Saturday, February 24, 2007

HIV, male circumcision and India

This blog has dealt with ethical questions about male circumcision and HIV before, but somehow the assumption crept in that this is a distinctively African controversy. Maybe it was because of the high HIV prevalence in that part of the world. Maybe its was because of the longstanding interest -- especially among anthropologists -- with circumcision rituals in Africa. Let us make a confession here: the author of this post has co-authored an article in the Journal of Medical Ethics called Male Circumcision and HIV Infection: Ethical, Medical and Public Health Tradeoffs in Low-Income Countries. And it too is guilty of identifying the issue a bit too much with sub-Saharan Africa.

Whatever way this came about, the ethical questions concerning the promotion of male circumcision to lower risk of HIV transmission have to embrace India. For one thing, the number of new HIV infections has rising in India dramatically over the last years. For another thing, male circumcision is a highly charged matter, both politically and religiously, when Hindus do not traditionally circumcise and Muslims do.

An article in the Times of India today gives an indication of just how sensitive the question is. The National AIDS Control program in India will not even think of conducting randomized controlled trial to test whether being circumcised lowers a man's risk of getting HIV infected: not because three such studies have been done before, but the whole idea seems too hot to handle. When Richard Feachem, Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said that he expected that Hindus would increasingly have more HIV infections because their men do not get circumcised, his inbox was inundated by hate mail. An interesting post on the Olive Ridley Crawl shows some of the passion the debate raises, and the issue is inseparable from the larger relationship between mainly Hindu India and its Muslim neighbor and rival, Pakistan. The foreskin has geopolitical significance.

The question is: when circumcision acts as a religious/cultural marker from neighboring groups, will men still agree to do it, to reduce their chances of getting HIV? A World Health Organization/UNAIDS meeting in Switzerland on March 6 is set to tackle these tradeoffs between cultural identity and public health, among others. When HIV infections globally are increasing, vaccines are probably at least 10 years away, and the once-promising microbicides are crashing and burning, the ancient practice of male circumcision is strangely enough carrying the torch in the fight against HIV/AIDS.

Labels: , ,

7 Comments:

Blogger TLC Tugger said...

Sorry, the question really is not "will men still agree to do it," but rather, how on earth did these studies get funded? Other studies have shown the opposite. If that had been the case this time, the study team would be guilty of a permanent mutilation which left the volunteers definitively worse for the experience.

That's a pretty strong incentive to MAKE SURE the outcome turned out as hoped for by the long-time circ justifers who ran these trials.

In non-cutting Japan, AIDS is more rare than in 95%-cut Israel. In the African nations of Malawi, Lesotho, Ghana, Rwanda, Tanzania, and Cameroon, AIDS is MORE prevalent among the circumcised than among the intact. In the mostly-cut US, we have 3 times the AIDS problem Europe has, even though circumcision is rare in Europe. 450,000 American men who were cut at birth have died of AIDS.

Circumcision does not prevent AIDS.

10:48 PM  
Blogger Stuart Rennie, Editor said...

Thanks for your comments. Let me reply point-by-point.

You are right that a few studies have not indicated any reduction in HIV transmission among circumcised males, but the majority did. That is precisely why these studies were funded: in order to test, in a randomized controlled trial setting, the association between circumcision and HIV transmission suggested by 25 years of observational and other studies.

As for higher prevalences among the circumcised in selected countries, that phenomenon has to be subjected to the same scientific scrutiny as the (majority of) settings where the circumcised have a lower prevalence. Again, the trials in South Africa, Uganda and Kenya were done to try to isolate the association from possible confounding factors. The old 'ecological' studies that brutely linked lower HIV prevalence with circumcision practices in a given region were considered unsound, because there were could be other factors responsible for the lower HIV prevalence. The same goes for your own ecological counterargument.

In USA, HIV transmission has historically been driven by homosexual sex and injection drug use, not heterosexual activity. The studies in question obviously do not claim to say anything about links between circumcision, male-to-male sex or injection drug use.

