We need to talk... about HIV

So you're having a baby boy, and you're considering circumcision because you've heard that it helps prevent HIV? We need to talk.


HIV is a scary, scary thing to think about when you're becoming a parent. It's understandable that you'd want to protect your child in every way you can. But you can't believe every rumor you hear. Not even if you hear it from your doctor. Not even if you hear it from 2 doctors or 3 doctors in your area. I'm not suggesting that Google can replace an MD, but you owe it to your son to research ANY irreversible alteration to his genitals.


We need to talk about the reasons people think circumcision prevents HIV and why those reasons are both fatally flawed and also simply not justification enough for the risk you take when putting your son's future favorite body part under the knife.


I'm going to tell you what I've learned, but I'm also going to link you to where I learned it. If you see text that is a different color, it's a link, and it will open in a new window. If any of them require you to register with the website to see the full text of the medical study and for some reason you are unable or unwilling to do so, you are free to instead e-mail me for the PDF. You can find my e-mail address at the bottom of the blog or on our Facebook page. You can take my word for it, but I don't want you to HAVE to, because that's how we end up with these kinds or problems in the first place - you hear something and you don't do the independent research to verify it. I'm going to give you what tools I can to help you independently verify, because your son is worth it.


African Studies
The claims that circumcision prevents HIV are based on studies coming out of Africa. The validity of these studies is questionable, and the ethical implications are disturbing. What's more, these studies are being done with adult men in Africa. Not infants in developed nations. This article from the Journal of Public Health in Africa "explores, in detail, the data on which this recommendation [circumcision as HIV prevention] is based, the difficulty in translating results from high risk adults in a research setting to the general public... and how circumcision compares to existing alternatives. Based on our analysis it is concluded that the circumcision solution is a wasteful distraction that takes resources away from more effective, less expensive, less invasive alternatives. By diverting attention away from more effective interventions, circumcision programs will likely increase the number of HIV infections."


 The December 2011 issue of the Journal of Law and Medicine cites numerous flaws in three African studies that make claims about circumcision reducing the risk of HIV transmission. You can read the full article here, but of course, I'll share some bits and pieces here:

"...the African trials suffered design and sampling problems, including problematic randomisation and selection bias, inadequate blinding, lack of placebo-control, inadequate equipoise, experimenter bias, attrition (673 drop-outs in female-to-male trials), not investigating male circumcision as a vector for HIV transmission, not investigating non-sexual HIV transmission, as well as lead-time bias, supportive bias (circumcised men received additional counselling sessions), participant expectation bias, and time-out discrepancy (restraint from sexual activity only by circumcised men).

The Ugandan trial which tested whether male circumcision could reduce male-to-female transmission of HIV was stopped early because 25 previously uninfected women became HIV-positive. It appears that male circumcision was associated with a 61% increase in HIV transmissions, leading Wawer et al to caution that "Condom use after male circumcision is essential for HIV prevention."

Wait a second, WHAT? "Condom use after male circumcision is essential for HIV protection." So it is CONDOMS, and NOT circumcisions, that are essential for HIV prevention.

Furthermore, there has been problematic reporting of the trials in the medical literature. Fox and Thomson stated: "Our concern is that such partial reporting of the trials will impact on the role that circumcision is perceived to play in HIV prevention... in perpetuating erroneous beliefs... that circumcision offers immunity to AIDS... If the contexts of the African trials can be so poorly represented in the medical literature, it is no surprise that accounts in the popular press are still more misleading."

Participants in the immediate male circumcision groups also received two years of free medical treatment plus supportive counselling and safe-sex advice, difficult to provide in any large-scale "roll out" of male circumcision in sub-Saharan Africa. WHO [World Health Organization] had specifically cautioned that the female-to-male Kenyan and Ugandan findings might not generalise to real-world settings.

It's important that we remember, also, that these studies were only conducted about adult heterosexual activity in Africa. In the U.S., according to this report, the primary mode of sexual transmission of HIV is male-to-male sexual activity. With that in mind, I'd like to bring up an article regarding a CDC study of HIV transmission in U.S. Men.

 "Overall, we found no association between circumcision status and HIV infection status among black or Latino (men who have sex with men)," said Millett, who presented his findings to the CDC's National HIV Prevention Conference in Atlanta.

Experts knew circumcision would not protect a female sex partner, nor the male sex partner being penetrated.

But Millett's study found no benefit of circumcision to any of the men. "We also found no protective benefit of circumcision among those men reporting recent unprotected sex with a male partner in which they were exclusively the insertive male partner," he said.

You can also read more here about a study by the U.S. Navy that found circumcision does NOT prevent the transmission of HIV or other sexually transmitted infections.


In the following video, Dr. Dean Edell outlines the many flaws in the studies coming out of Africa, as well as his sound opinion on the naivety and desperation of anyone who thinks we can walk into such an enormous continent and, instead of giving food, water, or medicine, we can give them all genital surgery. He makes some excellent points and I highly recommend you watch the video. It is well worth your time.

So here's what we've learned so far:

1. Circumcision can actually INCREASE a woman's risk of contracting HIV from her partner,
2. Supplying fresh water and soap to men will bring down AIDS infection as much as these studies claim circumcision will,
3. The U.S. has the highest rate of circumcision and the highest rate of HIV,
4. The studies that claim circumcision reduces HIV transmission are completely irrelevant to those most at risk in the U.S., and
5. You still have to wear a condom. 

Not only is circumcision clearly not a viable means of HIV prevention, it may actually impede your son's ability to fight off invading HIV. There are specialized cells produced in the mucosal lining of the human genitals - that lining is largely removed by circumcision and what is left dries up. These cells are called Langerhans cells, and their function is outlined in an Washington Post article: 

Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that "eats up" invading HIV -- possibly keeping the spread of the AIDS more contained than it might otherwise be.

Even more important, enhancing the activity of this protein, called Langerin, could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host.

However, "we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection," said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

So it stands to reason that if you want to protect your son from HIV, you'll leave his natural body as it is so that it can fight off infection properly, and you'll teach him the importance of using condoms. And remember, infants do not engage in risky sexual practices. This is not the time to be making decisions about your son's future sex life. It could be argued that there is never a time for you to make your son's sexual decisions. And let's face it, the best prevention of HIV is education and condom use. 

Even those promoting circumcision propaganda are aware of this fact. The following is a poster from the Uganda Ministry of Health. An advisory at the bottom, in incredibly small print, reads "Even with circumcision, having sex without condoms puts you at great risk of contracting HIV/AIDS."

So there you have it. HIV prevention is in no way a legitimate justification for infant circumcision. I'm glad we had this talk.