Research finds that Australian Children have superior health outcomes compared to when Circumcision was common

Health Outcomes in Children taken from Circinfo.org = 

Firstly, A recent Australian (2009) research found that present day Australian Children had far superior health outcomes to when routine infant circumcision was common, read as follows:

"The health of Australia’s children continues to improve, according to the latest report on child health from the Australian Institute of Health and Welfare, A Picture of Australia's Children 2009. During the period 1986-2006 there was a dramatic decline in infant and child deaths (which fell by half), improved survival in cases of cancer, and a reduction in the incidence of asthma.
These are significant findings, given that the period 1986 to 2006 witnessed a huge decline in the incidence of circumcision, from about 40 per cent of boys in the early 1980s to about 10 per cent in 2006. It is thus good empirical proof that “lack of circumcision” does not increase child health problems. Even more significantly, it is a decisive refutation of “scientific” predictions by Terry Russell, Brian Morris and other diehard promoters of routine circumcision that the fall in the circumcision rate would lead to an explosion of genito-urinary problems in boys and an ever-increasing death toll from urinary tract and bladder infections. No such problems are identified in this report, which does not even mention any health problems affecting the genito-urinary area.
On the contrary, the halving of the death rate among infants and children suggests that leaving the foreskin in place could even have significantly improved child health outcomes and contributed to the decline in infant and child mortality. It is, after all, quite illogical to claim that a boy with wound on his penis is somehow healthier than a boy who has not been injured there. As the British child health expert N.R.C. Roberton points out, “it is fundamentally illogical that mutilating someone might be beneficial.” *

The Australian Institute of Health and Welfare is the Australian Government’s premier health research foundation.
The full report and press release can be downloaded from the AIHW website.

Further Reading, data which refutes the idea circumcision leads to better health outcomes:

Reference
N.R.C. Roberton, “Care of the Normal Term Newborn Baby,” in Textbook of Neonatology, eds. Janet M. Rennie, N.R.C. Roberton, 3rd edn. (Edinburgh: Churchill Livingston, 1999), 378-379.

How bad is the African HIV Circumcision research?

The research did not prove life-long protection only partial episodic protection (relative to the trial conditions for only 18months). The trials also did not reflect not real world settings, and therefore how can they be applicable to real world settings. Rarely reported or emphasised, A significant number of circumcised men in the study became infected with HIV.  The participants were not randomly selected, but selected themselves, creating a potential bias or distortion in the generalisability of the results to any general population. The participants were paid adult male volunteers who wanted to be circumcised and therefore had a bias in favour of it, and could possibly have been in favour of circumcision because they were high risk candidates who had unprotected sex (no condoms) with multiple sex partners, and were looking for a way to maintain high risk behaviours. Therefore as the participants were not randomly selected, and were a potentially biased self-selected sample of the population, the results cannot be extrapolated to general populations outside of this population sub-group. (Van Howe & Storms, 2011) Inadequate Controls: Participants in the trials were not treated equally with the circumcised group given more education about healing from surgery, advised to not resume sex for 6 to 8 weeks and therefore, abstained from sex longer, and participants were given greater time and emphasis about wearing condoms during the period of healing from surgery. No control was undertaken to examine possible non-sexual blood exposures by participants. No control was undertaken for dry sex as practised by some african cultures. No control for the sex (gender) of partners, and no control for anal intercourse. (Van Howe & Storms, 2011) Unexplained and disrtorting the statistics was the finding that in the first three months of the Kenyan trial, five men became HIV-positive who reported no sexual activity in the period before the seroconversion (0.73/100 person-years, 95%CI=0.30-1.76). (Van Howe & Storms, 2011)Data suggests a percentage of infections were from non-sexual exposures, with 23 infected men reporting no sexual contact without a condom. No explanations or investigations undertaken for non-sexual exposures to HIV infections. (Van Howe & Storms, 2011) The African HIV Trial researchers were all pro-circumcision and with a history of activism in the area. Nearly 10 times as many participants dropped out of the clinical studies as were infected, with HIV status unknown.  The studies were ended early exagerrating effects.  The vast majority of participants in the study were HIV free, therefore, why was no attempt made by researchers to identify the 100% condom users and compare these to the circumcised group, Was 100% condom use more effective than circumcision = Most probably yes!! but researchers did not want to find this and report it.   No long term follow-up possible with all subjects circumcised at end of trial. Researchers used speculative hypotheses to explain trial findings, such as Langeran present in the foreskin cells are targeted by HIV, whereas later research found Langeran cells actually kill HIV. (Van Howe & Storms, 2011) The studies had such high numbers of participants leading to an overpowering of the statistical analysis, inflating the results. (Van Howe & Storms, 2011) French demographer Garenne criticised the findings by demonstrating that interventions with a near 50% clinical trial efficacy had very little population effect. At best the research findings are only valid for adult circumcision volunteers, and populations with high prevalence of HIV, not babies or low prevalence nations. At worst the research is so floored the findings only have validity within similar research conditions and virtually zero validity for real world situations. Comparisons with vaccinations are invalid.  Most vaccinations are administered orally, dermally or via injection and not surgery removing healthy tissue.  Those that are vaccinated are virtually fully protected, and those that come within proximity, whereas circumcision only partially protects the male for a period of 18months, does not protect female or male partners, with evidence of increased infections in female partners od circumcised males, does not protect against blood exposures, or injecting users, does not protect against male to male sex.  A very poor vaccine indeed. The conclusions to circumcise baby boys does not follow from the experiment which was tested on male adult volunteers for a period of 18 months. The research does not explain how many circumcised populations have higher HIV infections than non-circmcised populations.

