Circumcision cuts African AIDS! – Times
December 15th, 2006
Editors excited about way for heterosexuals to evade HIV
Millions will want the $20 operation, major funds ready to give – but is Padian so wrong?
Precisely why the editors of the Times made the HIV-circumcision story the top story on their Web front page and top right hand above the fold print edition front page headline yesterday is a matter of speculation, but we assume it is because the story involves a) heterosexuals b) African sex c) danger to the genitals d) a simple but effective solution to AIDS and e) women’s revenge (photo, left, is of a Somali woman parading against Ethiopia with an AK-47).
Not to mention it allows readers to indulge their envious prejudice, which the Times editors and reporters like to reinforce monthly, against Africans for supposed sexual excesses.
Nelson Mandela’s autobiography, “Long Walk to Freedom,†contains an unnerving but hilarious account of his own Xhosa circumcision, by spear blade, as a teenager. Although he was supposed to shout, “I am a man!†he grimaced in pain, he wrote…Dr. Mark Dybul, executive director of President Bush’s $15 billion Emergency Plan for AIDS Relief, said in a statement that his agency “will support implementation of safe medical male circumcision for H.I.V./AIDS prevention†if world health agencies recommend it…
AIDS experts immediately hailed the finding. “This is very exciting news,†said Daniel Halperin, an H.I.V. specialist at the Harvard Center for Population and Development, who has argued that circumcision slows the spread of AIDS in the parts of Africa where it is common.
In an interview from Zimbabwe, he added, “I have no doubt that as word of this gets around, millions of African men will want to get circumcised, and that will save many lives.â€
The Times editors are so excited about this revelation (a questionable result which has been around for some time) that they devoted an editorial to it as well, Rare Good News About AIDS comparing it to “the holy grail” of AIDS research, the long heralded but still AWOL vaccine:
For years, the holy grail of AIDS prevention has been a vaccine, even one that is only 50 to 60 percent effective. A real vaccine is years away. But as of yesterday, we know its near equivalent exists. International donors and governments should join together to spread the good news about circumcision and make the procedure available everywhere.
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December 14, 2006
Editorial
Rare Good News About AIDS
The announcement yesterday about the results in two African studies of male circumcision may be the most important development in AIDS research since the debut of antiretroviral drugs more than a decade ago. The National Institutes of Health halted studies in Uganda and Kenya when it became overwhelmingly clear that circumcision significantly reduces men’s chances of catching H.I.V.
The studies recruited men willing to be circumcised and randomly assigned them to immediate surgery or to a control group. In both studies, the circumcised men acquired half the number of H.I.V. infections as their uncircumcised counterparts did. The studies confirm the results of a trial that ended last year in South Africa, in which circumcision prevented 60 to 70 percent of new AIDS infections.
Until now, efforts at AIDS prevention have largely failed. Little wonder. It requires people to resolve — every day — either not to have sex or to use condoms. Circumcision, by contrast, is a one-time procedure. It is familiar and widely accepted all over the world, even by groups who do not practice it. And safe circumcision does not require a doctor. Community workers and traditional healers can be trained to do the operation safely and given the correct tools.
Based on the South African results, groups like the United Nations AIDS program and the World Health Organization were already discussing how they might promote circumcision in countries around the world. They should now move as quickly as possible.
Governments and international donors should also work urgently to provide new financing to help high-risk countries train community workers to do safe circumcision. News of the South African results has already led to a surge in demand for the procedure across Africa, and clinics that now offer it have long waiting lists.
Any campaign will have to be coupled with warnings that circumcision offers only partial protection against H.I.V. and should not become a license for risky sex. Governments must continue to promote condoms and partner reduction.
For years, the holy grail of AIDS prevention has been a vaccine, even one that is only 50 to 60 percent effective. A real vaccine is years away. But as of yesterday, we know its near equivalent exists. International donors and governments should join together to spread the good news about circumcision and make the procedure available everywhere.
Even if one is not a dissenter from the holey (as in Swiss cheese) HIV∫AIDS paradigm, this initiative looks fat headed. Soap would achieve the same result, any doctor will tell you. And do we really need to do unaesthetic surgery on millions of Africans to prevent the transmission of a virus which after billions of dollars worth of research has not yet been proved to cause any harm, although that assumption is built into most of the thinking on the subject? Are trainloads of foreskins going to be useful for interferon or other immune factors, is that it?
Anyhow, as far as HIV∫AIDS science critics are concerned, circumcision is a non solution to a non problem, ever since Nancy Padian demonstrated in her landmark 1997 study the heterosexual non transmission of HIV.
