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Nations to back male circumcision over HIV
By Our Foreign Staff
http://www.timesonline.co.uk/article/0,,3-2209173,00.html
FIVE southern African countries that have been hit hard by the Aids pandemic want to encourage men to be circumcised after a study indicated that the procedure reduced dramatically the risk of HIV infection.
Botswana, Lesotho, Swaziland, Tanzania and Zambia were holding talks with the UN Aids agency on making circumcision more accessible to men as part of HIV prevention efforts, a UN Aids adviser said.
A three-year study involving 3,274 men aged 18 to 24 in a South African township suggested that circumcision reduced the risk of contracting HIV by 60 per cent. “What we showed was a dramatic effect. Those who were circumcised were protected against acquiring HIV,” said Adrian Purven, the deputy director of the Institute for Communicable Diseases in South Africa, who led the study. So conclusive were the results that the researchers stopped the study in July and offered circumcision to all the men taking part.
UN Aids officials have launched two similar studies in Uganda and Kenya involving nearly 8,000 men. Interim results this month could establish the use of male circumcision in fighting against Aids. “This could be revolutionary for prevention but it is important to say this is not the silver bullet,” said Mr Lundstrom, who emphasised that condoms still offered the best protection against HIV.
Copyright 2006 Times Newspapers Ltd.
(\\__/) And if you don't believe The sun will rise
(='.'=) Stand alone and greet The coming night
(")_(") In the last remaining light. (C. Cornell)
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timmy
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Has no life at all |
Location: UK, in Devon
Registered: February 2003
Messages: 13800
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The study will be technically correct. Less mucous membrane means less chance of infective agents passing through it. But the paradigm is wrong.
Safe Sex is the only effective way of seeking to prevent STI transmission.
We will now get a load of ignorant people golbally saying "I have been circumcised so I am safe from getting or passing HIV on." This is wholly incorrect and very dangerous.
Author of Queer Me! Halfway Between Flying and Crying - the true story of life for a gay boy in the Swinging Sixties in a British all male Public School
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What is the mechanism? Why might circumcision affect susceptibility to HIV?
I'm not convinced that they should be using the word "protected". Assuming the figures are true, 60% reduction still means that for every ten uncircumcised persons catching HIV, 4 circumcised people will also catch it. Getting circumcised as a preventative measure is reckless at best, useless at worst. Anyway, for those people who are not already circumcised, circumcising would be a great deal more complicated, and less reliable, than simply using a condom.
I don't think this news surprises or incenses me in any way. The knowledge is more theoretical than practical, and as they say, it's hardly a magic bullet. I would worry, however, that people might be led to think it was. I assume the UN know what they are doing.
(Are we supposed to comment on these news items, BTW?)
David
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timmy
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Has no life at all |
Location: UK, in Devon
Registered: February 2003
Messages: 13800
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HIV is passed directly from bodily fluids from one perosn to another.
One mechanism is via injuries (this includes injuries caued by syringes, blood transfusions etc)
Another is via mucous membranes, such as mouth, rectum, glans and inner foreskin
A circumcised penis has less mucous membrane (little or no inner foreskin) and a keratinised mucous membrane (the glans) which is keratinised because of exposure mainly to the atmosphere.
Thus the circumcised penis will be less hospitable to inward transfer of the HIV infective agents than an uncircumcised one.
Author of Queer Me! Halfway Between Flying and Crying - the true story of life for a gay boy in the Swinging Sixties in a British all male Public School
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African AIDS Toll May Reach 100-Million
by Terry Leonard, Associated Press
http://365gay.com/Newscon06/06/060406hiv.htm
(Johannesburg, South Africa) It began quietly, when a statistical anomaly pointed to a mysterious syndrome that attacked the immune systems of gay men in California. No one imagined 25 years ago that AIDS would become the deadliest epidemic in history. Since June 5, 1981, HIV, the virus that causes AIDS, has killed more than 25 million people, infected 40 million others and left a legacy of unspeakable loss, hardship, fear and despair.
Its spread was hastened by ignorance, prejudice, denial and the freedoms of the sexual revolution. Along the way from oddity to pandemic, AIDS changed they way people live and love.