I agree that circumcision does not 'prevent' HIV. That is a misleading statement, especially if it suggests total protection. But there is a substantial scientific argument for circumcision reducing risk of HIV transmission from women to men.

Let me be frank: if a research team had run three randomized trials on an HIV vaccine that showed 65% efficacy, they would be preparing their Nobel speech. But because it is circumcision rather than a vaccine, they find themselves wading into an ideological quagmire instead.

12:34 PM  
Blogger HIV said...

We are a London based clinic in the process of clinical trial for a new herbal-based medicine for HIV, which we have been refining over the past 6 years. Animal experiments confirmed that it is 100% safe and even at high doses no immediate or delayed side effects were noted. We have completed clinical trial on 15 UK patients, all of whom have seen their viral count decrease significantly and CD4 count recover proportionally without any side effects.

The duration of the treatment is normally between 6 – 12 months depending on the individual patient’s profile and the stage of the infection. We are looking for candidates to join our on-going trial treatment programme.

Interested candidates can contact us via email at hiv.support.2001@googlemail.com

We are able to ship medicine free of charge to anywhere in the world in exchange we request that the participating candidates provide us with blood test results throughout the course of the treatment.

11:34 AM  
Blogger Hiv News said...

I think it's a wonderful/beautiful thing that you put all this energy in love for others. i'm a supporter and wish you all the best always. keep up the great work and keep us informed.
Last week I have found a nice informative guide on HIV from following URL http://www.helpcure.com/hiv/
You can log on to this site if interested because this guide says - How To Cure HIV Through herbal medicines and Holistic Treatment. Guide claims that HIV viruses can't be killed but they can be ousted out of the body cells using bio magnetic repulsion or something written. I dreamt of a HIV free world after reading this guide. Please add some thing more. I shall link from my blogs to this blog to day itself.

5:30 AM  
Blogger apostleshadamishe said...

THE CURE for HIV/AIDS.......AMBUSH

THE IDEA that AMBUSH cures AIDS
is being proven by the more than 400 individuals who have taken a dose of 60 ml three times daily for 21 days. The result is that AMBUSH 'KILLS' the virus by causing the protein envelope to rupture and the viral particles are discarded by the white blood cells. AMBUSH is able to 'KILL' the virus that are 'hiding' in the lymph system by its 'natural radioactive' properties. This process allows the body to 'return to normal health' with a corresponding immunity to that or those strains of the virus.

What is AMBUSH ?
AMBUSH is a radioactive isotope of uranium that is found in the 'palm' plant of which there are more than 3000 species. When ingested, AMBUSH causes the body temperature in the trunk area to rise to about 102 degrees when the individual is sleeping. The preparation takes four hours per batch, which is then given to the individuals for consumption 60 ml three times daily for 21 days. AMBUSH is a herbal preparation in this form but it contains an active ingredient which is a 'NEW' crystalline substance, a drug from the 'palm plant' similarly to ASPIRIN originating from the willow tree bark

RESULTS:
After 21 days on AMBUSH, ALL the individuals experienced a decrease in viral load to undetectable, an increase in cd4, increase in RBC, an improvement in general health such as more color to the face, decrease in Buffalo hump, an increase in gluteal muscles, a decrease to having no joint pains whereby individuals can bend to touch their toes, and walk up steps are but a few examples. There is also a dramatic increase in their sexual appetite beginning after the first week of therapy

DISCUSSION:
In any plant concoction such as percolated 'tea', there are 30-40,000 compounds, whi ch would take the scientific community twenty years to isolate one particular ingredient if they knew what they were looking for. The LORD GOD has given me seven steps to isolate the active ingredient, which is soft and metallic in nature and has a carbon- uranium-sulfur-(classified)-phentolamine configuration or structure. This is similar to Federick Kekule and the discovery of the benzene ring where he dreamt the structure.

