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Originally posted by Grizwald:
"Newly circumcised men should also avoid sex for at least six weeks, until they’re healed."

Ummmm, well, yeah...

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Originally posted by fredgiblet:
IIRC (and this is going off of an article I read a few years ago), the foreskin acts like a little cup and holds some of the fluids inside of it where they get in via small cuts and tears in the skin.

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Originally posted by fredgiblet:
I googled "circumcision hiv" and skimmed the first few pages of results. There is a couple anti- sites and most of the pro- sites are simply repeating the same story.

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Originally posted by chrisisall:
Oh puhleeze. How many times have you shagged until bleeding?

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Originally posted by Khyron:
I think it's really cool how more and more Americans are using the word 'shag' these days.

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Originally posted by fredgiblet:

IIRC (and this is going off of an article I read a few years ago), the foreskin acts like a little cup and holds some of the fluids inside of it where they get in via small cuts and tears in the skin.

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Originally posted by Khyron:

The first one that comes up (the one I linked) says: "Circumcision is thought to help protect against HIV because cells under the foreskin are vulnerable to the virus."

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Originally posted by SigmaNunki:
Although that /is/ certainly true, the same fluids are *far* more abundant where they originate, where they must be acquired from in the first place. It is because of this that I see no benefit in circumcision as a way to lower the risk of contracting HIV.

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Originally posted by Grizwald:
The things we talk about here.

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Originally posted by SigmaNunki:
Read what I quoted from the BBC article. It seems as though they don't know much.

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Originally posted by BigDamnNobody:

I've heard the same thing said about man-made global warming. Should we stop investigating that as well?

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Originally posted by Khyron:

They say it's not certain that it'll be an effective solution. They also say it's worth a shot. Should one risk not doing it just because it might not work (keeping in mind that it doesn't harm the indivduals... unless they do something really stupid like have sex before it's healed)?

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Originally posted by SigmaNunki:
Especially given the fact of the urethral orifice.

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Originally posted by SigmaNunki:
But, that's only the exterior. What about the fluids that *will* enter through the urethral orifice. Seems to me that the interior of the body will be more vulnerable to a virus than something on the exterior.

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Also, from reading the article, there is a fatal flaw with this study: they didn't control the number of sexual experiences nor did they control the number of females that they had sexual contact with that were infected with HIV. If only because of this, this study has absolutely no validity at all.

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IMO this study [...] is quite amoral.

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What I'm talking about is the irresponsibility of publicizing positive results when it is far from conclusive (which /is/ admitted in the BBC article).

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When there is no control over the experiment (which /is/ implied in the BBC article).

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Originally posted by SigmaNunki:
Although, circumcision itself doesn't harm the individual (pretty much), this will install a false sense of security in the majority of people. I believe it is this that must be understood.

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Originally posted by Khyron:

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IMO this study [...] is quite amoral.

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Participation was voluntary, in which case it can't be amoral.

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Originally posted by fredgiblet:
It can be immoral if the participation was based off of false premises.

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Originally posted by fredgiblet:

The urethra orifice is controlled for by the fact that everyone has one.

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Originally posted by SigmaNunki:
Basically, this experiment doesn't have a control group because it doesn't control either group.

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Originally posted by Khyron:

Although I never bothered to check afterwards (hey, I'm a guy, I'm already fast asleep ), I think it's reasonable to assume that there are still some fluids inside the tract which prevent vaginal fluids penetrating too far into the penis. Aside from that, it's only been said that this treatment may reduce the risk of infection, not eliminate it. The risk of infection through the urethral orifice is still present, but overall risk of infection is reduced.

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Originally posted by Khyron:

3,280 sexually active men took part in the study, just less than half of which decided to get circumcised, so that's more than 1,500 men for either case. This is quite a large sample size, and it's justified to assume that in the case of such large sample sizes environmental factors such as number of sexual experiences and number of infected females will be very similar (law of averages). So in my opinion the study is valid. Whether it's conclusive is another question, but I find no reason to dismiss this study out of hand because I don't regard your criticisms of it as valid.

