Circumcision in India

Menstuff® has compiled the following issue of circumcision and disease. Note. This press release is regarding information on research that was done in India. For details, . It reports that "They had severe methodological flaws. In India, Muslim men are circumcised, but Hindu men are not circumcised. The two groups studied came from different religions and cultures." And, "the incidence of HIV infection in the United States, where most men are circumcised, is four times higher than the incidence of HIV infection in Europe where most men are not circumcised."


Circumcision in India
A Reality Check
A US Review of the India Study

Circumcision in India


Uncircumcised men are eight times as likely to become infected with HIV than circumcised men, according to a study of nearly 2,300 men in India.

A researcher at Baltimore's Johns Hopkins University School of Medicine suggested that the inner surface of the foreskin does not have the same protective layer as the outside, and is potentially more vulnerable to HIV.

Male circumcision is common in North America and elsewhere for religious and cultural reasons and to help prevent urinary tract infections and penile cancer.

The procedure involves removal of the foreskin, which covers the tip of the penis, and is typically done shortly after birth.

In the United States, some two-thirds of male infants are circumcised annually. Worldwide, the rates vary widely, depending on culture and religion. In many countries, including India, circumcision is uncommon.

"It's important that we offer measures to help curb the spread of AIDS, particularly in developing countries, where it continues to grow at an alarming rate," Dr. Steven Reynolds, a post-doctoral fellow in the division of infectious diseases at Johns Hopkins and a study investigator said in a statement.

The America Academy of Pediatrics has said it no longer recommends routine circumcision because -- despite some medical benefit -- there can be complications.

Johns Hopkins also studied the risk of other sexually transmitted diseases among circumcised and uncircumcised men. Although the incidence of diseases like syphilis, gonorrhea and genital herpes was slightly higher among uncircumcised men, the difference was not statistically significant.

The research was part of a larger study investigating risk factors for HIV infection based on men attending one of three sexually transmitted disease clinics in Pune, India, between 1993 and 2000.

Demographics, sexual risk behaviors -- including having sex with a prostitute -- and condom use were similar between both groups, Reynolds said.

He added that there are methods uncircumcised men may be able to use to protect themselves against HIV, including condoms and, in the future, a potential topical microbicide product that might be applied to the foreskin before sex.

"Circumcision as a potential prevention strategy requires confirmation by randomized clinical trials," Reynolds said. There are clinical trials underway currently in Uganda, Kenya and South Africa.

Results of the study were presented at a San Diego meeting of the Infectious Diseases Society of America.

Source: www.ivillagehealth.com/news/men/content/0,,412648_599511,00.html  

A Reality Check


I am the executive secretary of Doctors Opposing Circumcision. I have been asked to send you some material relative to the effectiveness of circumcision at preventing HIV infection.

There is a recent story on the menstuff website that claims that intact men have an eight-fold greater chance of contracting HIV infection. This story is filled with inaccuracies.

Some circumcision studies were in fact carried out in Pune, India. They had severe methodological flaws. In India, Muslim men are circumcised, but Hindu men are not circumcised. The two groups studied came from different religions and cultures.

The Cochrane Library is the leading source of evidence-based medicine. The Cochrane Library recently published an exhaustive comprehensive review of the evidence relating to the use of circumcision to prevent HIV infection. That review included the Pune studies.

That review is available on line at: www.cirp.org/library/disease/HIV/cochrane2003/ The file is very large and slow loading so be patient. The Pune studies are listed as Mehendale 96 and Mehendale 96a.

They have serious methodological flaws according to the Cochrane Review. The studies are of "high-risk" individuals who attend Sexually Transmitted Infection (STI) clinics and may not be applicable to general population groups.

The Cochrane Library concluded, after an exhaustive two year analysis, that there is insufficient evidence to support a intervention by circumcision.

I might also mention that the incidence of HIV infection in the United States, where most men are circumcised, is four times higher than the incidence of HIV infection in Europe where most men are not circumcised.

Three new random controlled trials (RCT) are underway. These may provide better information on the value of circumcision in preventing HIV. The data will have be carefully analyzed and the many negatives factors associated with circumcised considered before a recommendation for circumcision can be made.

It is very probable that Reynold's interpretation is influenced by North American culture, which tends to favor circumcision.

Abstinence or safe-sex are the only safe preventive measures that can be taken.

Very truly yours,

George Hill
Executive Secretary
Doctors Opposing Circumcision
Suite 42, 2442 NW Market Street
Seattle, Washington 98107
Web site: www.doctorsopposingcircumcision.org/

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