Male circumcision overstated as prevention tool against AIDS
New study finds the key to understanding the global spread of AIDS is the size of the infected prostitute community around the world
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The study has a number of important findings that should impact policy decisions in the future. First, male circumcision, which in previous studies had been found to be important in controlling AIDS, becomes statistically irrelevant once the study controls for the number of prostitutes in a country. The study finds that the more Muslim countries of North Africa do indeed suffer much less AIDS than southern and western Africa, but this lower prevalence is not due to higher numbers of circumscribed males in these Muslim communities, but rather results from the fact that there are significantly fewer prostitutes in northern Africa on a per capita basis. It appears that religious families in the north, specifically concerned fathers and brothers, do a much better job protecting their daughters from predatory males than do those in the south. A history of polygamy in these Muslim communities does not appear to contribute to hi gher AIDS prevalence as previously speculated. In a frequently cited academic paper, Daniel Halperin, an H.I.V. specialist at the Harvard Center for Population and Development and one of the world’s leading advocates for male circumcision, weighted results from individual countries by their population. When this artificial weighting was removed Talbott found that circumcision was no longer statistically significant in explaining the variance in AIDS infection rates across the countries of the World.
Second, to date, there has not been an adequate explanation as to why Africa as a continent is experiencing an AIDS epidemic far in excess of any other region of the world with some African countries’ prevalence rates exceeding 25% of the adult population and tens of millions dying from the disease on the continent. Talbott’s new study suggests that the reason is that Africa as a whole has four times as many prostitutes as the rest of the word and they are more than four times as infected. Some southern Africa countries have as many as 7% of their adult females infected and working as prostitutes while in the developed world typically this percentage of infected prostitutes is less than .1%. If these 7% of infected prostitutes in Africa sleep with five men in a week that means they are subjecting 35% of the country’s male population to the virus weekly. The virus is not easy to transmit heterosexually, b ut over time with multiple exposures, infection is inevitable. These men then act as a conduit to bring the virus home to their villages, their other casual sex partners and to their wives.
The study has important policy implications. Several international AIDS organizations have begun to provide funding for male circumcisions as a deterrent to AIDS. While male circumcision may indeed reduce the risk of transmission by some 50% to 60% in each sexual encounter, reducing single encounter transmission rates alone cannot control the epidemic. The reason is that individuals in highly infected countries have multiple contacts with the infected so reducing transmission rates only defers the inevitable.
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http://www.eurekalert.org/pub_releases/ ... 062007.php
Posted: Tue Jun 16, 2009 6:13 pm