2012-04-16 Gisselquist - WHO and UNAIDS got the wrong message from studies of circumcision and HIV

[admin]

Have WHO and UNAIDS gotten the wrong message from studies of circumcision to reduce men’s risk for HIV?

david_gisselquist@yahoo.com
16 April 2012

https://sites.google.com/site/davidg...s-risk-for-hiv

In 2003-06, a study team funded by the US National Institutes of Health (NIH) recruited HIV-negative intact (uncircumcised) men in Rakai, Uganda, circumcised some, and then followed and retested both circumcised and intact men to see who got HIV.[1] The most widely reported data from this study say that men in the intervention (circumcised) group got HIV at the rate of 0.66% per year vs. 1.33% per year for men in the control (intact) group. These data have been used to motivate efforts to circumcise 20 million African adults by 2015 as well as to introduce routine infant circumcision.


Circumcise vs. wait and wipe

However, other data from the same study show a more effective, less dangerous, less culturally intrusive, and less expensive option for intact men to protect themselves from HIV after sexual contact – simply waiting at least 10 minutes after coitus before doing anything to clean one’s penis, and then just wiping it with a dry cloth, without water (Table). (Condom use reliably protects men from acquiring HIV from sexual partners; this note discusses waiting and wiping as an alternative to circumcision, not as an alternative to condom use.)

While all intact men in the NIH-funded Rakai trial got HIV at the rate of 1.33% per year, HIV infections in intact men concentrated in men who cleaned their penises within 3 minutes after coitus (2.32% per year) and men who used water alone to do so at any time after coitus (2.26% per year). On the other hand, intact men who cleaned their penises after coitus but waited at least 10 minutes to do so got HIV at the rate of 0.39% per year. Intact men who cleaned their penises after coitus by wiping with a dry cloth (within 3 minutes or later) got HIV at the rate of 0.55% per year. Notably, intact men who waited at least 10 minutes to clean and/or cleaned with a dry cloth were at less risk for HIV than circumcised men; and intact men who waited at least 10 minutes to clean were even at less risk than men who reported no sex partners (see Table).

According to Ronald Gray, the head of the Rakai study team, one message from the study is “there ought to be a little time left for postcoital cuddling before you go and wash. Don’t just finish and jump out of bed.”[5]



Why did intact men who cleaned later without water have lower risk for HIV? . . .

[admin]

In plain English, it's about washing. In the African "Randomized" "Controlled" Trials, intact men who waited more than 10 minutes to wash up after sex acquired HIV less than intact men who washed up immediately, AND LESS THEN THE CIRCUMCISED MEN.

-Ron

[antibunk]

Intact men who waited at least 10 minutes to wash up were at less risk than those who reported no sex partners? How is this possible? Are all the people who don't have sex using dirty heroin needles? Are they lying about having no sex partners?

Also, why is it beneficial to wait at least 10 minutes to wash up? How does it lower risk to use a dry cloth and no water? I'm just trying to understand the logic here.

[admin]

Originally Posted by antibunk

Intact men who waited at least 10 minutes to wash up were at less risk than those who reported no sex partners? How is this possible? Are all the people who don't have sex using dirty heroin needles? Are they lying about having no sex partners?

I think it just points out a failing of the studies. Medical treatments (not sex) are the vector for a huge share of HIV infections in Africa.

[intact]

rumor has it, that needle exchange and not sex, spreads this stuff.

[madbr3991]

remember HIV is a virus it can be spread through sex an through blood. what is the most common way to spread it in affrica? i don't know. but i know that proper sanitation and hygiene combined with safe sex practices including condoms. can and will reduce HIV rates significantly.

[antibunk]

These numbers just have me baffled. What the hell are these experts doing in Africa!? Geez. The water, dry towel, 10 minutes things really had me scratching my head. I wear a condom all the time these days. But I still like to head to the bathroom immediately after and wash with a bit of soap and water because condoms are not 100% and many allege that herpes and HPV can be spread even with condom use. Should I stop with the immediate soap/water treatment and go to the 10 minute method and dry towel??

[alex-oh]

This looks like a huge mistake. It's inconceivable that such a minor difference in washing habits could actually affect HIV transmission rates so much (0.4% infection rate for men who washed after 10+ min vs. 2.3% for men who washed in <3 min).

My first thought about this is that it's probably a very different effect than described. I think it seems much more likely that men who waited longer after sex before washing had fewer partners or their partners had fewer partners. Waiting longer would seem to indicate a greater degree of comfort a man has with his partner. The comfort of these men might typify men who aren't cheating or whose partners aren't cheating. These men might be less promiscuous. It seems like men who are less comfortable with their partners sexually (or women generally) might also want to wash sooner after sex. Or it might be that men who waited longer before washing after sex with women were also much less likely to have sex with men. They didn't determine or try to determine how the studied men acquired the disease, they just naively assumed it was all heterosexually acquired or took men at their word. Yet it seems obvious that nominally straight men would be very reluctant to admit any homosexual acts especially in a homophobic society and especially as an answer to how a terrible and very stigmatized disease was acquired.

Considering that and how obvious it all appears, Gray presuming that waiting longer to wash could provide a protective effect is just foul. When you consider the effect of male circumcision on men's willingness to use condoms, these African RCTs just look like an obvious attempt to talk the entire world into male circumcision, unsafe sex and infecting each other with HIV. Circumcisionists disregard for (among other things) human life seems completely subhuman. How has the scientific community been so easily mislead here?

I think it's because the concept of circumcisionism is not popular enough for people to know to recognize it--especially the peer-reviewing scientists who accepted this.

[AC_Tech85]

Alex, I believe it was suggested that the vaginal juices kill the virus. It appears that HIV needs water to thrive, hence the not washing with water. Though it wasn't suggested in the study, the foreskin's langheran (sp?) cells may help to fight HIV infection. When soap and water are introduced too early it may disrupt this function and then become very susceptible to infection.

This makes sense to me at least. It is part of why one shouldn't shave their junk or brush their teeth prior to sex. Minor cuts and abrasions are receptive to infection.

Honestly, I believe these HIV studies should be performed on death row inmates. Knowingly subject them to an HIV infected person everyday for two years. Discover a means to test immediately for HIV instead of testing antibodies. And ethically, make it voluntary and reward inmates for participation. Commute the sentence to life perhaps.