Slowed but unchecked, the epidemic's relentless march has established footholds in the world's most populous countries. Advances in medicine and prevention that have made the disease manageable in the developed world haven't reach the rest.
In the worst case, sub-Saharan Africa, it has been devastating. And the next 25 years of AIDS promise to be deadlier than the first.
AIDS could kill 31 million people in India and 18 million in China by 2025, according to projections by U.N. population researchers. By then in Africa, where AIDS likely began and where the virus has wrought the most devastation, researchers said the toll could reach 100 million.
"It is the worst and deadliest epidemic that humankind has ever experienced," Mark Stirling, the director of East and Southern Africa for UNAIDS, said in an interview.
More effective medicines, better access to treatment and improved prevention in the last few years have started to lower the grim projections. But even if new infections stopped immediately, additional African deaths alone would exceed 40 million, Stirling said.
"We will be grappling with AIDS for the next 10, 20, 30, 50 years," he said.
Efforts to find an effective vaccine have failed dismally, so far. The International AIDS Vaccine Initiative says 30 are being tested in small-scale trials. More money and more efforts are being poured into prevention campaigns but the efforts are uneven. Success varies widely from region to region, country to country.
Still, science offers some promise. In highly developed countries, cocktails of powerful antiretroviral drugs have largely altered the AIDS prognosis from certain death to a manageable chronic illness.
There is great hope that current AIDS drugs might prevent high-risk people from becoming infected. One of these, tenofovir, is being tested in several countries. Plans are to test it as well with a second drug, emtricitabine or FTC.
But nothing can be stated with certainty until clinical trials are complete, said Anthony Fauci, a leading AIDS researcher and infectious diseases chief at the U.S. National Institutes of Health.
And then there is the risk that treatment will create a resistant strain or, as some critics claim, cause people to lower their guard and have more unprotected sex.
Medicine offers less hope in the developing world where most victims are desperately poor with little or no access to the medical care needed to administer and monitor AIDS drugs. Globally, just 1 in 5 HIV patients get the drugs they need, according to a recent report by UNAIDS, the body leading the worldwide battle against the disease.
Stirling said that despite the advances, the toll over the next 25 years will go far beyond the 34 million thought to have died from the Black Death in 14th century Europe or the 20 to 40 million who perished in the 1918 Spanish flu epidemic.
Almost two-thirds of those infected with HIV live in sub-Saharan Africa where poverty, ignorance and negligent political leadership extended the epidemic's reach and hindered efforts to contain it. In South Africa, the president once questioned the link between HIV and AIDS and the health minister urged use of garlic and the African potato to fight AIDS, instead of effective treatments.
AIDS is the leading cause of death in Africa, which has accounted for nearly half of all global AIDS deaths. The epidemic is still growing and its peak could be a decade or more away.
In at least seven countries, the U.N. estimates that AIDS has reduced life expectancy to 40 years or less. In Botswana, which has the world's highest infection rate, a child born today can expect to live less than 30 years.
"Particularly in southern Africa, we may have to apply a new notion, and that is of `underdeveloping' nations. These are nations which, because of the AIDS epidemic, are going backwards," Peter Piot, the director of UNAIDS, said in a speech in Washington in March.
Later, at a meeting in Abuja, Nigeria, last month, Piot cited encouraging news including a sharp fall in new infections in some African countries. There also has been an eightfold increase in the number of Africans benefiting from antiretroviral treatment, he said.
But, he warned, "the crisis of AIDS continues and is getting worse and any slackening of our efforts would jeopardize the hard-won gains of each and every one of us."
Besides the personal suffering of the infected and their families, the epidemic already has had devastating consequences for African education systems, industry, agriculture and economies in general. The impact is magnified because AIDS weakens and kills many young adults, people in their most productive years.
So many farmers and farmworkers have died of AIDS that the U.N. has invented the term "new variant famine." It means that because of AIDS, the continent will experience persistent famine for generations instead of the usual cycles of hunger tied to variable weather.
Africa's misery hangs like a sword over Asia, Eastern Europe and the Caribbean.
Researchers don't expect the infection rates to rival those in Africa. But Asia's population is so big that even low infection rates could easily translate into tens of millions of deaths.
