
Why the “circumcision solution” to the AIDS epidemic in Africa may increase it - isomorph
http://blog.practicalethics.ox.ac.uk/2012/05/when-bad-science-kills-or-how-to-spread-aids/
======
ivank
[http://webcache.googleusercontent.com/search?q=cache:blog.pr...](http://webcache.googleusercontent.com/search?q=cache:blog.practicalethics.ox.ac.uk/2012/05/when-
bad-science-kills-or-how-to-spread-aids/&strip=1&vwsrc=0)

Bill Gates doesn't seem to care that that science behind the project is
terrible. It must have been pointed out to him, yet he was still promoting the
project in 2015:
[https://www.youtube.com/watch?v=_ovf8GYfNbw&t=40s](https://www.youtube.com/watch?v=_ovf8GYfNbw&t=40s)

[https://www.youtube.com/watch?v=HFtSt862sKY](https://www.youtube.com/watch?v=HFtSt862sKY)
\- how much informed consent do you think was involved here?

A lawsuit against PSI Zimbabwe, also supported[1] by the Bill & Melinda Gates
Foundation [http://nehandaradio.com/2018/09/02/400-000-circumcision-
laws...](http://nehandaradio.com/2018/09/02/400-000-circumcision-lawsuit-
family-sues-over-unsanctioned-sons-foreskin-removal/)

15,269,720 "voluntary medical male circumcisions" based on this bogus science
[http://www.aidsmap.com/PEPFAR-funded-15-million-medical-
male...](http://www.aidsmap.com/PEPFAR-funded-15-million-medical-male-
circumcisions-between-2007-and-2017/page/3343169/)

[1] [https://www.psi.org/2016/11/using-market-research-for-
long-t...](https://www.psi.org/2016/11/using-market-research-for-long-term-
sustainability-of-vmmc-in-zimbabwe-and-zambia/)

~~~
valtism
I've heard from people inside WHO that Gates' mentality is that he wants
solutions NOW and doesn't concern himself much with potential issues around
the solutions. I've heard that they would rather not have his money than be
forced to put out vaccines that have questionable manufacturing practices.

~~~
xkcd-sucks
Well yeah he probably wants to see results before he dies

~~~
m0llusk
Do gooders tend to cause harm Thu do not intend. That Gates has good
intentions means little if he makes things worse by pushing non solutions that
happen to harmonize with his dick chopping ideology.

------
robotbikes
Basically I agree with this sentiment "So what should we conclude? Green et
al. get it right: “Before circumcising millions of men in regions with high
prevalences of HIV infection, it is important to consider alternatives. A
comparison of male circumcision to condom use concluded that supplying free
condoms is 95 times more cost effective.”"

~~~
nostromo
That's as silly as focusing on teaching abstinence. Sure, it'd work... in
theory. In practice, people don't like condoms and HIV rates would be largely
unchanged.

The best hope we have is to work on many fronts at the same time: education,
condoms, voluntary circumcision, etc.

~~~
telchar
You're indicting the entire premise of modern safe sex. Either condoms are
rarely used and people cannot be taught to use them reliably, or you're wrong.
The low infection rate in industrialized countries with good sex education and
readily available condoms suggests you're wrong. Contrarily, abstinence hasn't
been demonstrated to work anywhere.

------
wirrbel
The page currently times out loading, but from what I gather from the title,
it seems that my distrust in the circumcicion against AIDS stories was on
track.

It always felt a bit like puritans trying to find empiric evidence for their
moral and cultural traditions.

~~~
Analemma_
It’s unbelievable how far people will twist themselves in knots trying to find
utilitarian justifications for what is, at the end of the day, non-consensual
mutilation done for no reason other than “because tradition.”

~~~
gumby
My kid was born in a US hospital and the woman who did the circumcisions was
very pushy that we should get it done ASAP. We said we'd let him decide when
he became an adult and she said "but if you let him decide he'll decide not to
do it" which seemed like a pretty good argument to me!

I did hear from the staff that she got peed on pretty much every time.