Of course, Padian has had to ‘clarify’ this result since it was noticed and taken up by HIV∫AIDS dissidents and used as a club to bash the paradigm and its defenders, one which knocks away the basic prop of the global pandemic. Without significant heterosexual transmission, there is no global pandemic and no need to circumcise millions of Africans.
Padian’s clarification was published a few months ago on the leading AIDS truthiness site run by John P. Moore of Cornell and other HIV apologists, AIDSTruth.org, the specific page being HIV heterosexual transmission and the “Padian paper myth”,and it reads as follows, with our corrective comments:
HIV heterosexual transmission and the “Padian paper myth”One of the more egregious myths perpetrated by AIDS denialists is that HIV is not heterosexually transmitted.
The debate on the validity of the HIV∫AIDS paradigm is a hall of mirrors, where the defense of the paradigm is very often conducted by co-opting the arguments of the critics and turning them back on their originators (who do the same to them, rather more tellingly, by pointing out that it is the paradigm defenders who are the true “denialists”, for their ostrich like approach to the myriad objections to HIV∫AIDS).
In this case, the word “myth” as in “The AIDS Myth” or “The Myth of Heterosexual AIDS” is appropriated, but rather ineffectively, since it inevitably calls attention to the possibility that the HV∫AIDS paradigm itself may be the greatest myth of all in the field.
Part of the “evidence” that underlies this myth is a 1997 paper by Dr. Nancy Padian and her colleagues at the University of California, San Francisco (Padian NS, Shiboski SC, Glass SO, Vittinghoff E. 1997. Heterosexual transmission of human immunodeficiency virus (HIV) in Northern California: results from a ten-year study. Am J Epidemiol 146, 350-357) (1).
A thorn in the flesh of the paradigm apologists indeed, this study, for its results accounted for the biggest flaw in the HIV∫AIDS explanation for the outbreak of immune deficiency in the US, which is that it cannot explain away the absence of a heterosexual AIDS epidemic in this country, and moreover, it is a study which is now a prime justification for rejecting the standard interpretation of events in Africa, which is that a heterosexually transmitted HIV pandemic has swept the continent and the world.
The denialists either misinterpret or misunderstand this paper. Some internet sites/Blogs even go so far as to suggest that the “HIV/AIDS establishment” (sic) finds Dr. Padian’s work inconvenient and has suppressed it, to the detriment of her professional career.
On the contrary, the skill with which Dr Padian has navigated between the Scylla of the establishment disowning her and her research and the Charybdis of renouncing it herself is a marvel to behold and an inspiration for the many other establishment researchers who have come out with embarrassing results which contradict the paradigm, such as those who came out wih the HAART and the JAMA studies this summer, and Dr Gisselquist.
The following commentary from Dr. Padian addresses HIV heterosexual transmission, discusses what her seminal 1997 paper does actually say and, ipso facto, speaks to the absurdity of the notion that her work has been suppressed, or is inconvenient to other AIDS researchers.Heterosexual transmission of HIV
Nancy Padian, PhD
University of California, San Francisco
HIV is unquestionably transmitted through heterosexual intercourse.
This kind of statement is increasingly a characteristic of HIV∫AIDS papers which these days typically come up with findings which do not fit into conventional wisdom. First, there is this kind of obligatory obeisance to the reigning belief, the sine qua non of HIV∫AIDS research, which is that all symptoms are first and foremost caused by the dread Virus itself, however much other factors may enter into the picture. For example, patients may die of drug effects such as liver rot, but HIV is really the cause, even though liver problems are not on the CDC list of HIV∫AIDS symptoms.
Indeed, heterosexual intercourse is now responsible for 70-80% of all HIV transmissions worldwide (2). The current likelihood of male to female infection after a single exposure to HIV is 0.01-0.32% (2, 3), and the current likelihood of female to male infection after a single exposure is 0.01-0.1% (2). These estimates are mostly derived from studies in the developed world. However, a man or a woman can become HIV-positive after just one sexual contact.
Rates of between 1 in 10,000 to 1 in 3,000 , or between 1 in 10,000 and 1 in 1,000 for woman to man, are not high enough to sustain a spreading epidemic.
In developing countries, particularly those in sub-Saharan Africa, several factors (co-infection with other sexually transmitted diseases, circumcision practices, poor acceptance of condoms, patterns of sexual partner selection, locally circulating viral subtypes, high viral loads among those who are infected, etc.) can increase the likelihood of heterosexual transmission to 20% or even higher (4).
