informed consent is the ethical issue here.  Clearly, this common counterargument had been subsumed in the discussion and discounted long before IAS 2011. Not once but often we heard the refrain, do you have any evidence to support your position? Our answer was to refer to the myriad published studies that support our contentions usually through reinterpretation. This was not often convincing to a skeptical scientific audience.  Your job is to provide truthful accurate information and not the impossible which is to convince those that do not want to believe. You need to clarify what arguments you want to make, at one level it is a bit unclear to me also.
The question is how can we provide any plausible counterarguments if we are not in Africa, not doing the research, not involved in the roll out or planning phases of circumcision campaigns, and generally confined behind our screens and keyboards. That is the crux of the issue.  The circumcision lobby has gone into Africa, and whatever their motivations, they have bought 100's of millions of dollars of medical resources, to combat a disease that has cost 10's of millions of lives. How can you possibly be expected to compete with that.  If we could get a wealthy benefactor such as Gates to donate hundreds of millions of dollars and provide healthcare and education, retroviral medication, offering a non-surgical solution for Africa's HIV epidemic, then we may have earned greater influence. At the very least, we need to present something even if it is only within our booth and not part of the official program. With the resources you had, you did brilliant, just need to have realistic expectations about what is possible with only a small percentage of the resources you had. We either get involved or sit it out and let the circumcisers continue to drive developments. This conference clarified this for me.  Clarify your goals what are they?  Is it to end infant ciircumcision in America or to end HIV/AIDS epidemic in Africa? What adult volunteers decide to do with their bodies is different to what you do to a baby that cannot consent!  This is the key argument.  Proper Informed  consent is a valid criticism, and you can make points here.  Only adults can make proper informed consent.  Babies cannot become informed or consent.  Babies havent yet decided what life-style options they will pursue, and are not yet aware of the circumstances of their environment  = such as do they live in a high risk hiv prevalance area or a low risk low hiv prevalance area?
I call on the community of intactivists to think this through and come up with a strategy that will arm us with better information and counterarguments to face this threat to genital integrity and informed consent in Africa and ultimately the United States.  From a scientific point of view, intactivist who are peers of the scientists making claims of 70% reductions in HIV infections, have to examine the methodology and results of the published work and write to peer review journals, identifying the scientific/methodological floors if there are any.  Superficially, there appears to be many confounding factors in what is being reported.

The well known evidence/arguments are established and as follows;

How is HIV sexually acquired and  sexually spread, & How can we reduce or eliminate infections.  The further question = Does circumcision reduce HIV sexually acquired and spread infections and if so how?

Sexually acquied HIV is acquired through sexual activity, hypothesised to be least likely via dermal (skin) absorption, and most likely via blood exposures, through micro-tears in genital/human skin.  The greatest risk factor in the spread of the disease is unprotected sex spread via multiple sex partners. 

Well established and universally recognised prevention methods are Education and behaviour change.  Using condoms appear the most effective way of reducing skin and blood exposures.   Behaviour change can be very challenging though.  Changing sexual practices such as having sex with multiple sex partners is difficult as there are powerful cultural variables at play.  Long term education is required here.  Unfortunately one of the greatest risk factors is the possibility of behavioural disinhibition, with circumcision becoming a licence for unprotected sex with multiple sex partners.  One auther quoted a non-statistically significamt figure of 0.84 condom use of circumcised men compared to intact men.