~~~
gus_massa
It's seams like a very bad argument for me. What about tonsil removal ASAP? He
may decide not to do that. What about a lobotomy ASAP?

~~~
gumby
Her argument was very convincing _against_ her position.

However now you mention lobotomy...that might have made child rearing much
simpler. A bit late for me, but you might consider proselytizing this issue
for the good of parents everywhere...

~~~
cam_l
Bonus that a child who had a premptive lobotomy would never regret the
decision or wonder what life would have been like without it. There is
literally no downside...

------
ummonk
I mean, I'm sure FGM reduces AIDS rates too, since women who were subjected to
it are going to be less interested in sexual activity...

------
Fundlab
__These is personal experience and views;

Male circumcision is prevalent in Africa mostly as as the norm. It is painless
at childhood but gruesome when done to older kids. In some cultures around the
world male circumcision is akin to piercing the ears of a baby girl for
earrings.

In places where circumcision is a ritual, it gets done to older kids (early
teens) as a rite of passage into adulthood. To me that will be more agonizing
considering the awareness of the pain eg. when your dick gets caught in a
zipper.

I personally dont find male circumcision at birth repugnant because I
literally have no memory of it and I but I appreciate it was done to me
appropriately.

According to
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422680/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422680/)

"The timing and reason for circumcision in boys or men vary across the
continent. Circumcision is prevalent in as much as 93% of the countries in
Northern Africa compared to 62% of countries in sub-Saharan Africa. Whereas
the procedure is done for religious purposes in Western and Northern parts of
Africa, it is seldom performed in neonates in Eastern and Southern regions of
the continent where circumcision is, often, a rite of passage into adulthood"

 __What I 'll love to see if the comparative AIDS footprint between countries
with varying degrees of circumcision.

------
jesssse
Mutilating baby penis is a tragedy.

------
erichocean
Circumcision of children should be banned entirely. If adults want to do it,
fine.

------
Theodores
There is also the aspect of who has a dog in the fight and skin in the game.

When you have Americans telling Africans to get themselves circumcised you do
have to wonder what is really going on, particularly when there is this
dubious level of 'science'.

In the U.S. there is always the profit motive. Hence male circumcision is sold
to parents as hygienic and beneficial, they go along with it and the hospital
makes some money, everyone getting bonuses except for the baby boy.

To contrast with this profit-motive-situation you have places like the UK
where healthcare is provided by the government - e.g. the NHS. The hospital
has no financial incentive to circumcise as many boys as possible, doing so
would be a cost, not a profitable thing, so it doesn't happen. Therefore the
population ends up being un-circumcised as a general rule.

By adulthood men have had long enough to rationalise with what happened to
their foreskin. If it has been removed then they tend to want this for others
including their own boys. Meanwhile, those with intact foreskin don't talk
about such matters in public as they know that open discussion will deeply
hurt someone in the room who has been circumcised.

I think that this experiment to circumcise millions of African men for their
own good would have been easier to get to the bottom of if everyone involved
had to explain their viewpoint in just their 'birthday suit'.

~~~
spamizbad
For what it's worth, circumcision is slowly declining in the US[1]. We did not
circumcise our son when he was born. The hospital asked us, we said no. No
questions asked. We came fully prepared to justify our decision, worried that
doctors would perform it by default or try to guilt us into it to avoid the
spread of STDs.

[1]
[https://www.usatoday.com/story/news/nation/2013/08/22/circum...](https://www.usatoday.com/story/news/nation/2013/08/22/circumcision-
infants-hospitals/2681253/)

~~~
Theodores
Well that is terrifying, the fact you have to think ahead like that, fearing
what you might have to say, assuming a default.

Since it is a binary option with moral overtones and since your boy will
eventually compare notes with his contemporaries you could gift him a story
that sidesteps the matter.

