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Circumcision, a vaccine against AIDS?

In recent years, scientific studies have showed that circumcised men have a dramatically lower risk of contracting HIV, the virus that causes AIDS. Many African governments are contemplating encouraging voluntary circumcision alongside more conventional prevention methods.

Zied, a Tunisian blogger, doctor and public health worker who blogs at zizou from Djerba, tackles this controversial topic in a recent post, “Circumcision: A Vaccine Against AIDS?” [Fr]

Apres les vaccins, apres les pilules contraceptives, apres les preservatifs, voila venu le temps de la circoncision. Eh oui ! plusieurs etudes menees ces dernieres annees ont demontre ce que d'autres ont clame depuis une decennie: La circoncision diminue le taux de transmission du virus du Sida… Elle le diminue de 60% ! Incroyable hein ! et nous qui nous nous sommes toujours demande pourquoi la region d'Afrique du Nord et du Moyen Orient a eu des taux si bas malgre la faiblesse de leur reponse a cette epidemie ? nous voila face a la reponse: LA CIRCONCISION.

After vaccines, after contraceptive pills, after condoms, the time has now come for circumcision. Yes! Several studies conducted in recent years have shown what others have claimed [to be true] for decades: circumcision reduces the transmission rate of the AIDS virus…by 60%! Incredible, no? And we, who have always wondered why North Africa and the Middle East have had such a low [transmission] rate despite the weakness of their response to the epidemic. The answer is before us: CIRCUMCISION.

Il est evident que cette intervention, seule, ne sert a rien. Mais en parallele a tout ce qui existe deja, on peut s'attendre a des miracles… Le Rwanda a deja commence une campagne de circoncision a large echelle alors que plein d'autres pays sont en train d'etudier et de planifier des activites en ce sens. Les opposants a la circoncision sont nombreux et le debat fait rage parmi les scientifiques et aussi dans les spheres religieuses et autres. les uns trouvent que le preservatif reste la seule vrai reponse, d'autres pensent que la circoncision est une pratique barbare qui diminue le plaisir, a part ceux qui trouvent que ce n'est pas ethique de couper la peau du gland a qlq sans son consentement.
Ca va etre dur de convaincre tout le monde….

It is clear that this intervention alone will do nothing. But in parallel with everything that already exists, we can expect miracles…Rwanda has already begun a large-scale circumcision campaign, while many other countries are in the process of studying and planning similar activities. The opponents of circumcision are numerous and the debate rages in the scientific, religious, and other communities. Some find that condoms are still the only true response [to the epidemic], others think that circumcision is a barbaric practice that diminishes pleasure, aside from those who think its unethical to cut someone's foreskin without their consent.
It will be difficult to convince everyone…

Circumcision and Islam

Reader Karim2K asks if Zied is trying to say that, “thanks to the benefits of Islam, body and spirit will be holy” [Fr].

Muslims are the largest group in the world to practice circumcision, but several readers reject the idea that this as anything to do with promoting Islam.

An anonymous reader:

qui a parlé d'Islam? la circoncision est aussi pratiquée par les juifs…..
alors arrétez cette stigmatisation!

who is talking about Islam? circumcision is also practiced by the Jews….
so stop with this stigmatization!

Another reader excerpts the Wikipedia article on circumcision, noting that it was practiced in ancient Egypt, and is also stil customary among certain Christian sects.

Not a silver bullet

Of course, the oft-cited risk of promoting circumcision in conjunction with AIDS prevention is that some men might dangerously misconstrue the message and think that if they are circumcised, they don't need to use condoms.

Reader Tarek address exactly this point:

Je pense qu'il est dangereux de faire croire au gens que la circoncision prévient la transmission. Elle ne fait que réduire le risque.

I think it is dangerous to make people think that circumcision prevents transmission. It only reduces the risk.

Zied, realizing he may have given exactly this impression, offers a partial correction by quoting an email he received from a reader named Isabelle:

“Je m'étais fait la même réflexion concernant la transmission du VIH en entendant le bruit qui court a Djerba qu'il était inutile de mettre des préservatifs puisqu'une récente étude démontrait que les hommes circoncis ne risquaient rien. Ce qui est totalement faux, une étude en cours étudie cela et il a juste été démontré que la circoncision “semblerait” en effet atténuer les risques de transmission pour l'homme circoncis uniquement et en aucun cas pour sa ou ses partenaires du fait de la sensibilité particulière du virus à la déssiccation entre autres.”

“I had the same thought about HIV transmission when I heard all the brouhaha in Djerba about it being useless to use condoms since a recent study showed that circumcised men risk nothing. This is completely false. A study underway is examining just that issue and it was shown merely that circumcision would only “appear” in effect to diminish the risks of transmission for the circumcised man, and in no way for his partner or partners, because of the virus's particular sensitivity to dryness among other factors.

3 comments

  • Le vrai danger est de se croire à l’abri d’une infection parce que l’on est circoncis. La circoncision a des vertus hygiéniques certaines mais cela s’arrête là. Il ne faut pas baisser la garde! Restez vigilants et surtout sortez couverts…
    Sida ! Que dieu nous préserv-atif !

  • Whereas it is great that we have found one more way to reduce the risk of HIV, I think it would be dangerous to promote it as anything more than icing on the cake.I think ultimately promotion and practical implementation of ABC plus more concentrated efforts by Ministries of Health around prevention and taking care of the afflicted is ultimately the best way to do it. We can also of course learn a lot from a country like Cuba which dealt with the crisis in an extraordinary manner.

  • Association contre la Mutilation des Enfants :
    http://www.enfant.org

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