What has science found that works :
1. Condoms are very effective, however the reality is humans dont consistently use them. The key here would be how to get humans to use condoms more consistently. Europe which has the lowest HIV infections in the western world also has the highest condom usage.  If its education wealth and healthcare that are the variables here, Africa is a long way from Europe and may require additional strategies.
2. Current HIV vaccines have only proven partial effectiveness. More work needs to be done here, and its hope lies in the future.
3. HIV Viral medication appears promising.  More research and money needed here to up-scale these programs.
4. Controversially male circumcision has been found to have an effect in partially reducing exposures for males who have sex with females, but does not protect females, or men who have sex with men.  Controversially because there have been many criticisms of the male circumcison trials and the methodology used, and some then use this data to advocate universal infant circumcision, which has issues of consent, and whose body is it.  Some of the confounding factors include how much has the education, attention, clinical input, and being part of these campaigns reduced HIV infections versus the circumcision itself.
5. If circumcision is partially effective how does it work. Removing the foreskin removes a large area of genital skin, and therefore reduces skin absorption and micro-tears in genital skin and potential blood exposures.  So in a way it has to work in part.  The questions here are as follows?  Why just stop at male genital skin, why not offer the same partial protection option to females? The vulva will have the same risk factors as the male foreskin, research has found a correlation between lower hiv infections in circumcised African women.  Western values of course will intervene.  However, if adult males can be fully informed about the limitations of the protection of circumcision, and the anatomical losses of the foreskin, they are aware of whether they live in a high or low hiv prevalence are, then it is an option for them to choose for themselves.
6.  Ethics, it is one thing for an adult male to make a fully informed consent decision, versus infant circumcision where the human being has no say over their body or future lifestyle options, not to mention the risks of complications of the surgery on a baby who cannot consent.
7. In the end Africans need to decide for themselves, we just need to make sure American, Australian, European  Asian and Latin Maerican babies arent circumcised because of what Africans decide to do for themselves.

Thursday, July 21, 2011

A desonestidade de pesquisadores da circuncisão

A desonestidade de pesquisadores circuncisão nunca deixa de me surpreender, principalmente quando apresentam informações como fato para uma mídia crédula e público.

Mais recentemente, em um relatório da ONUSIDA em Roma Circuncisão Pesquisadores relataram que os programas de circuncisão havia sido eficaz em reduzir novas infecções por HIV em 55%.

O que realmente foi comparado homens que escolheu-se a fazer a circuncisão, que tendiam a ser mais jovens, mais instruídos e mais propensos a conhecer o seu estado HIV, que se oferecera para circumcison e tinha recebido educação, aconselhamento, triagem clínica, e preservativos gratuitos, e compararam suas taxas de novas infecções para os homens que se recusou a obter-se circuncidar, eram mais velhos, menos educados, menos provável que conheça o estado de HIV, tinha recebido menos ou nenhuma educação, aconselhamento, triagem clínica, ou preservativos gratuitos, basicamente, não participou em qualquer aspecto dos programas de intervenção.

A questão aqui é honesto científica quanto é que as variáveis: Idade, Educação Atitude, a circuncisão, aconselhamento, triagem clínica, Preservativos grátis, o conhecimento do estado serológico, e participação nos outros não-cirúrgico aspectos do programa de intervenção contribuir para diminuir infecções por HIV em comparação com o efeito da circuncisão??

No entanto, os pesquisadores circuncisão apresentar a diferença nas taxas de novas infecções como devido a circuncisão. Como desonesto e não-científica que é isso?

La malhonnêteté de la circoncision des chercheurs

 La malhonnêteté de la circoncision n'a jamais chercheurs cesse de me surprendre, surtout quand ils présentent l'information comme un fait à un média crédules et public.

Plus récemment, dans un rapport de l'ONUSIDA dans les chercheurs circoncision de Rome a rapporté que les programmes de circoncision a été efficace dans la réduction des nouvelles infections à VIH de 55%.

Ce qu'ils comparés sont les hommes qui ont choisi de se faire circoncire, qui avaient tendance à être plus jeunes, mieux éduqués et plus susceptibles de connaître leur statut VIH, qui s'étaient portés volontaires pour circumcison et avait reçu l'éducation, le counseling, le dépistage clinique, et des préservatifs gratuits, et comparé leurs taux de nouvelles infections à des hommes qui ont refusé de se faire circoncire, étaient plus âgés, moins instruits, moins susceptibles de connaître le statut VIH, ont reçu moins ou pas d'éducation, le counseling, le dépistage clinique, des préservatifs gratuits ou, fondamentalement n'a pas participé à tous les aspects des programmes d'intervention.

La question ici est honnête scientifiques combien avez les variables suivantes: âge, éducation, attitude à la circoncision, de counselling, le dépistage clinique, des préservatifs gratuits, la connaissance du statut VIH, et la participation dans l'autre non-chirurgical des aspects du programme d'intervention contribuent à la baisse infections à VIH par rapport à l'effet de la circoncision???