The story might not be grounded in truth any more than Santa Claus is. The
mythical backstory could be that it was decided on a coin toss, heads it
stayed on, tails it came off. Maybe embellish it so that the doctor, his mum
and yourself all had coins, it being a 'best of three' with the doctor calling
'tails', you calling 'heads' and his mum having the deciding coin.

Such a white lie can be useful for him when he needs to dig himself out of a
conversational hole when he gets older so as to not have that awkward moment
with a religious workmate/sister's boyfriend etc., even if by then he knows
the story is a myth.

------
isomorph
Site has been overwhelmed by traffic - cached version:
[http://webcache.googleusercontent.com/search?q=cache:blog.pr...](http://webcache.googleusercontent.com/search?q=cache:blog.practicalethics.ox.ac.uk/2012/05/when-
bad-science-kills-or-how-to-spread-aids/&strip=1&vwsrc=0)

------
jzl
This piece from 2012 (posted now why?) loses all credibility in the section
called "2\. Misleading results":

 _It is tempting to think that the 60% figure that’s being thrown around in
media reports is just too large a percentage to ignore–even if the studies had
some flaws. But do you know what the “60%” statistic is actually referring to?
Boyle and Hill explain: What does the frequently cited “60% relative
reduction” in HIV infections actually mean? Across all three female-to-male
trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became
HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive, so
the absolute decrease in HIV infection was only 1.31%._

 _That’s right: 60% is the relative reduction in infection rates, comparing
two very small percentages_

I don't even know where to begin. What does he _think_ people will interpret
it to mean? His entire point here is made in bad faith. What he's saying
basically comes down to "the infection rate in this trial was low to begin
with, therefore there's no point trying to make it lower," which is
preposterous. The authors claim a _reduction_ , which any speaker of the
English language should know how to interpret.

I think it's entirely valid to argue the validity of the study and the
blowback issue, but his sloppy argumentation throughout the article is
underscored here.

~~~
FabHK
Not sure why you are being downvoted. That part of the article is indeed
disingenuous (I'm not sure whether it's sloppy or purposely misleading). Of
course the 60% reduction is a relative reduction in infection rates.

In fact, the "absolute decrease [of] only 1.31%" claimed by the article, if
anything, is misleading, because that number (representing 60% of the 2.49%)
is over a certain small amount of time, and therefore will only grow larger as
time passes.

------
jes
I am a 59 y/o male and an "Intactivist." Tomorrow morning, I'll be flying from
my home in Kirkland, Washington, to Orlando, Florida, to join my colleagues in
protesting non-therapeutic circumcision at the site where the AAP is hosting
its convention. I routinely join the Bloodstained Men and their Friends in
their various protests / education events. I also carry my various signs in
front of a local hospital (Evergreen Hospital, Kirkland, WA) which performs
NTC on healthy male infants and neonates when their parents request it. I also
routinely speak against NTC in the public meetings of the Board of
Commissioners for EGH.

I'm currently contemplating what kind of legal action I could take against the
Board of Commissioners of the Public Hospital District that oversees the
EvergreenHealth organization.

Over the last year, I have been sharing information with them. The management
team of EGH has been relying on the AAP 2012 Circumcision Policy Statement as
their justification for offering the harm they offer to parents. I have
informed them that the Policy Statement expired in 2017, but they continue to
defend the offering of this harm. I also submitted copies of a statement-by-
statement refutation of the Policy Statement written by Dr. Robert S. Van
Howe, who was (may still be) the Interim Chairman of the Department of
Pediatrics at the Central Michigan College of Medicine.

If anyone has any suggestions for me as regards what kind of legal action
might be considered, to compel / encourage the Board of Commissioners to do
the work necessary to decide for themselves whether they are harming healthy
infants and neonates by continuing to offer this harm, I would appreciate it.

