Suriname starts free circumcision project

[Fire_Medic_Dave]

PARAMARIBO (AFP) – Suriname has launched a three-month pilot project offering free circumcisions in a bid to cut sexually transmitted diseases, Health Minister Celsius Waterberg said Friday.
Circumcision "could also minimize the risk of HIV infection", he said, adding the project would run in the capital city, Paramaribo.
Some two percent of the Suriname population is HIV-infected, about 10,000 people, and the project aims to carry out the operations on 100 men aged between four and 21 years old over the next three months.


http://news.yahoo.com/s/afp/20090313/hl_afp/healthaidssuriname;_ylt=AhAhXaVcZrie2dMoR2N7w9TVJRIF


This should be interesting.


David

[Veritas_et_Aequitas]

1. In my head, I can hear Morbo screaming

"Circumcisions do not work that way!"

[Fire_Medic_Dave]

2. I'm not familiar with your reference.

[Veritas_et_Aequitas]

3. The news monster on Futurama...

http://www.youtube.com/watch?v=ZQg8JKo_3ZQ

[Canuckistanian]

4. I wish they hadn't used the term "cut sexually transmitted diseases"

Yoiks.

[progdonkey]

5. emphasis on "could"...

I can see this easily turning into a type of moral hazard: you tell men that being circumcised "could minimize the risk of HIV infection" and they'll get a false sense of security and would be even less likely to use condoms. I guarantee it will be viewed popularly like a vaccination--"get circumcised and you won't have to worry about getting AIDS."

Education and comprehensive sex education--including wide availability of condoms--will be far more effective than taking a knife to some boys'/men's penises because it could "minimize the risk of HIV infection."

[Fire_Medic_Dave]

6. I'm not familiar enough with the research to make an informed decision about the policy.

[progdonkey]

8. there is a definite correlation...

I think the basic idea is that the foreskin is both extra skin that would be available for infection and it closes easily over the head, trapping any nasty things that might have been present, whereas a circumcised penis is very easy to clean. If you're uncircumcised but shower thoroughly after unprotected sex, the difference becomes almost non-existent.

My problem is turning this into policy--using (and selling) a surgical procedure as a defense against STD's, when a regular latex condom is much more effective, non-permanent and doesn't require surgery (which is like a police stop: there's really no such thing as "routine") or open the possibility of that "moral hazard."

As I said, I can see men getting circumcised and then being more reckless, and you might even have women who then refuse to have sex with uncircumcised men because they think it's more suspect, yet they then have unprotected sex with a circumcised man because they've bought the same misconception.

Basically, it's a relatively well-established benefit to being circumcised, but not so much for it to be a reason to get circumcised. Free condoms will absolutely be much more effective than free circumcisions.

[Fire_Medic_Dave]

10. Maybe the groups they are targeting are resistant to condom use.

[progdonkey]

18. very possibly...

I don't know the culture in Suriname, but I wouldn't be surprised if there's a strain of machismo and it's seen as weak to use a condom or whatever. In African countries (all over, really, but Africa has a well-known, severe AIDS problem), I think they're having some success with advertising campaigns trying to spin that around so it's seen as being manly to wear a condom: that you're looking out for the woman (or other man) and yourself, etc. Also, there are programs handing out condoms to prostitutes who then can say "no condom, no sex" without worrying about losing money because they have to buy condoms.

A lot of the resistance in those countries is also due to the pernicious influence of religious groups selling abstinence-only education and who routinely spread lies about condom effectiveness--so you get the one-two punch of "it makes you less of a man AND it doesn't protect you anyway." If some of that is present in Suriname and other SA countries, it can be fought with the comprehensive sex ed (ugh, I'm turning into a broken record :P ).

[boppers]

14. "shower thoroughly after unprotected sex"?

Might there be some western economic assumptions in that kind of thinking?

There are quite a few parts of the world that still lack running water, let alone running water *and* ready access to condoms *and* STD awareness.

I hear you on the concerns about being reckless, and the need for *many* measures, but for much of the world, showering after sex isn't something they can afford, let alone condoms for every encounter.

[progdonkey]

17. true... I meant that more in the context of the research...

Re: condom use, that's why I'd say it would be better to have free condoms instead of free circumcisions. If the policy works, great, and it isn't that ridiculous, since the basis is relatively sound scientifically, but if the government is going to be paying for anything, I think it would be better to subsidize free condoms and free or at least cheap comprehensive sex ed.

Also, I didn't really mean that it has to be a "shower" shower, but really just cleaning off the genital area--so they could still do well with a cup of well water if necessary. Your point there is absolutely valid, though.

No single thing (other than total abstinence, of course) will stop all STD transmission, but I just see this program as the poor targeting of government funds, and something that could open them up to the other problems I mentioned.

[boppers]

19. Not to belabor the point...

But condom use requires compliance.

Circumcision does not.

Condom costs are ongoing.

Circumcision is one time.

I'm not saying I agree with their numbers, but I see how they could happen... and future "medical costs" for circumcision are so minor compared to treating AIDS that, well... you see where I'm going.

[crimsonblue]

20. there's science to back up circumcisions..

It has been shown to cut the transmission of HIV in persons who engage in unprotected sex.