Pourtant, les chercheurs de circoncision présenter la différence dans les taux de nouvelles infections en raison de la circoncision. Comment malhonnêtes et non scientifique est-ce?

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Нечестность обрезания исследователи

Нечестность обрезания исследователи никогда не перестает меня удивлять, особенно если они представляют информацию как факт, чтобы доверчивые СМИ и общественности.

Совсем недавно, в докладе ЮНЭЙДС в Риме Исследователи сообщили, что обрезание обрезание программы были эффективными в плане уменьшения числа новых ВИЧ-инфекций на 55%.

То, что они на самом деле по сравнению было людей, которые выбрали сами, чтобы сделать обрезание, который, как правило, моложе, лучше образованы и более вероятно, знают свой ВИЧ-статус, который добровольно circumcison и получил образование, консультирование, клиническая скрининга и бесплатные презервативы, а также по сравнению своих новых инфекций к мужчинам, которые отказались получить себе обрезание, были старше, менее образованы, менее вероятно, знаете ВИЧ-статуса, получил меньше или нет образования, консультирования, клинический скрининг, или бесплатные презервативы, в основном не участвовали в какой-либо аспект из программ вмешательства.

Честный научный вопрос здесь в том, сколько же переменные: возраст, образование, отношение к Обрезание, консультирование, клиническая Скрининг, бесплатные презервативы, знания о ВИЧ-статусе, а также участие в других не-хирургические аспекты вмешательства программы способствовать снижению ВИЧ-инфекции по сравнению с эффектом от обрезания??

Тем не менее исследователи обрезание настоящее разница в новых инфекций, как из-за обрезания. Как нечестные и ненаучным это?







La falta de honradez de los investigadores circuncisión

La falta de honradez de los investigadores circuncisión nunca deja de sorprenderme, sobre todo cuando presentan la información como un hecho a los medios de comunicación y el público crédulo.

Más recientemente, en un informe de ONUSIDA, en Roma, los investigadores información sobre la circuncisión que los programas de circuncisión han sido eficaces en la reducción de nuevas infecciones por VIH en un 55%.

Lo que en realidad se comparó hombres que se optó por la circuncisión, que solían ser más jóvenes, mejor educados y más probabilidades de conocer su estado serológico, que se habían ofrecido para circumcison y había recibido la educación, el asesoramiento, la detección clínica, y condones gratuitos, y compararon sus tasas de nuevas infecciones a los hombres que se negaron a recibir ellos mismos la circuncisión, eran más viejos, menos educados, menos probabilidades de conocer el estado del VIH, había recibido menos o ninguna educación, consejería, la detección clínica, o preservativos gratuitos, básicamente no participar en ningún aspecto de los programas de intervención.

La pregunta científica honesta aquí es ¿hasta qué punto las variables: edad, educación, actitud hacia la circuncisión, Asesoramiento, Evaluación Clínica, condones gratis, conocimiento del estado serológico, y la participación en los otros no quirúrgicos aspectos del programa de intervención contribuirá a reducir los infecciones por VIH en comparación con el efecto de la circuncisión??

Sin embargo, los investigadores circuncisión actualidad, la diferencia en las tasas de infección por el nuevo debido a la circuncisión. ¿Cómo deshonesta y poco científico es eso?

The Dishonesty of Circumcision Researchers

The dishonesty of circumcision researchers never ceases to amaze me, particularly when they present information as fact to a gullible media and public.

Most recently, In a report to UNAIDS in Rome Circumcision Researchers reported that circumcision programs had been effective in reducing new HIV infections by 55%.

What they actually compared was men who chose themselves to get circumcised, who tended to be younger, better educated and more likely to know their HIV status, who had volunteered for circumcison and had received education, counselling, clinical screening, and free condoms, and compared their new infection rates to men who refused to get themselves circumcised, were older, less educated, less likely to know HIV status, had recieved less or no education, counselling, clinical screening, or free condoms, basically did not participate in any aspect of the intervention programs.

The honest scientific question here is how much did the variables of : Age, Education, Attitude to Circumcision, Counselling, Clinical Screening, Free Condoms, knowledge of HIV status, and participation in the other non-surgical aspects of the intervention program contribute to lower HIV infections compared to the effect of circumcision???