~~~
isomorph
The legal system cannot help at this stage. I have met this guy
[http://www.oldsquare.co.uk/our-people/profile/james-
chegwidd...](http://www.oldsquare.co.uk/our-people/profile/james-chegwidden)
who successfully defended two boys’ right to choose in the UK (this was only
made possible because their mother DIDN’T want them circumcised and their dad
did).

There is no legal basis for circumcision but unfortunately the law cannot help
in this case as it reflects public opinion.

Check this out written by the author of this article
[https://youtu.be/sQQTIpBWqvY](https://youtu.be/sQQTIpBWqvY)

I am considering retraining from software engineering into health policy to
combat non-therapeutic infant circumcision in the UK

------
DrJaws
circumcision is just mutilation

------
nostromo
This article is FUD. If the article raised some questions about the (multiple)
studies that show the effect, I would just shrug and let it go. But then to go
on and say it "may increase it" is irresponsible. There is zero evidence for
this -- and in fact a lot of evidence to the contrary. [1]

Yes, every study has limitations. The fact that you can't do a blind study or
a placebo control with circumcision is just a fact of life -- people tend to
know if they're circumcised or not. This does not refute the many studies'
findings.

Can you imagine the outrage if the author published a paper questioning the
effect of smoking on lung cancer, and then wondered if smoking actually
reduces your chances for lung cancer? That's what this article is doing.

I'm glad that Gates is standing on the side of science here.

1\. [http://www.croiconference.org/sessions/impact-male-
circumcis...](http://www.croiconference.org/sessions/impact-male-circumcision-
scale-community-level-hiv-incidence-rakai-uganda)

~~~
notahacker
> Can you imagine the outrage if the author published a paper questioning the
> effect of smoking on lung cancer, and then wondered if smoking actually
> reduces your chances for lung cancer? That's what this article is doing.

I don't think the evidence bases are exactly comparable (even acknowledging
that the study you've linked to doesn't sound quite as appallingly constructed
as the one described by the blog). And people argue about whether
recommendations with thin justifications around stuff like diets have
counterproductive side effects all the time, especially when the
recommendations are pretty drastic.

~~~
nostromo
The article is very old now, so that was a fair point... when it was
published.

But in 2018 we have a lot of evidence that show the effect on transmission is
real -- and we also have evidence that circumcised people do not engage in
more risky behavior. [1]

So that's why I think this is similar to denying climate change or claiming
vaccines cause autism. It could have a real impact on public health.

I suspect I'm getting downvoted because some people are passionately anti-
circumcision. And that's fine! Nobody is going to make you get circumcised.
But the science doesn't care about one's personal views regarding
circumcision.

1\.
[https://www.fhi360.org/sites/default/files/media/documents/M...](https://www.fhi360.org/sites/default/files/media/documents/MCC_ResearchBrief_SHABS.pdf)

~~~
defen
> I suspect I'm getting downvoted because some people are passionately anti-
> circumcision. And that's fine! Nobody is going to make you get circumcised.

Yeah, the problem is that this "science" is inevitably used to justify
performing an invasive, unnecessary procedure on babies because in 15+ years
it will reduce his risk of acquiring HIV during unprotected sex with an HIV-
positive woman from 4/10,000 to 2.4/10,000.

 _Maybe_ that's worthwhile in certain cultures experiencing pandemic levels of
HIV, but in the USA it's borderline medical malpractice. There are only about
250,000 women in the entire country with HIV.

~~~
isomorph
Actually - someone did make me get circumcised. I was forcibly circumcised as
an infant

------
stephengillie
> _After all, if someone knows (or thinks) that they’re getting a great big
> helping of medicine, they might act in various ways—whether consciously or
> unconsciously—that have the effect of generating positive health outcomes
> but which have nothing to do with the intervention itself._

That sounds strangely like the Hawthorne Effect[∆].

[∆][https://en.m.wikipedia.org/wiki/Hawthorne_effect](https://en.m.wikipedia.org/wiki/Hawthorne_effect)

------
FabHK
Mods: maybe add (2012)