These factors might raise the transmission rate but to a level of 2000 per 10,000 – ie 2,000 times as much – is unlikely, on the face of it.
Evidence that specifically documents the heterosexual transmission of HIV comes from studies of HIV-discordant couples (i.e., couples in a stable, monogamous relationship where one partner is infected and the other is not); over time, HIV transmission occurs (5).
Not in this study.
Other studies have traced the transmission of HIV through networks of sexual partners (6-9). Additional evidence comes from intervention studies that, for example, promote condom use or encourage reductions in the numbers of sexual partners: the documented success of these interventions is because they prevent the sexual transmission of HIV (1,10,11).
Such results are inconsistent wth her study which was the largest ever conducted.
In short, the evidence for the sexual transmission of HIV is well documented, conclusive, and based on the standard, uncontroversial methods and practices of medical science. Individuals who cite the 1997 Padian et al. publication (1) or data from other studies by our research group in an attempt to substantiate the myth that HIV is not transmitted sexually are ill informed, at best. Their misuse of these results is misleading, irresponsible, and potentially injurious to the public.
The intemperate language suggests a political and emotionally driven stance, and that an unproven belief (that HIV is the cause of AIDS) is acting as a premise in addressing the counterarguments. Here Padian is protesting that her study does not suggest that the paradigm is incorrect. Methinks she doth protest too much. The reason is that her results are in direct conflict with the paradigm. Substantial heterosexual transmission is a pillar of the HIV∫AIDS paradigm, a sine qua non of the supposed global panademic. Her study demonstrated it was so insubstantial that it didn’t appear at all.
A common practice is to quote out of context a sentence from the Abstract of the 1997 paper: “Infectivity for HIV through heterosexual transmission is low”. Anyone who takes the trouble to read and understand the paper should appreciate that it reports on a study of behavioral interventions such as those mentioned above: Specifically, discordant couples were strongly counseled to use condoms and practice safe sex (1,12).
As many as 47 couples did not consistently use condoms or any other means of interfering with transmission for up to six years.
That we witnessed no HIV transmissions after the intervention documents the success of the interventions in preventing the sexual transmission of HIV.
Again, as many as 47 couples did not consistently use condoms or any other means of interfering with transmission for up to six years.
The sentence in the Abstract reflects this success — nothing more, nothing less. Any attempt to refer to this or other of our publications and studies to bolster the fallacy that HIV is not transmitted heterosexually or homosexually is a gross misrepresentation of the facts and a travesty of the research that I have been involved in for more than a decade.
To say “Nothing more, nothing less” is blatantly misleading, and we suspect his was written by John P. Moore, rather than Padian. In fact as many as 47 couples did not use condoms or any other means of interfering with transmission. Yet still for these couples there was no transmission during the study. This without question demonstrated the “fallacy” in heterosexual transmission. There was none for these couple in six years.
If safe sex practices are followed, and if there are no complicating factors such as those mentioned above, the risk of HIV transmission can be as low as our studies suggest…IF.
Of course, this is presumably true. Using condoms does block transmission of any live organism pretty effectively, depending on using them properly. But the problem is that her study showed that even if safe sex practices were not followed there was also nil transmission.
But many people misunderstand probability: they think that if the chance of misfortune is one in six, that they can take five chances without the likelihood of injury. This “Russian Roulette” misapprehension is dangerous to themselves and to others.
The Russian Roulette factor only means that an individual can escape the average, and possibly, even if the chance of an event is 1 in 1000, hit the 1 time the first time, or the 1000th time, or never. This doesn’t change the average, which in this case was nil, a rather conclusive result which shows the chances of transmission of the supposed agent are far too low to initiate any epidemic, since according to her study, normal healthy heterosexuals are virtually incapable of transmitting HIV even if they are not taking any precautions.
Furthermore, complicating factors are often not evident or obvious in a relationship, so their perceived absence should not be counted on as an excuse not to practice safe sex.
The phrasing of this remark is telling. Although it is on the surface merely a practical observation, it continues the fundamental defense of the paradigm in religious terms ie have faith (and fear) that there is something there even though you cannot see any evidence for it.
Finally, it is a complete fallacy to allege or insinuate that this work has been “suppressed” or “ignored” by the AIDS community or unsupported by UCSF or any other institution with which I have worked. To the contrary, these findings have been seen as central and seminal to the problem of heterosexual transmission rates and the development of interventions to lower the rate of transmission and infection worldwide, many of which are being conducted by my research group. The success of my working group has been fueled, not hindered, by our research on the heterosexual transmission of HIV, attested to by our long record of peer-reviewed publications.
