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Lack of Clarity in Reporting on HIV and Circumcision of Gay Males

Timothy Kincaid

August 26th, 2009

Several studies have shown that in African and Asian nations heavily impacted by HIV, circumcision can reduce infection rates in males by 50 – 60%. Now a CDC doctor has announced that while circumcision is effective in reducing female to male transmission during vaginal sex, it does not assist in resisting infection between gay males during anal sex. (U.S. News & World Report)

Circumcision “is not considered beneficial” for gay men concerned about lowering their risk of becoming infected with HIV, Dr. Peter Kilmarx of the CDC told the Associated Press. He released the study findings at a conference on Tuesday.

The finding are at odds with some studies conducted in Africa, which have suggested that circumcised males may be less prone to HIV infection during heterosexual sex. But circumcision may not offer the same protection when it comes to anal sex, Kilmarx said.

In the study, the CDC team tracked the HIV infection rate of nearly 4,900 men who had anal sex with an HIV-infected partner. The researchers found an HIV infection rate of 3.5 percent — whether the men were circumcised or not.

While this may appear informative to a heterosexual, this reporting leaves more questions than it answers.

  • Were these 4,900 tops who engage in insertive sex only? Because if not, how could the circumcision of a bottom (passive partner) possibly impact HIV transmission?
  • Does the 3.5% infection rate reflect a bottom to top transmission? Was this 3.5% in a year, a decade, when?
  • Were these “partners” in relationships or just sex-partners?
  • Or did they just say, “Here are some cut men and here are some uncut men. Let’s see to what extent they seroconvert”?

This story is but another illustration of why it is important that gay men and women are included in reporting stories that effect our lives. It would be interesting to know the extent to which bottom to top HIV transmissions occur and whether circumcision of the top could impact this transmission. But reporting like this tells us nothing of much use at all.

Comments

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AJD
August 26th, 2009 | LINK

What I want to know is, what ever happened to the concept of using condoms? After celibacy, that’s the most sure-fire way to prevent HIV whether you’re gay or straight…

I’m concerned that the following scenario will become increasingly common:
“Wait a minute, do you have a condom?”
“No need for condoms, babe, I’m circumcised!”

Coxygru
August 26th, 2009 | LINK

AJD is right. Only condoms offer complete protection. Circumcising adult men on a large scale is 1.) costly, 2.) a significant medical expense, and 3.) perhaps dangerous in areas where clinics lack many basics.

What about the broader issue of fluidity in human sexuality and sexual practices? My brother is 100% hetero but tells me he enjoys lots of anal sex with his many female partners. He’s circumcised but his practices put him at risk.

In terms of HIV transmission, how different is a female rectum from a male rectum? Are there any studies on that?

Timothy Kincaid
August 26th, 2009 | LINK

What about the broader issue of fluidity in human sexuality and sexual practices? My brother is 100% hetero but tells me he enjoys lots of anal sex with his many female partners. He’s circumcised but his practices put him at risk.

In terms of HIV transmission, how different is a female rectum from a male rectum? Are there any studies on that?

Per the CDC:

In general, the person receiving the semen is at greater risk of getting HIV because the lining of the rectum is thin and may allow the virus to enter the body during anal sex. However, a person who inserts his penis into an infected partner also is at risk because HIV can enter through the urethra (the opening at the tip of the penis) or through small cuts, abrasions, or open sores on the penis.

Unfortunately, I have found it difficult to identify the extent to which such HIV transmission occurs. Urban legend says very rarely, but it’s not easy quantifying this risk.

Burr
August 26th, 2009 | LINK

Yeah this whole circumcision thing is a red herring, and a bit insulting in a way. It’s sort of throwing your hands up and saying “Well they’ll never learn to use condoms, so let’s find this other way that will at least reduce it a bit that they don’t have to think about.” Not a great solution

I doubt there’s any difference between female/male rectums. Anal sex is anal sex. It’s the anal part that’s the problem as far as ease of transmission goes, there’s less protection so to speak.

One thing that’s bugged me is that all the tests of microbicides to prevent HIV transmission are only done in heterosexuals and focus on women using it. There’s no explanation in the media I’ve seen as to why this wouldn’t work for others.

Timothy Kincaid
August 26th, 2009 | LINK

Coxygru,

I did find some additional information:

The estimated per-act risk for acquiring HIV from unprotected insertive anal intercourse with a positive partner is 6.5 per 10,000 exposures.

Burr,

I don’t think that this is a red herring or an instance of throwing up one’s hands.

The more information that is available about this disease, it’s transmission risks, it’s “safer” options, the extent to which – for example – Coxygru’s brother is at risk, etc., the better.

I, for one, want to know whether there is a difference in insertive risk by circumcision. The less we rely on urban legend and what we heard from that guy that one time talked to someone who once met this really cool scientist guy so he knows all the inside info – the better.

And, yes, I want to know about microbicides as well.

Zeke
August 26th, 2009 | LINK

All of this circumcision prevents AIDS is total BULLSH*T! I haven’t found a single person who can explain to me why America has a higher AIDS rate, Gonnarhea rate, Clamydia rate, Herpes rate and EVERY other sexually transmitted disease that EVERY country in Europe, NONE of which routinely circumcise their boys.

Here’s a report by a doctor that says many of the things I’ve been saying for years. He points out some of the very clear flaws with the Africa “study” that I noticed when I ACTUALLY READ the study’s methodology, instead of blindly repeating the bogus claims the way most people have.

http://www.huffingtonpost.com/ali-a-rizvi/male-circumcision-and-the_b_249728.html

And by the way, I’m ALL for circumcision if that’s what a grown man or woman chooses to do with their genitals. But I believe “My body my choice” should apply to EVERYONE.

Thomas Kraemer
August 27th, 2009 | LINK

The study the CDC refers to is a meta-analysis that combines multiple studies and methods, such as reporting or not reporting separate data for tops and bottoms:
(See Gregorio A. Millett, et al., “Review: Circumcision Status and Risk of HIV and Sexually Transmitted Infections Among Men Who Have Sex With Men,” JAMA, Oct. 8, 2008, 1674-1684, corrected Mar. 18, 2009, p. 1126-1129, DOI:10.1001/jama.300.14.1674)

Even for heterosexuals, the supposed benefit of circumcision is marginal at best.

The same type of data could be used to justify cutting off baby girls’ breasts to prevent future breast cancer, which is more common than HIV infections in the U.S.

My last two postings on the CDC bias were: Circumcision promotes promiscuity? (8/27/09) and CDC may recommend circumcision (8/24/09)

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