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Originally posted by Khyron:

Participation was voluntary, in which case it can't be immoral.

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Originally posted by Khyron:

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What I'm talking about is the irresponsibility of publicizing positive results when it is far from conclusive (which /is/ admitted in the BBC article).

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In which case the media wouldn't be allowed to report on any science news.

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Originally posted by Khyron:

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When there is no control over the experiment (which /is/ implied in the BBC article).

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Where was it implied? The sentence "The South African trial, conducted by a team of French and South African researchers and sponsored by ANRS (the French National Agency of Research on Aids)" implies that there was a controlling body.

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Originally posted by Khyron:

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Originally posted by SigmaNunki:

Although, circumcision itself doesn't harm the individual (pretty much), this will install a false sense of security in the majority of people. I believe it is this that must be understood.

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All media reports that I have heard and read on this say that it at best reduces the risk of infection, it doesn't eliminate it. The BBC article itself has a mini-headline 'Not a condom substitute', and we can, I think, assume that the researchers will have told the participants the same. Whether the participants follow this advice or not is out of the researchers' control, but seeing as condoms are widely available even in rural African areas and yet hardly used, trying to reduce the risk of infection through other means shouldn't be dismissed simply because these alternative methods aren't fool-proof.

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Originally posted by Khyron:
[It controls both groups as much as it needs to. Don't forget, this is supposed to monitor the rates of infection amongst circumcised and uncircumcised men when they go about their lives naturally. If the reseachers had said: "Okay, you have sex with only these three chicks for the next year, and you over there, you only get to have sex with these three, etc.", people would (rightly) be complaining that the study was artificial. In THAT case it wouldn't have been valid.

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Originally posted by SigmaNunki:
I question the ethics of people who would even think to ask people to have unprotected sex.

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By definition, fluid exchange is still more than just likely.

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And given how this study was done, IMO this hasn't even remotely been established.

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Actually your law of averages doesn't apply as the sample size /is/ quite low; it is _not_ a representative sample (~3,280 vs a population size of 45.3 million). Thus, your "law of averages" remark does not apply.

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Now, if the guys were all sexually active in the exact same place and only had sex with woman in the exact same place, and those woman only had sex with the woman in the exact same place, then we'd have something.

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But, the fact of the matter, is that in any given area, these factors are going to be different, which makes the risk factor different.

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Basically, there are *many* non-scientific aspects to this study.

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But, let's say that your criticisms of my criticisms are valid.

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Tell me, what was the exposure rate? After all, knowing this is critical of knowing whether this study is valid or not.

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You're assuming that the participants are educated and have full awareness of the consequences of the possible outcomes. This is a very bad assumption given the region of the world we are talking about.

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IMO, these "researchers" are taking advantage of uneducated people by getting them to be involved in *very* high risk behaviour.

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To use some hyperbole, an equivalent study might be to get people to play Russian Roulette seeing if wearing a hockey helmet would help in preventing there grey matter from being splattered on the wall.

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I'm _not_ talking about oversight for the researchers. I'm talking about having a reliable control over factors that the researchers are not testing for. That way by the pigeon hole, they can say what the mitigating factors are. This just isn't in this study. There is basically no control.

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Also, for the study to have any validity the participants would have to have had unprotected sex. So, any number of participants using condoms would be fatal to the study.

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Originally posted by stinkingrose:
This thread has taken on the tone that they tend to get just before someone calls someone else "poopy head".

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One (admittedly uncontrolled, possibly bad to run, and relatively small) study does not a medical revelation make.

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Additionally I do not see anywhere in the article where it states that the subjects were only having sex with women.
Blood and bodily fluids is the usual vector for the HIV virus.

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Both circumsized and uncircumcised males contract the HIV virus. Period. Fact. Really.

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Originally posted by Khyron:

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Originally posted by fredgiblet:
It can be immoral if the participation was based off of false premises.