Yes, the record of Padian’s work as fundamentally disruptive to the conventional wisdom in HIV∫AIDS yet somehow turned into a piece which fits into it without a ripple is a prime exhibit of how HIV∫AIDS’s double think, Orwellian fantasy works. While the embarrassing inconsistency of her results is recognized and various escape hatches are opened – genital sores, African “dry sex”, HIV piggy backing on other diseases and so on – Nancy Padian has managed to stay a member of the club despite her study being the best argument of all against belief in the paradigm.
Nancy Padian is a Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of California and she has worked on the heterosexual transmission of HIV since 1984. She is a frequent participant in annual NIH Office of AIDS Research planning workshops and has chaired the workshop on international research for the last four years. She is an elected member to the Institute of Medicine and the American Epidemiology Society. She served as vice-chair of the University of California task force on AIDS and currently directs international research for UCSF Global Health Sciences, the UCSF AIDS Research Institute and she is co-director of the Center for Reproductive Health Research and Policy.
An impressive list of appointments which is a tribute to the political skills of Dr Padian and the way she has exchanged reinterpretation of her results to conform with the paradigm for membership of the club, a club which like the English aristocracy knows that the best way to defeat revolutionaries is to bring them in from the cold.
Unkind cut would save very few
Going back to look at the paper, we find something interesting – the numbers involved in this great halving of the risk are very small fractions of the population.
The two trials were being conducted by researchers from universities in Illinois, Maryland, Canada, Uganda and Kenya and involved nearly 3 000 heterosexual men in Kisumu, Kenya and nearly 5 000 in Rakai, Uganda. None were infected with HIV. They were divided into circumcised and uncircumcised groups, given safe sex advice [although many presumably did not take it] and retested regularly.The trials were stopped this week by the NIH Data Safety and Monitoring Board after data showed that the Kenyan men had a 53 percent reduction in new HIV infection.
Twenty-two of the 1 393 circumcised men in that study caught the disease, compared with 47 of the 1 391 uncircumcised men. In Uganda, the reduction was 48 percent.
Even if the figures for transmission reached somehow in this and other studies are valid, and HIV is a threat backed by the literature, instead of being called into question by even paradigm-based papers without valid rebuttal, mass circumcision seems an overreaction.
For example, in the two trials, the trumpeted halving of the rate of new HIV infection was 53 per cent in Kenya and 48 per cent in Uganda, which sounds good but in fact represented only 25 men in 1393 total saved from HIV, a reduction of less thn 2%.
Of course, the remaining question is how accurate was the testing and what did it represent if the difficulty in transmission is as high as Nancy Padian found it was in her study? Presumably the tests are cross reacting with other transmissible diseases, the most likely one being TB, which is very widespread in Africa.
Nancy Padian Hero of AIDS
Encounterimg her at the party following the HIV/NET trials conference in Washington this last spring, we congratulated Nancy Padian on her outstanding research, which had made her a hero of AIDS in our view. “Oh I don’t think I am that!” she demurred, “Why do you say so?”
We explained it was because she had been the first to demonstrate that HIV did not transmit heterosexually very significantly if at all.
She seemed taken aback, and after gathering her wits, pronounced feebly, “But it transmits more in Africa!”
Could it be that Dr Padian has a special interest in emphasizing heterosexual transmission in favor of her own strategy in combating HIV transmission in Africa?
Surely not. But in 2002 she won the largest single private grant ever made to UCSF, $28 million, from the Gates Foundation, “to examine the effectiveness of the diaphragm in slowing the spread of the AIDS virus.”
Director of the Bill and Melinda Gates Foundation’s HIV/AIDS and TB Program at the time was Helene Gayle, who said “finding additional barrier methods that are female-controlled is a public health priority.”
Not, of course, if heterosexual transmission without any barrier is virtually absent.
Padian’s references:
1. Padian NS, Shiboski SC, Glass SO, Vittinghoff E. Heterosexual transmission of human immunodeficiency virus (HIV) in Northern California: results from a ten-year study. Am J Epidemiol 1997;146:350-7.
2. Downs AM, De Vincenzi I. Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts. European Study Group in Heterosexual Transmission of HIV. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Apr 1;11(4):388-95.
3. Wiley JA, Herschhkorn SJ, Padian NS. Heterogeneity in the probability of HIV transmission per sexual contact: the case of male-to-female transmission in penile-vaginal intercourse. Stat Med 1989;8:93-102.
