Sunday, May 18, 2014

Circumcision & Risk Compensation

Risk compensation is a theory that developed from observing that human beings changed their behaviour according to their assessment of risk level.  It basically states that human beings will do more of something if they feel they have a low risk of harm, or do less of something if there is a high risk of harm.   When applied to circumcision it suggests that if circumcised men feel they are at less of a risk of acquiring an STI/HIV infection, then they are less likely to practice safe sex and more likely to practice risky sexual behaviour, leading to the unwanted outcome of placing circumcised men and their partners at greater risk of infection.  We are already now seeing HIV infections rising in Africa following circumcision campaigns =

When you look at epidemiological health outcome data, you find that the USA with the highest adult circumcision rate in the western world also has the highest rates of HIV & STI infections in the western world.  In Africa 10 of 18 nations, the circumcised populations have higher HIV.  In one longitudinal study in NZ which followed males from birth they found no statistical difference in STI infections and circumcision status. In a recent study from Puero Rico they found circumcised men had higher STI infections:  What all this data suggests is one of 2 things, firstly that circumcision status does not prevent HIV/STI infections, or secondly that if circumcision does provide some protection against HIV STI infections, then high risk behaviour or risk compensation behaviour cancels it out.

The latest research shows risk compensation taking hold in South Africa

A study of a rural community in South Africa has found that circumcised men generally are more likely to be infected with HIV, and that males circumcised in hospitals are 20 per cent more likely to be HIV positive than those left intact. Where 24 per cent of uncut men were found to be HIV positive, the incidence of HIV among males circumcised in hospitals was 31 per cent. These findings have come as a shock to the South African Medical authorities who have been following the orders of US and WHO health officials and “rolling out” the provision of mass circumcision as a response to the nation’s AIDS crisis. As the authors of the report comment ruefully, it seems that when it comes to the spread of HIV, anatomy is less important than behaviour - exactly what critics of the circumcision programs have been arguing for years. In fact, many other studies have found that in the real world there are many regions in Africa where there is little or no difference in the incidence of HIV infection between cut and uncut men, and that in quite a few places cut men are more likely to be HIV positive.
The conclusion of the report reads as follows: “Medically circumcised older men in a rural South African community had higher HIV prevalence than uncircumcised men, suggesting that the effect of selection into circumcision may be stronger than the biological efficacy of circumcision in preventing HIV acquisition. The impression given from circumcision policy and dissemination of prior trial findings that those who are circumcised are safer sex partners may be incorrect in this age group and needs to be countered by interventions, such as educational campaigns.”

In realty, Circumcision is not a medical solution to HIV/STI prevention, circumcision is just a deeply embedded cultural practice which forever seeks to justify itself because its victims need for validation. In this current age, circumcision cultures try to defend the practice by pointing to medical benefits, which epidemiological outcome studies have repeatedly shown dont exist at population levels.  Europe & Japan with the lowest circumcision rates have the lowest HIV/STI's rates in the world, and its people live the longest with lowest levels of disease.  Proof circumcision not required for good health.

If one is truly interested in reducing the risk of HIV/STI infections then Education, Behaviour Change, Condoms, HPV Vaccination & Retro-Viral medication are much more effective without all of the problems associated with circumcision.

The human tendency to risk compensate means circumcision is at the very least useless or at its worst, a risk to public health by endangering both men and women to infections, disease and ultimately death in some situations. (Death has been documented from circumcision itself, and many circumcised men have died from HIV/AIDS around the world, just look at America)