HPV infections findings of Thorough Research versus Inadequate Research

Below is a study from University of washington which found a slight but non-statistically significant higher HPV infection rate in circumcised men compared to intact men.  This contrasts with African research which found higher HPV infections in intact men.  However, when you look at the methodologies, you find the African researchers only tested for HPV at 1 site, the glans, versus the washington uni tested for HPV at multiple sites on the penis.  The more thorough investigation found a reported "no difference in HPV infections" using the more thorough methodology.  If you read the statistics circumcised men actually had had higher HPV rates with the ratio of 10 circumcised had infections versus 9 intact had HPV infections .

 

Circumcised men at equal risk of HPV infection

A large-scale study at the University of Washington has found no difference in the incidence of HPV infection between circumcised and uncircumcised male college students. HPV (Human Papilloma Virus) is a large group of viruses that may cause genital warts, and are implicated in the genesis of genital cancers. HPV is very common among the sexually active population. but most people never show any symptoms. The risk factors for the development of cancer have been shown to be numerous different sexual partners and smoking. The new study confirmed previous research which showed that the location of the virus differed between circumcised and uncircumcised men: circumcised men tend to carry the virus on the shaft skin of the penis, while intact men are more likely to carry it on the glans. The study also also found that circumcised men have more sexual partners. In a previous study the researchers found found that for college females the circumcision status of their partner was NOT a risk factor for HPV infection in women. The authors comment that the African Random Clinical Trials, which seemed to show that uncircumcised men were more likely to carry the HPV virus, were seriously flawed because they took samples only from the glans (not from the shaft skin, where the virus is concentrated in the circumcised).
ABSTRACT
Background: The role of circumcision in male HPV acquisition is not clear.
Methods: Male university students (aged 18–20 years) were recruited from 2003 to 2009 and followed up triannually. Shaft/scrotum, glans, and urine samples were tested for 37 human papillomavirus (HPV) genotypes. Cox proportional hazards methods were used to evaluate the association between circumcision and HPV acquisition. Logistic regression was used to assess whether the number of genital sites infected at incident HPV detection or site of incident detection varied by circumcision status.
Results: In 477 men, rates of acquiring clinically relevant HPV types (high-risk types plus types 6 and 11) did not differ significantly by circumcision status (hazard ratio for uncircumcised relative to circumcised subjects: 0.9 [95% confidence interval{CI}: 0.7–1.2]). However, compared with circumcised men, uncircumcised men were 10.1 (95% CI: 2.9 –35.6) times more likely to have the same HPV type detected in all 3 genital specimens than in a single genital specimen and were 2.7 (95% CI: 1.6–4.5) times more likely to have an HPV-positive urine or glans specimen at first detection.
Conclusion: We found no differences by circumcision status in overall HPV acquisition or in number of HPV types acquired. Findings held for all clinically relevant HPV types, as well as for the subgroups of high-risk types, high-risk -9 types, and HPV-16. This observation is consistent with findings from other longitudinal studies.
Bottom line: Circumcision does not lower the risk of infection with Human Papilloma Virus. People who claim that uncircumcised men are more likely to develop or communicate genital cancers are ignoring the facts and spreading misleading information.
Source: Kelley Van Buskirk et al, Circumcision and Acquisition of Human Papillomavirus Infection in Young Men, Sexually Transmitted Diseases 38 (12), December 2011.
Journal homepage: http://journals.lww.com/stdjournal/pages/default.aspx
Abstract available at journal - Published ahead of print: http://journals.lww.com/stdjournal/toc/publishahead

New African HIV Research claiming 76% reduction is flawed

New African research claiming circumcision reduces HIV infections by 76% actually compared young men who were interested  and participated in the circumcision HIV prevention program who were given health care, education and other resources vs older men who were not interested and didnt participate in the program and were not resourced by the programmers, and Researchers found a difference in infection rates? Is this surprising?  You are talking about 2 different types of men with different beliefs, values and behaviours.  One group that cares about HIV prevention and is prepared to receive help, have a healthy body part removed, and to change their behaviour to more safe sex, versus another group which cares less about HIV prevention, does not want to participate in a prevention program, and is most probably less prepared to change their behaviour.  Yet these researchers just focus on the variable of Circumcision.

HELLO which variables are causing the change!!!!!! This is typical procirc propaganda and   Disingenuous Science & Reporting!!  And as usual the media reports it as fact!!

What to say to dr's & nurses about foreskin retraction

It can be difficult to communicate with those in positions of power or authority so here is just one suggestions on how to make this easier.  Many other sources have other suggestions.

In our decision to keep our son intact and refuse circumcision we have adopted the medical/health models from non-circumcision cultures which understand and  value the foreskin.  In those cultures the foreskin is seen as normal and healthy, and the foreskin is not retracted until the boy retracts it himself.  Anatomically the foreskin is fused to the glans and separates naturally, and this is seen as a normal developmental process.  Forceably retracting the foreskin is seen as harmful, and can cause health problems including infections.   We would appreciate that you respect our position and or refer us on if you cannot.  (You can type/copy this and hand to doctors)

If the doctor or nurse responds to you with health reasons to retract.  You can respond by saying, that In cultures that value the foreskin like the Europeans, Men are healthier, live longer, and have less STI/HIV and penile cancer than circumcised American men, and therefore you want to follow the genito/urinary practices of the European health authorities which say no to premature retraction.

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.

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?