[Eryemil]

24. That's a lie.

[crimsonblue]

26. No, it's not a lie.

http://www.nytimes.com/2006/12/14/health/14hiv.html

You're a liar for saying it's a lie.

[Eryemil]

27. The New York times? You're fucking kidding me

This so called "research" attempts have been either fraught with errors, assumptions or obvious manipulation and misinterpretation of evidence.


Here's a good critique of the findings by:

Gary W Dowsett.
Professor and Deputy Director, Australian Research Centre in Sex, Health and
Society, Faculty of Health Sciences, La Trobe University, Melbourne, Australia.

Murray Couch.
Senior Research Fellow, Australian Research Centre in Sex, Health and Society,
La Trobe University, Melbourne

http://www.cirp.org/library/disease/HIV/dowsett2007/


Here are some abstracts you should read.

http://www.ncbi.nlm.nih.gov/pubmed/7576329
http://www.nature.com/nm/journal/v13/n3/abs/nm1541.html
http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431
http://www.jaids.org/pt/re/jaids/abstract.00126334-200712150-00017.htm;jsessionid=J8RQ1vxV5zZ8ztJSyTgcjxpQ8hBwLymhLjyKjz2Tg3yf6czl2LJS!-1046349743!181195628!8091!-1


Here's a condensed editorial on the issue, citing various experts.

http://www.cirp.org/library/disease/HIV/


Finally some additional commentary on the Africa situation and more:

"All 3 studies found that non-circumcised males contract HIV infection more quickly than circumcised males. This was because the circumcised males required a long period of abstinence after their circumcision."

Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005) ANRS 1265 trial. PLoS Med 2:e298
Bailey RC, Moses S, Parker CB, et al. Kenya: a randomised controlled trial. Lancet 2007;369:643-56
Gray RH. Kigozi G, Serwadda D, et al. Uganda: Lancet 2007;369:557-66

"All 3 studies were terminated early, before incidence of infection in sexually abstained circumcised males could catch up with incidence of infection in the non-circumcised males. If the studies had continued for their scheduled time, it's most likely there would have been no difference between the circumcised group and the non-circumcised group. Mills & Siegfried point out that early termination caused the numbers to be exaggerated."

Lancet 2006;368:1236
Health Matters 2007;15(29):33-44

"Brewer DD found higher rates of HIV infection in circumcised virgins and adolescents. The United States has the highest rate of HIV infection and the highest rate of male circumcision in the industrialized world. Male circumcision, therefore, cannot reasonably be thought to prevent HIV infection."

Brewer DD, Potterat JJ, Roberts Jr JM.
Ann Epidemiol 2007;17:217--26.

"Male circumcision removes nerves from the penis and causes significant loss of sexual sensitivity and function. For this reason, many circumcised men are reluctant to use condoms. A program of mass circumcision may reduce condom usage and have an adverse effect on the overall HIV infection incidence."

Taylor JR, Lockwood AP, Taylor AJ. Br J Urol 1996;77:291-5.
Kim D, Pang M. BJU Int 2006 doi: 10.1111/j.1464-410X.2006.06646.x

"Men who have been circumcised might now consider themselves immune to HIV and at no risk to their female partner, due to pro-circumcision misinformation"

Moore DM, Hogg RS. Int J Epidemiol 2004;33(3):542-8.

[Eryemil]

28. If you must ABSOLUTELY get your information from a news outlet...

...try the following.

http://www.cbc.ca/news/viewpoint/vp_strauss/20051121.html

[crimsonblue]

21. there's science to back up circumcisions..

It has been shown to cut the transmission of HIV in persons who engage in unprotected sex.

[LeftyMom]

7. Seems to me like you could buy a whole fuckload of condoms for what 100 sterile surgeries cost

and if you're cutting corners on sterility, well, that's not going to help your HIV rate at all.

[HillbillyBob]

9. It seems to me..long term hiv survivor and not passing on the virus

that rubbers and a wash up soon after are the best most effective means short of abstaining are the best methods of stopping transmission.
I have been Poz for 25 years btw.

[Fire_Medic_Dave]

11. Glad you are doing well.

[Howzit]

12. Despite "research" that shows circumcision prevents AIDS,

the results don't seem self-evident outside these studies:

The US has very high percentage of circumcised men, compared to Norway, yet the US has a much larger proportion of the population infected with AIDS.

The South African Xhosa and Zulu tribes have similarly high rates of AIDS infection. Xhosas are 99% circumcised while Zulus are 99% uncircumcised.

This suggests that irresponsible behavior within an already infected population is what spreads AIDS - circumcision status has very little to do with it.

[Fire_Medic_Dave]

15. Good info thanks.

[Eryemil]

13. This is based on either discredited or suspect research to begin with...

...and mark my words; It will have absolutely no effect.

[aquart]

16. And the Dick Protection Squad rushes to the rescue.

Save the teeny tiny turtlenecks!!!

[Maru Kitteh]

22. Oooh! Free genital mutilation!

Can I have my toes sewn together too?

[Fire_Medic_Dave]

23. I'm sure you could get someone to do it.

[Quantess]

25. Toes? You're kinky.