AUSTRALIA: Tale of Two Opinions on Circumcision

NOTE: This is a republished “best of” post from 2009. Unfortunately, not all of the links are still live. Sorry about that.

Excellent analysis of the latter article below is available from the Intactivism Pages.

HIV and circumcision share one very interesting trait. Both advance under the specter of fear and ignorance. Fear of HIV has given circumcision a more prominent spot on the world stage then it should have. This fear is leveraged to fund extravagant and complicated social projects to fight a disease which is easily avoidable with simpler measures.

Fear of disease, most lately HIV, has been used to perpetuate circumcision. In every case, the rationale used to promote it are half-baked and never well thought out. Often when one scratches just below the surface, one can see the weaknesses and unexpected outcomes such advocacy produces. Occasionally, an obvious example comes along. Thanks to an article in the Australian by Professor Murray, we have one such example to examine.

In January, The Australian published an article that laid out just how fear is used to stoke the fire that drives circumcision. Citing what is made to appear to be a relatively sharp increase in the proportion of male heterosexually acquired HIV infections along with the relative decrease in per-exposure risk observed in Africa, the author, Alex Wodak, tries to make the case that Australians should be encouraged to increase their rate of circumcision which has been falling for over 30 years and sits at around 10%.

Wodak buttresses his argument by pulling out all the stops perpetuating circumcision myths while citing low complication rates in the African study groups. Among the myths perpetuated include the assertion that circumcision reduces the risk of:

  1. Other more common STDs, a claim that hasn’t been shown to be true in most first world studies and even if it was true, would amount to a trivial reduction of a problem that can always be treated more conservatively;
  2. Penile cancer despite the fact that for at least the last 10 years groups such as the American Cancer Society have explicitly said that circumcision does not prevent penile cancer not to mention the fact that the HPV vaccine has now been demonstrated to be effective in boys potentially making a very rare cancer even rarer;
  3. Cervical cancer despite the fact that we have not one but two vaccines which can prevent HPV infection of the types of HPV responsible for close to 3/4s of cervical cancer (again not to mention the fact that considering current screening programs, there is a legitimate argument that even a vaccine is not necessary from a public health policy or cost-benefit point of view).

Wodak also points to low rates of complications in the study group, perhaps missing the report that circumcision in the general population has produced shockingly high rates of complications. According to the review, produced by none other than Daniel Halperin, rates of complications in clinical circumcision was nearly 20% with more than 20% not healing fully even after 60 days. When presented with such a report, I suspect that Mr. Wodak might point out that such a high rate of complication wouldn’t be experienced in a first world country such as Australia. One wonders then why he hasn’t looked at the HIV question from the first world perspective throughout his analysis.

Fortunately, this week, John Murray, associate professor in the school of mathematics and statistics at the University of New South Wales and the Nations Centre in HIV Epidemiology and Clinical Research, has provided just such an evaluation. Rather then relying on fear, Professor Murray relies on rational thinking. Professor Murray starts by pointing out that in Australia, access to HIV testing and anti-retrovirals is universal which we know contributes substantially in reducing the risk of exposure. Hygiene and access to prophylaxis, such as condoms, is substantially better and the prevalence of other STDs is significantly lower.

Professor Murray goes on to point out that of the 854 Australians men diagnosed with HIV in 2006, only about 77, about 9%, were thought to have acquired it through heterosexual contact. While this is an increase since 2000 (62), a close look at the statistics reveal that the average age of HIV infection for these 77 men was 46, most of the increase (10) were in men 60 and over, and none of the men were younger than 24. The vast percentage of new infections therefore were in men of a generation that was already circumcised.

This is the difference between alarmist, such as Mr. Wodak who take every opportunity to spread fear and panic in order to opportunistically promote circumcision, and rational thinkers such as Professor Murray who bring us back down to earth.

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