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How so? For one thing, in general, if the premise isn't known to be false at the start of a study, the study can't be immoral. Even if the premise turns out to be false, it still doesn't make the study immoral. Testing on willing participants is common practice in many medical fields, for instance new drug treatments are tested on volunteers. If the new treatments don't work, does that mean conducting the test was immoral?

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Originally posted by Khyron:

Where is it written that they did that? The research was never about "have unprotected sex", it was "go about having sex as you usually do" - which, in many cases, happens to be unprotected. That's the way I understood it, if I'm wrong then please show me the relevant quote so that I can retract my statement that the study wasn't immoral.

More tomorrow.

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Originally posted by Khyron:

Right. I question the amount of fluid exchange that occurs in the urethal orifice, but that's irrelevant, because, again, circumcision doesn't claim to eliminate the risk of infection, it claims to reduce it. Of course fluid interchange and infection may still occur, there are no claims to the contrary.

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Originally posted by Khyron:

The study was about rates of infection, not establishing how exactly circumcision seems to reduce the risk of infection. There's no reason to dismiss the study just because one isn't sure why the results might be true.

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Originally posted by Khyron:

The size of the population is irrelevent.

For statistical results to have some credibility, the sample size needs to be large enough, and most researchers (in almost any field) would be quite happy with a sample size of around 1500 for each case. Factors such as the mean and variance play a role, but in general, for a sample size of 1000, the chances are 95% of coming within +/- 3% of the actual values that one wants to measure, and for 1500 this would be slightly improved. Under these conditions statistical results apply, amongst other things "my" law of averages.

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Originally posted by Khyron:

We'd have something, but something that's an artificial result. In epidemiology, if one looks at the rates at which a disease spreads inside a population one can't take infected and uninfected members of the population out of it and then only look at the consequences of their interactions, one has to let the population go about its usual ways and take representative samples to tell one what's going on.

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Originally posted by Khyron:

If you're talking about differences inside the geographical area in which the study was conducted, it's fair to assume that the participants were well-mixed, i.e. it's uinlikely that out of 3,280 people, 90% of those who lived in the Eastern half wanted circumcisions and 90% on the Western half didn't. If you're talking about wider regional differences, this was a relative measure, not an absolute one, so these differences shouldn't play a role.

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Originally posted by Khyron:

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Basically, there are *many* non-scientific aspects to this study.

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IMO if one dismisses the methods used in and results from this study, one should also dismiss a plethora of other studies that were conducted in a similar way (and are accepted). This sort of research doesn't give exact results, it only gives an indication of what the exact results might be.

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Originally posted by Khyron:

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Tell me, what was the exposure rate? After all, knowing this is critical of knowing whether this study is valid or not.

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Do you mean number of times the participants had sex with an infected person on average? If you mean this, I have no idea, nor do I think the researchers would have such statistics. Once again, I think the sample size is large enough to assume that such factors would be very similar.

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Originally posted by Khyron:

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You're assuming that the participants are educated and have full awareness of the consequences of the possible outcomes. This is a very bad assumption given the region of the world we are talking about.

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Many people in that area would have been circumcised anyway, and aside from the circumcisions all that the researchers did was monitor the rates of infection afterwards. As long as the circumcised participants understood that they should wait until their wounds are healed before having sex, which doesn't take much education, I don't see how the level of schooling plays a role.

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Originally posted by Khyron:

I suppose the high risk comment stems from you thinking the researchers encouraged the participants to have unprotected sex, which I don't think was the case...

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Originally posted by Khyron:

...on the other hand, if it were the case, I would completely agree with your hyperbole and your assertion that the research was immoral. But I think in this case every human rights society in the world would be on the researchers' ass for unethical conduct, and that that would be a bigger story than the results themselves.

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Originally posted by Khyron:

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I'm _not_ talking about oversight for the researchers. I'm talking about having a reliable control over factors that the researchers are not testing for. That way by the pigeon hole, they can say what the mitigating factors are. This just isn't in this study. There is basically no control.