4. Gray RH, Wawer MJ, Brookmeyer R, Sewankambo NK, Serwadda D, Wabwire-Mangen F, Lutalo T, Li X, vanCott T, Quinn TC; Rakai Project Team. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet. 2001 Apr 14;357(9263):1149-53.
5. Ellerbock TV, Lieb S, Harrington PE, et al. Heterosexually transmitted human immunodeficiency virus infection among pregnant women in a rural Florida community. N Engl J Med 1992;327:1704-9.
6. Hunter DJ. AIDS in sub-Saharan Africa: the epidemiology of heterosexual transmission and the prospects for prevention. Epidemiology. 1993 Jan;4(1):63-72. Review.
7. Venkataramana CB, Sarada PV. Extent and speed of spread of HIV infection in India through the commercial sex networks: a perspective. Trop Med Int Health. 2001 Dec;6(12):1040-61.
8. Adimora AA, Schoenbach VJ, Doherty IA. HIV and African Americans in the southern United States: sexual networks and social context. Sex Transm Dis. 2006 Jul;33(7 Suppl):S39-45.
9. Latora V, Nyamba A, Simpore J, Sylvette B, Diane S, Sylvere B, Musumeci S. Network of sexual contacts and sexually transmitted HIV infection in Burkina Faso. J Med Virol. 2006 Jun;78(6):724-9.
10. Ghys PD, Diallo MO, Ettiegne-Traore V, Kale K, Tawil O, Carael M, et al. Increase in condom use and decline in HIV and sexually transmitted diseases among female sex workers in Abidjan, Cote d’Ivoire, 1991-1998. AIDS 2002;16(2):251-58.
11. Katzenstein DA, McFarland W, Mbizo M, Latif AS, Machekano R, Parsonnet J, et al. Peer education among factory workers in Zimbabwe: providing a sustainable HIV prevention intervention. Paper presented at the 12th International Conference on AIDS, Geneva, June 28-July 3, 1998.
12. Padian NS, O’Brien TR, Chang Y, Glass S, Francis DP. Prevention of heterosexual transmission of human immunodeficiency virus through couple counseling. J Acquir Immune Defic Syndr. 1993 Sep;6(9):1043-8
===============================================
The New York Times December 14, 2006 Circumcision Halves H.I.V. Risk, U.S. Agency Finds By Donald G. McNeil Jr., who is a reliable conduit at the Times for all official pronouncements on HIV∫AIDS, SARS, Bird Flu, and similar alarms.
December 14, 2006
Circumcision Halves H.I.V. Risk, U.S. Agency Finds
By DONALD G. McNEIL Jr.
Circumcision appears to reduce a man’s risk of contracting AIDS from heterosexual sex by half, United States government health officials said yesterday, and the directors of the two largest funds for fighting the disease said they would consider paying for circumcisions in high-risk countries.
The announcement was made by officials of the National Institutes of Health as they halted two clinical trials, in Kenya and Uganda, on the ground that not offering circumcision to all the men taking part would be unethical. The success of the trials confirmed a study done last year in South Africa.
AIDS experts immediately hailed the finding. “This is very exciting news,†said Daniel Halperin, an H.I.V. specialist at the Harvard Center for Population and Development, who has argued that circumcision slows the spread of AIDS in the parts of Africa where it is common.
In an interview from Zimbabwe, he added, “I have no doubt that as word of this gets around, millions of African men will want to get circumcised, and that will save many lives.â€
Uncircumcised men are thought to be more susceptible because the underside of the foreskin is rich in Langerhans cells, sentinel cells of the immune system, which attach easily to the human immunodeficiency virus, which causes AIDS. The foreskin also often suffers small tears during intercourse.
But experts also cautioned that circumcision is no cure-all. It only lessens the chances that a man will catch the virus; it is expensive compared to condoms, abstinence or other methods; and the surgery has serious risks if performed by folk healers using dirty blades, as often happens in rural Africa.
Circumcision is “not a magic bullet, but a potentially important intervention,†said Dr. Kevin M. De Cock, director of H.I.V./AIDS for the World Health Organization.
Sex education messages for young men need to make it clear that “this does not mean that you have an absolute protection,†said Dr. Anthony S. Fauci, an AIDS researcher and director of the National Institute of Allergy and Infectious Diseases.
Circumcision should be used with other prevention methods, he said, and it does nothing to prevent spread by anal sex or drug injection, ways in which the virus commonly spreads in the United States.