As an antiviral and 'natural radioactivity' producing agent, AMBUSH is also effective against leukemia, lupus and HPV. Here I am saying that I have 'GIVEN' AMBUSH in the same 'strength' and dosage to patients with leukemia, lupus and HPV. A 35 year old male with HIV found it difficult to impossible to urinate was put on 'green tea' and water while the doctors contemplated prostrate surgery. One of the doctors gave him my number , I sent him a supply of AMBUSH an d he has not been given any more ARV's, since taking AMBUSH 18 months ago, is in 'good' health and has expressed a willingness to be examined by HIV investigators like many others who have taken AMBUSH.

I have sent this 'IDEA' to most HIV research agencies, scientist of the field, universities, hospitals, clinics, politicians and news agencies to which it is REJECTED because the name of THE LORD GOD is mentioned. He has steered me scientifically through the processes such as which plant and how to produce the active ingredient. What are the odds of a Florida Pharmacist picking a plant would contain the CURE for HIV/AIDS ?
I have never charged any of the people for their supply of AMBUSH but a life saving has been spent on the project with NO renumeration from any sources because AMBUSH falls outside the walls of modern medicine and research.

PROPOSAL:

My proposal is that I PROVE that AMBUSH CURES HIV/AIDS by giving it to a number of END-STAGE or DRUG-RESISTANT people and the scientific community watches their recovery. This proposal addresses the problem in that I have already outlaid the results to be obtained.

This IDEA is unconventional in that the scientific community has rejected AMBUSH because I say it is GOD given. Secondly if I wrote it according to certain standards, then it might be peer reviewed. However, THE LORD GOD has also shown me that there are five enzyme systems associated with the virus, reverse transcriptase, protease, fusion and two more of which causes the virus to be AIRBOURNE. This means that without DIVINE intervention mankind and ALL warm- blooded mammals will be extinct in a number of years.

The PROOF of what I am saying is found in scientific papers wherein it is found that when the protease cuts the viral strands, it cuts it at DIFFERENT lengths EVERY time, to which it should always be a valine at the end but is a different amino acid every time. This is why it is IMPOSSIBLE to produce a VACCINE.

Since this is NOT a hypothesis but there are about 400 individuals who have taken AMBUSH, here lies a vast area in which to check, recheck and confirm that AMBUSH CURES AIDS. Let it be mentioned that during the HIV reproductive cycle, reverse transcriptase converts viral RNA into DNA compatible to human genetic materials. Thus the human DNA has been 'hijacked' and since each person has a DIFFERENT DNA, then the new viral copy is unique to that person which shows that each individual has a DIFFERENT STRAIN of the virus. Consider two HIV positive people swapping viral strains and increasing its complexity with multiple partners.
It can also be proposed that they be revisited as proof that the strain or strains that they had were 'killed' at the time of taking AMBUSH considering that a person can catch as many different strains as there are people who are infected by HIV.
I am also willing to work with the scientific community in identifying those individuals who took AMBUSH and wish to be identified with this process notwithstanding that some are stigmatized while others are jubilant,

Once AMBUSH is verified as being able to accomplish that which is aforementioned then the next stage might be the natural and artificial synthesis of the substance.

Finally, if this is accepted or not, believed or not, THE LORD GOD always wins and this is the heavenly truth to which AMBUSH was divinely given to mankind for the CURE of HIV/AIDS and it will be here forever. Apostle Shada Mishe.

apostleshadamishe@gmail.com

Here is a video taped presentation that I gave at t he Martin Luther King library in Washington

http://www.youtube.com/watch?v=8V53D1w__Po
http://www.youtube.com/watch?v=vPwuwlVBOV0
http://www.youtube.com/watch?v=ZejptOwMTzQ
http://www.youtube.com/watch?v=CqcTgIAhrhc
http://www.youtube.com/watch?v=f7HPKcT_iwY
http://www.youtube.com/watch?v=W9iQfgiYAnw
http://www.youtube.com/watch?v=i3RzRS6tJDM

1:24 AM  
Blogger Kaley said...

I am sure that male circumcision does not prevent or reduce the risk of contracting HIV or tumor cells .. This is a crazy idea, and international health agencies should be involved in such practices

11:52 AM  
Blogger Anna said...

If this surgery is so necessary they at least could make it in adequate conditions. Winstrol

9:29 AM  

Post a Comment

<< Home