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When looking at population dynamics, everything needs to be taken into account. The best way to do this is to let the population do what it does and monitor what happens.

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Originally posted by Khyron:

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Also, for the study to have any validity the participants would have to have had unprotected sex. So, any number of participants using condoms would be fatal to the study.

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Once again, the sample size is large enough to make the assumption that such things as condom use would be very similar on both sides. And there's no guarantee that participants who generally use condoms will always use them.

I want to emphasise that nobody is taking this study as conclusive proof that circumcision reduces the risk of infection, it's seen as a (scientifically justified, btw) study that indicates that this might be the case, and that more studies into this need to be conducted.

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Originally posted by Khyron:

Sigma seems to be a level-headed guy, so I can't see that happening. I can't even see this discussion becoming heated, it's just a discussion.

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Originally posted by SigmaNunki:
And where is stated that the study was about people going about there normal business?

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Btw, I infer that the men were told that they should have protected sex because in the BBC article it states that "The researchers decided at this point it would be unethical to continue the study." Why would it be unethical to continue a study in which they are only taking blood from time to time?

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Originally posted by SignyM:
AFA as testing on human subjects... Tests have been cut short on moral grounds, either because a treatment was found to have negative results (example- beta carotene on smokers) or because the treatment is SO effective that continuing with a placebo is considered immoral.

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Originally posted by SigmaNunki:

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Originally posted by Khyron:
Right. I question the amount of fluid exchange that occurs in the urethal orifice, but that's irrelevant, because, again, circumcision doesn't claim to eliminate the risk of infection, it claims to reduce it. Of course fluid interchange and infection may still occur, there are no claims to the contrary.

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A hole shoved into a place where bodily fluids are rather abundant. How exactly do you question the amount of fluid exchange?

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But, the question does result in another factor that isn't accounted for; the time of exposure i.e. someone who has sex for 2 hrs is going to stand a far greater chance of getting infected than some that has sex for 10 minutes (or less, poor guy/gal ).

Also, as (I believe) someone above mention, there's the whole IV drug thing. Which isn't stated to be controlled for. Hell, some of these guys could use condoms 100% of the time, yet get HIV through a needle.

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Originally posted by Khyron:
The study was about rates of infection, not establishing how exactly circumcision seems to reduce the risk of infection. There's no reason to dismiss the study just because one isn't sure why the results might be true.

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Actually from the conclusion given at the New Scientist article:

"""
It may not seem like the kindest cut, but circumcision has been hailed as a vital new way to combat HIV. In a report issued on 28 March, the World Health Organization and UNAIDS issued a series of recommendations to increase rates of circumcision in countries where the HIV problem is most serious.
"""

They have concluded that circumcision reduces infection rates when they also state (BBC article):

"""
HIV infection rates are lower among groups in Africa who practise circumcision, but it was not known if this was due to cultural differences.
"""

Basically, they have _not_ established that circumcision actually helps matters. And that's by there own admission. Yet they are recommending that a great deal of effort be expended to circumcise men because of these "results".

In other words, if these results are cultural, then one does _not_ need to be circumcised to get any benefits. One just needs to have there attitude "re-educated".

These guys are running off of circumstantial evidence and they even admit it!

Basically, these guys are saying things that completely contradict what you're saying here.

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To do a study in /only/ one place is rather poor form. When companies do studies in North America, to gain statistical significance, they do the study in several cities across the country.

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There are a variety of reasons for doing so, but the one that is most relevant here is difference in lifestyle. Though diet will probably play a strong role as well. Anyone know how rich Orange Farm is? This /will/ play a role as the immune system will be *much* better in one that is _not_ malnourished among other things.

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The BBC article also quotes Keith Alcorn as saying, "Two further studies in Kenya and Uganda have yet to be completed, and will give us more information."

Now if those show the same results, then we might have something.

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But as it sits right now, all we have is something that indicates that circumcision has something to do with a lower HIV infection rate. What circumcision has to do with it is still very much in the air. Again, this is by these people's own admission. We still know pretty much nothing.