Yet the circumcision researchers present the difference in new infection rates as if due solely to circumcision. How dishonest and unscientific is that?

Friday, July 15, 2011

Why Circumcision doesnt work

Circumcision doesnt work for a number of reasons.

Lets start with Infants & UTI's, firstly UTI's predominatly occur because of kidney disease and abnormality of the urinary tract.  REmoval of the foreskin does not address these issues. UTI's are uncommon in male babies and easily treated by anti-biotics, the harm of circumcision is far greater than an easily treated UTI infection.  Therefore it is medically unethical to use a such an aggressive prophalactic method as a way of treating a rare occurance that is easily treated conservatively.

Lets next look at things like hygeine and STI/HIV infections.

Hygeine is easy just wash, enough said.  Circumcised men still have to practice daily hygeine so makes no difference: you are either a clean/hygeinic man who washes daily or you are a dirty man foreskin or circumcised.  The behaviour of the man is more important than his circumcision status.  You cant force a circumcised man to wash, if he doesnt wash he becomes dirty man!

HIV/STI infections are caused by human behavioural factors. Every research that has done an in-depth analysis of the causes has found the No.1 variable involved in STI infections is having sex with multiple sex partners. The next most important variable was the use or not of condoms. Unless these 2 variables are addressed which are behavioural in nature no progress will ever be made in reducing HIV/STI infections. It is why the USA with highest circumcision rates in the western world has the highest rates of HIV/STI infections in the western world. Advocates for Youth research found Americans had higher number of sex partners and used condoms less than their Non-Circumcised European peers.   The false message that circumcision prevents HIV/STI's can have the negative consequence of encouraging men to continue having unprotected sex with multiple sex partners and lead to a public health disaster.  Which seems to be happening in Africa with reports in press that Men circumcised in Africa are engaging in unprotected sex with multiple sex partner in the false belief that circumcision is like a condom!  Who will take responsibility for this catastrophe?
Human anatomy and human behaviour.  One argument for circumcision is that removing the foreskin reduces entry points for viruses.  Well so would removing the female vulva but we dont advocate that.  2 of the most prominant ways viruses enter the human body is via dermal (skin) absorption/conduction, and via bodily fluids in particular when micro tears occur in the skin allowing blood exposure.  Firstly in relation to skin absorption, well last time I looked a circumcised penis is still made of skin, so it is useless in preventing this method of infection.  Secondly blood exposure, while the foreskin is susceptible to micro-tears, and removing it reduces blood exposure from micro-tears in the foreskin, circumcised men have less sensitive penises, and therefore have to increase friction to reach pleasure thresholds, therefore this increases the risk of micro-tears in remaining skin, and allowing blood exposures to occur.
Over a lifetime circumcision doesnt work and why Intact Europe has healthier men that live longer and have less STI/HIV than their circumcised peers in the USA.  Men change their behaviour, and given behaviour is more important than circumcision status, over a lifetime circumcision is useless!!!

Friday, July 8, 2011

What I hate about Pro-Circumcision Propaganda

I hate the lies, that the foreskin is a useless piece of skin when in fact research has found it has 20,000 pleasure nerves, that it is rich in sensory pleasure, it has a gliding mechanism which facilitates intercourse for both males and females and compliments masturbation, that it keeps the glans moist and internal as nature intended it to be!

I hate the lies about the so called health benefits of circumcision, when in fact research has found intact men who have a natural foreskin are the healthiest men in the world, they live the longest, have the lowest infant mortality and lowest HIV/STI rates in the world.  The truth is good health, hygeine, education, conservative medicine, and safe sex practices are the greatest determinants of male sexual/genital health, not the butchering the male sex organ.

I hate the avoidance about ethics.  That no acknowledgement is given to the rights of the child to make a decision about an important part of their bodies, that culture and parental rights are given prominance over the individual human rights of the child.

I hate the way procircs misuse science and statistics to promote their propaganda!

I hate the way mainstream media never questions procirc propaganda and presents their garbage as fact!

I hate the way procirc's minimize and deny the facts that circumcision has many complications and babies die needlessly every year from the procedure.