Although fewer than 1 percent of its people are infected, India has topped South Africa as the country with the most infections, 5.7 million to 5.5 million, according to UNAIDS.
The astonishing numbers have grown from a humble beginning.
Nobody knows for sure when or where, but the AIDS epidemic is thought to have begun in the primeval forests of West Africa when a virus lurking in the blood of a monkey or a chimpanzee made the leap from one species to another, infecting a hunter.
Researchers have found HIV in a blood sample collected in 1959 from a man in Kinshasa, Congo. Genetic analysis of his blood suggested the HIV infection stemmed from a single virus in the late 1940s or early 1950s.
For decades at least, the early human infections went unnoticed on a continent where life routinely is harsh, short and cheap.
Then, on June 5, 1981, the Centers for Disease Control in Atlanta reported five young actively homosexual men in Los Angeles had a new, mysterious and as yet unnamed illness that attacked the immune system and caused a type of pneumonia. A month later, it reported an odd surge among homosexual men in the number of cases of Karposi Sarcoma, a rare cancer now linked to AIDS.
In the early days of the epidemic, just the mention of AIDS elicited snickers and jokes. Few saw it as a major threat. It was the "Gay Plague," and for some, divine retribution for a lifestyle Christian fundamentalists and other conservatives consider deviant and sinful.
When heterosexuals began to contract the disease through blood transfusions and other medical procedures, they were often portrayed as "innocent" victims of a disease spread by the immoral and licentious behavior of others.
The initial reactions and prejudices associated with AIDS slowed the early response to the epidemic and limited the funding. Too much time, money and effort was spent on the wrong priorities, Stirling aid.
"Over the last 25 years, the one real weakness was the search for the magic bullet. There is no quick and simple fix," he said. "But with the recent successes we are starting to see the end of epidemic."
"There is evidence to suggest we are at the tipping point," said Stirling.
The pace of change over the last couple of years suggests the number of new infections can be reduced by 50 to 60 percent by 2020 - if the momentum continues.
"It is surely possible, it is doable," Stirling said.
©365Gay.com 2006
(\\__/) And if you don't believe The sun will rise
(='.'=) Stand alone and greet The coming night
(")_(") In the last remaining light. (C. Cornell)
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Hi EJ,
I am circumcised myself and was never an advocate for getting people to stop circumcising thier boys, but I saw no real cause to be irritated when I read what Tim wrote about it. I am not so sure that these statistics showing the risk of aids are accurate. Now lets suppose they just said that in the USA the incidence of aids is far less than in areas such as some place in Africa where most were not circumcised and using that sort of data to make the point that being circumcised meant you were far less likely to get aids. That is not necessarily true of course and sexual interaction with multiple partners and lack of protection such as condoms is probably a much larger reason for getting aids and spreading it. Also if there is already a lot of infected people in the population, it would stand to reason you were much more likely to become infected by having sex with someone.
I am not convinced by this as there are a lot of factors that can enter into this and it may just be a coincidence that aids is more rampant in those areas where there is little circumcision. I wouldnt like to bet my life on it!
Ken
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Ken,
>I am not so sure that these statistics showing the risk of aids are accurate.
Hmm, okay...
>Now lets suppose they just said that in the USA the incidence of aids is far less than in areas such as some place in Africa where most were not circumcised and using that sort of data to make the point that being circumcised meant you were far less likely to get aids.
That would, indeed, be faulty logic, but I see nothing to suggest that that is the case. The study was "a three-year study involving 3,274 men aged 18 to 24 in a South African township". So questioning the study by using arguments of that kind -- without being aware of their methods, without having access to their statistics-- is a bit ludicrous. I would be inclined to take their results on face value (though that does not mean I believe them, only that at the present time there is no reason to disbelieve them) until either they are verified by independent studies, or I have a chance to study their methodology. The only worry is that people will see the results and jump to unscientific and invalid conclusions.
>Also if there is already a lot of infected people in the population, it would stand to reason you were much more likely to become infected by having sex with someone [than in America].
True. But any academic researcher worth his salt would be perfectly aware of that. The study appears to have all taken place within the same town, so regional/international differences would not apply.
David
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I can understand where this may apply to hetrosexual relations. In the Homosexual world isnt HIV mostly contracted thru anal sex?