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Originally posted by Khyron:
We'd have something, but something that's an artificial result. In epidemiology, if one looks at the rates at which a disease spreads inside a population one can't take infected and uninfected members of the population out of it and then only look at the consequences of their interactions, one has to let the population go about its usual ways and take representative samples to tell one what's going on.

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Well, if we were talking about how HIV spreads you'd be spot on, but we are _not_ talking about how HIV spreads. What we /are/ talking about is if circumcision itself reduces the risk of getting infected with HIV upon exposure through sex. The conclusion on the article you linked to even states this!

"""
The researchers planned to test all participants for HIV at three, 12 and 21 months, to see whether there was a difference in the rate of new infections between the two groups.
"""

From the beginning it was all about circumcised vs non-circumcised. Does one have a lower rate of infection.

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Originally posted by Khyron:
If you're talking about differences inside the geographical area in which the study was conducted, it's fair to assume that the participants were well-mixed, i.e. it's unlikely that out of 3,280 people, 90% of those who lived in the Eastern half wanted circumcisions and 90% on the Western half didn't. If you're talking about wider regional differences, this was a relative measure, not an absolute one, so these differences shouldn't play a role.

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The differences /will/ play a role when it's general conclusion time. As it sits, the only thing that we know right now is, in this particular part of South Africa, circumcision itself may or may not reduce the risk of getting infected with HIV.

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Though the "researchers" say that they /think it/ does. Enough in fact, to recommend based on circumstantial evidence that we should (New Scientist article) "increase rates of circumcision in countries where the HIV problem is most serious."

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You seem to be defending an absolute conclusion based on what you call a "relative measure".

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Skepticism is a main stay of science. So, is proper scientific method.

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This study uses... questionable methods. In fact, the "methods" that they use indicate that they cannot come to the conclusion that they claim. In fact, there are so many variables that they are _not_ accounting for it isn't funny.

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Not to mention that they themselves state (BBC article) "UNAids has said the trial found promising results, but more work needs to be done to confirm its findings". Yet, (New Scientist article) "UNAIDS issued a series of recommendations to increase rates of circumcision in countries where the HIV problem is most serious."

They contradict themselves i.e. in the BBC article, more study is needed, but in the New Scientist article they say that the study has such strong results that they are going to recommend significant policy change.

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Basically, this "study", on its own, should be dismissed.

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As for your comment that we should discard all studies of this type if we discard this one. Well that bit of hyperbole is just plain wrong.

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Those other studies have had other more rigorous studies to confirm them. Or other studies that have a different set of variables, that further reduce what could be going on. And after many studies to try to confirm those results, we end up with a logical conclusion.

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The main problem with your line of thinking here is that with the studies that we should apparently discard, they have been confirmed time and time again. Whereas this "study" is the *first*. There are two others that are going on /right/ /now/ (BBC article).

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Again, *if* those studies show the same thing, then we have enough evidence for an actual rigorous study.

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Basically, this is only the beginning in a possible long chain of studies regarding circumcision and its chance of reducing the chance of HIV infection.

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Quite frankly, I find such pre-mature announcements in rather poor taste. And when it comes to the specific topic here quite dangerous and as such, ethically questionable. This really should have stayed in the literature until at least the other two studies had been completed. But, that would have stolen the thunder of the WHO and UNAIDS (or at least the people involved in this particular study). After all, fame requires one to be first.

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Originally posted by Khyron:

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Tell me, what was the exposure rate? After all, knowing this is critical of knowing whether this study is valid or not.

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Do you mean number of times the participants had sex with an infected person on average? If you mean this, I have no idea, nor do I think the researchers would have such statistics. Once again, I think the sample size is large enough to assume that such factors would be very similar.

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Well, we actually can't.

Sexually active can mean being in a monogamous relationship or having sex once every couple months or a couple times a day or anywhere inbetween or more extreme. And each time one has sex, one rolls the dice to whether they are "getting it on" with someone that is HIV+. If only for these uncontrolled factors, we certainly cannot say that the exposure rate is homogeneous.