The two trials, conducted by researchers from universities in Illinois, Maryland, Canada, Uganda and Kenya, involved nearly 3,000 heterosexual men in Kisumu, Kenya, and nearly 5,000 in Rakai, Uganda. None were infected with H.I.V. They were divided into circumcised and uncircumcised groups, given safe sex advice (although many presumably did not take it), and retested regularly.
The trials were stopped this week by the N.I.H. Data Safety and Monitoring Board after data showed that the Kenyan men had a 53 percent reduction in new H.I.V. infection. Twenty-two of the 1,393 circumcised men in that study caught the disease, compared with 47 of the 1,391 uncircumcised men.
In Uganda, the reduction was 48 percent.
Those results echo the finding of a trial completed last year in Orange Farm, a township in South Africa, financed by the French government, which demonstrated a reduction of 60 percent among circumcised men.
The two largest agencies dedicated to fighting AIDS said they would now be willing to pay for circumcisions, which they have not before because there was too little evidence that it worked.
Dr. Richard G. A. Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has almost $5 billion in pledges, said in a television interview that if a country submitted plans to conduct sterile circumcisions, “I think it’s very likely that our technical panel would approve it.â€
Dr. Mark Dybul, executive director of President Bush’s $15 billion Emergency Plan for AIDS Relief, said in a statement that his agency “will support implementation of safe medical male circumcision for H.I.V./AIDS prevention†if world health agencies recommend it.
He also warned that it was only one new weapon in the fight, adding, “Prevention efforts must reinforce the A.B.C. approach — abstain, be faithful, and correct and consistent use of condoms.â€
Researchers have long noted that parts of Africa where circumcision is common — particularly the Muslim countries of West Africa — have much lower AIDS rates, while those in southern Africa, where circumcision is rare, have the highest.
But drawing conclusions was always confounded by other regional factors, like strict Shariah law in some Muslim areas, rape and genocide in East Africa, polygamy, rites that require widows to have sex with a relative, patronage of prostitutes by miners, and men’s insistence on dangerous “dry sex†— with the woman’s vaginal walls robbed of secretions with desiccating herbs.
Outside Muslim regions, circumcision is spotty. In South Africa, for example, the Xhosa people circumcise teenage boys, while Zulus do not. AIDS is common in both tribes.
Nelson Mandela’s autobiography, “Long Walk to Freedom,†contains an unnerving but hilarious account of his own Xhosa circumcision, by spear blade, as a teenager. Although he was supposed to shout, “I am a man!†he grimaced in pain, he wrote.
But not all initiation ceremonies are laughing matters. Every year, some South African teenagers die from infections, and the use of one blade on many young men may help spread AIDS.
In recent years, as word has spread that circumcision might be protective, many southern African men have sought it out. A Zambian hospital offered $3 circumcisions last year, and Swaziland trained 60 doctors to do them for $40 after waiting lists at its national hospital grew.
“Private practitioners also do it,†Dr. Halperin said. “In some places, it’s $20; in others, much more. Lots of the wealthy elite have already done it. It prevents S.T.D.’s, it’s seen as cleaner, sex is better, women like it. I predict that a lot of men who can’t afford private clinics will start clamoring for it.†(S.T.D.’s are sexually transmitted diseases.)
Male circumcision also benefits women. For example, a study of the medical records of 300 Ugandan couples last year estimated that circumcised men infected with H.I.V. were about 30 percent less likely to transmit it to their female partners.
Earlier studies on Western men have shown that circumcision significantly reduces the rate at which men infect women with the virus that causes cervical cancer. A study published in 2002 in The New England Journal of Medicine found that uncircumcised men were about three times as likely as circumcised ones with a similar number of sexual partners to carry the human papillomavirus.
The suspected mechanism was the same — cells on the inside of the foreskin were also more susceptible to that virus, which is not closely related to H.I.V.

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A retrial of the six health workers ended in Tripoli last month. The prosecutor demanded the death penalty after five Libyan experts in H.I.V. and AIDS stood by their 61-page report, written in 2003, that found that the infections of the Libyan children had resulted from an intentional act.A Libyan court is expected to deliver a verdict on Dec. 19.
Perhaps 114 Nobel laureates can be assembled to write to Dr Anthony Fauci to urge that an independent review commission be appointed. They would have to be drawn from other fields, since scientists in the field appear to have a religious conviction that HIV causes AIDS even in the absence of confirming evidence, other than data collected and analyzed on that very assumption.






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