I believe in Karma....what you give is what you get returned........
Affirmation........Savage Garden
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timmy
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Has no life at all |
Location: UK, in Devon
Registered: February 2003
Messages: 13800
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As a generalisation you are right. The rectum is a mucous membrane designed to absorb nutrients, being the final part of the digestive tract. Thus it is almost designed to allow HIV infective agents to pass through he wall wheher there is injury to the recal wall or not and whetehr there is injury to the anus itself or not.
Agains as a generalisation it is more likely that the penetrated person becomes infected form an HIV+ penetrator than the other way around. Thsi is because of the greater asurface area of mucous membrane in the rectum than on the penis. Even so infection in either direction is posisble.
However, if we now move to the vagina, it, too, is mucous membrane. It does not need to be injured in order for HIV to be transferred. The mechanism of infection is similar.
In each case it should be noted that the penetrated partner need not be (yet) infected, and that the semen of the last penetrator may infect the next penetrator through the mucous membrane of the penis.
It should also be noted that the urethra and the urethral meatus are both mucous membrane, and that this tissue is unaffected by circumcision
There is also an interesting by-product of circumcision: Sex becomes rougher because the penis becomes less sesnitive. Thus it needs to be thrust eother for longer or with more force to achieve orgasm. Thsi tends to abrade the vessel into which it is placed, leading to possible injury and easier transmission of HIV.
A solution for heterosexual HIV transmission would be for all women to have their vaginas sewed closed. Then no vaginal transmission would occur. Of course this woudl be viewed as morally reprehensible, since a woman must have her vagina unmutilated. Oddly the corrollory does not seem to apply with men and penises.
Author of Queer Me! Halfway Between Flying and Crying - the true story of life for a gay boy in the Swinging Sixties in a British all male Public School
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Timmy said,
>A solution for heterosexual HIV transmission would be for all women to have their vaginas sewed closed. Then no vaginal transmission would occur. Of course this woudl be viewed as morally reprehensible, since a woman must have her vagina unmutilated. Oddly the corrollory does not seem to apply with men and penises.
I must say -- that is a remarkably succinct summary of the differing perceptions between female and male genital mutilation. I don't have anything to add -- I agree with you, Timmy, circumcision should only be carried out for medical reasons, and then only if absolutely necessary -- but until then I was viewing the thread with a certain detachment. You've left a rather a vivid and revolting picture in my mind.
Come to think of it, amputating the penis would also help to prevent HIV. I bet it would cut down the infection rate even more than the mere 60% from circumcision.
If we're going on statistics alone, chopping off a man's head would have a 100% success rate in preventing him from being infected by HIV.
Am I just being silly here?
David
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timmy wrote:
> As a generalisation you are right. The rectum is a mucous membrane designed to absorb nutrients, being the final part of the digestive tract. Thus it is almost designed to allow HIV infective agents to pass through he wall wheher there is injury to the recal wall or not and whetehr there is injury to the anus itself or not.
>
> Agains as a generalisation it is more likely that the penetrated person becomes infected form an HIV+ penetrator than the other way around. Thsi is because of the greater asurface area of mucous membrane in the rectum than on the penis. Even so infection in either direction is posisble.
All good points. On a health ed. note, it is also worth pointing out that the bodily secretion in HIV+ people that has the highest concentration of HIV virus is anal mucus ("anal snot") - *much* higher than the concentration in semen, for example (and, unlike the viral load in blood and semen, it is *not* reduced by any of the currently-available drug therapies).
This is fairly recent research, which is only just starting to be reflected in Health Education programs, so I thought it was worth pointing out.
"The ultimate weakness of violence is that it is a descending spiral, begetting the very thing it seeks to destroy. ... Returning violence for violence multiplies violence, adding deeper darkness to a night devoid of stars." Martin Luther King
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timmy
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Has no life at all |
Location: UK, in Devon
Registered: February 2003
Messages: 13800
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This comes back most strongly to safe sex. Good condoms, within their expiry period, used with compatible lube.
I would also like to mention that the hepatitis family are prevalent and unpleasant. They are just not newsworthy.
Author of Queer Me! Halfway Between Flying and Crying - the true story of life for a gay boy in the Swinging Sixties in a British all male Public School
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