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Originally posted by Khyron:

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You're assuming that the participants are educated and have full awareness of the consequences of the possible outcomes. This is a very bad assumption given the region of the world we are talking about.

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Many people in that area would have been circumcised anyway, and aside from the circumcisions all that the researchers did was monitor the rates of infection afterwards. As long as the circumcised participants understood that they should wait until their wounds are healed before having sex, which doesn't take much education, I don't see how the level of schooling plays a role.

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I was responding to you saying "Participation was voluntary, in which case it can't be immoral." {I know, I responded to your response }

What I was getting at is that these researchers knew that they were probably going to indirectly cause the infection of a fair number of people. Yet they did it anyway. This I find amoral.

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When it comes to the level of education, educated people are *far* less likely to enter such a risky endeavor (especially when they are pretty much guaranteed to contract HIV as a result). These researchers chose a rural community, _not_ a city. An area which is *far* less likely to have educated people in it. Thus "ripe for the picking" when it comes to participants. Which can been seen in the ~3300 males who joined up. I find that number disturbingly high.

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But, you bring up an interesting point regarding circumcision. That some would have been already. But, by the BBC article:

"""
Just under 3,280 young, sexually active, uncircumcised,
"""

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So, /all/ of the guys had been circumcised by these doctors assumedly at the same time. Which leads into another point. Did these guys have the "full effect" of circumcision? Were the non-circumcised not allowed to have sex during these 6 weeks so that everything was a level playing field?

Sure, 6 weeks to heal. But, that's just the cuts due to the circumcision! The whole thought is that the tougher skin on the penis would provide better protection against HIV. Is 6 weeks enough time to get the full "benefits" of circumcision?

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Originally posted by Khyron:
I suppose the high risk comment stems from you thinking the researchers encouraged the participants to have unprotected sex, which I don't think was the case...

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How would circumcision play a role if they were using condoms?

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Originally posted by Khyron:
...on the other hand, if it were the case, I would completely agree with your hyperbole and your assertion that the research was immoral. But I think in this case every human rights society in the world would be on the researchers' ass for unethical conduct, and that that would be a bigger story than the results themselves.

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I'm not sure I agree. If the study was about if circumcision affected infection rate (which it is), and the researchers chose people who engaged in unprotected sex already, then I don't see any human rights org shitting on these guys. Especially since there work is all about reducing the spread of HIV.

Getting human rights people after you because you're doing research to prevent the spread of HIV. Now there's irony

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Originally posted by Khyron:
When looking at population dynamics, everything needs to be taken into account. The best way to do this is to let the population do what it does and monitor what happens.

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But, when trying to see if one specific factor is a determining factor, one must mitigate all other factors to negligible.

Here, they are trying to determine if circumcision is a significant factor in the risk of contracting HIV. And it looks like they haven't even tried to mitigate /any/ factors.

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Originally posted by Khyron:
I want to emphasise that nobody is taking this study as conclusive proof that circumcision reduces the risk of infection, it's seen as a (scientifically justified, btw) study that indicates that this might be the case, and that more studies into this need to be conducted.

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Really? (New Scientist article):

"""
circumcision has been hailed as a vital new way to combat HIV.
"""

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Originally posted by Khyron:
On the other hand, most scientists, who indeed should be skeptical, would react like this: "Huh, that's interesting. I wonder if further studies would back this up."

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In fact, there are so many variables that they are _not_ accounting for it isn't funny.

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Quite frankly, I find such pre-mature announcements in rather poor taste. And when it comes to the specific topic here quite dangerous and as such, ethically questionable. This really should have stayed in the literature until at least the other two studies had been completed. But, that would have stolen the thunder of the WHO and UNAIDS (or at least the people involved in this particular study). After all, fame requires one to be first.

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Yes, the media shouldn't be reporting the latest scientific and medical findings. Informing people what's going on in the world of science and medicine is, uhm, just wrong... for some reason.

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