Talk:Circumcision and HIV

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Compliments for article contributors[edit]

I'd just like to say, you guys have done a great job with this article. I was watching a program that mentioned the controversy over condom efficacy on the HIV issue in Uganda, and I came across mention of the additional preventative step of circumcision. I was looking for a specific article, regarding the studies done on the efficacy of circumcision on HIV prevention, and this page did an excellent job of presenting all the elements, in a framework that's easy to understand. Obviously it's incredibly important to note, that the different circumstances of a patient's life, would affect the efficacy of the procedure - particularly if they more regularly engage in anal sex versus vaginal, and whether being circumcised will lead one to riskier behavior, like lack of condom use. This article makes the distinctions, without ever trying to interpret whether any one fact is or is not an argument for male circumcision - it's one of the least POV articles I've come across, despite covering a potentially volatile topic.

And I was pleasantly surprised to see the Talk page wasn't littered with people advocating for sentiment over facts, or a lot of personal agendas, just a commitment to presenting all the applicable information, in a factual way, with the appropriate sources.

As a person who really depends up Wikipedia for giving as much information as I can acquire on a topic - hence why I check the Talk page as well as the main page - I just want to say thanks for your efforts. I did check the Help system, to confirm it was acceptable to simply interject a thanks into the Talk page, and the Cup of Tea page suggested it was. So if it is not appropriate, my apologies - but this page deserves props :) CleverTitania (talk) 05:51, 17 April 2014 (UTC)

"it's one of the least POV articles I've come across".. were we reading the same article? JQ (talk) 06:52, 6 October 2014 (UTC)
Well it was in April of 2014 that I posted this. And a lot of edits were made in July, So technically no, we probably weren't "reading the same article." However I have read it now, and my opinion stands. If you have an example of lack of POV, or a suggestion to improve the NPOV, perhaps you should share it with everyone. CleverTitania (talk) 10:48, 10 July 2015 (UTC)
This article is not neutral. It is heavily biased. An interest group created an article with findings that suit there point of view. It was criticized by real scientists. But scientists from the elite university of Oxford aren't counted as reliable. --Rævhuld (talk) 00:50, 27 June 2017 (UTC)

Edit using de Witte and Ogawa[edit]

An editor recently added this:

A research group of Youichi Ogawa et alii [1] confirmed the findings of de Witte et alii, that langerin protects Langerhans cells from being infected by HIV and other STD. [2] "This study also showed that langerin was involved in capture of HIV and subsequent internalization within Birbeck granules, where it was degraded." However, Oguwa et alii found, "when LCs were exposed to high viral concentrations of HIV, there was significant infection of LCs by R5 virus, followed by viral transmission to T cells." Oguwa et alii also observed, that anaerobic bacteria do not "enhance HIV susceptibility in LCs". However they conclude, that Gram-positive bacteria components "directly augmented HIV infections in LCs by activating TLR2".

References

  1. ^ Ogawa, Youichi/Kawamura, Tatsuyoshi/ Kimura, Tetsuya/Ito, Masahiko/ Blauveit, Andrew/ Shimada, Shinji 2009: Gram-positive bacteria enhance HIV-1 susceptibility in Langerhans cells, but not in dendritic cells, via Toll-like receptor activation. In: Blood, 21.5.2009, Vol. 113, Nr. 21, 5157-5166.
  2. ^ Lot de Witte et alii: "Langerin is a natural barrier to HIV-1 transmission by Langerhans cells" http://www.nature.com/nm/journal/v13/n3/abs/nm1541.html

I do not think it is an improvement to the article for many reasons: the sourcing is insufficient per WP:MEDRS, the sources do not appear to actually cover the topic of this article: circumcision and HIV, the proposed article content actually appears to contradict what one of the sources says and so fails WP:V, and the proposed content quoting selected very technical passages is much too hard for our typical lay reader to understand, or see the connection to the article topic.

The first source is de Witte here, which does not mention "circumcision" at all and mentions "foreskin" only in one of the captions accompanying a multi-part illustration, so it does not appear to be directly on the topic of this article. This is a letter to the editor and so is at the bottom of our evidence quality scale per WP:MEDASSESS. The Ogawa source is PMID 19279330 (full text here), it is an in vitro primary study from 2009, and it does not mention "circumcision," "foreskin" or "prepuce" anywhere in it all. Also the proposed article content interprets this primary study by saying that it "confirmed the findings of de Witte alii" but actually in the two places where Ogawa source cites de Witte they discuss contrary findings. Interested in the thoughts of others. Overall the use of these two lower-quality/off-topic sources should not be used to cast doubt on the clearly-stated summaries of the higher-quality sources currently in use in our article.

Editor Alexbrn recently did a significant clean-up of the sourcing for this article so I am notifying him of this discussion. Zad68 14:47, 30 July 2014 (UTC)

I concur with Zad68 - we would need much stronger WP:MEDRS sourcing to support this kind of material here. Alexbrn talk|contribs|COI 11:18, 4 August 2014 (UTC)

Circ and HIV[edit]

The problem with this text

"The effect of circumcision in the developed world is unclear, although among a sample of developed countries, UNAIDS found that The United States(70% circ rate) HIV infection rate per 100,000 was 61, compared to England's 11(20% circ rate), therefore making Americas HIV rate 700% higher then England's, who had only 1/3rd the circumcised population America did.[1][2]"

  • This ref is not suitable [1]
  • This ref's content is being misrepresented.[2]

What it says about circ is "The interplay of multiple factors obscures causal linkages and prevents categorical conclusions. A study in four African cities (Cotonou, Kisumu, Ndola and Yaoundé) revealed that the most common behavioural and biological factors in those cities with the highest HIV prevalence were: young age at women’s first sexual intercourse; young age at first marriage; age difference between spouses; the presence of HSV-2 infection and trichomoniasis (a sexually transmitted infection); and lack of male circumcision."

References

Doc James (talk · contribs · email) 02:52, 20 October 2015 (UTC)

  • Concur: we shouldn't have this content for the reasons Doc gives. Alexbrn (talk) 04:50, 20 October 2015 (UTC)

This Article is Biased[edit]

Evidence of the University of Oxford and other prestigious institutions critize the studies to be biased and even claim that circumcision might be a reason for AIDS.[1][2]

I know. The studies are mostly made by interest groups. And even though I don't know it for sure: I bet the Wikipedians are circumcised or part of circumcised cultures. If we take a closer look, we definitely see, that countries with the highest circumcision rate have the most AIDS patients. If circumcision would protect from AIDS, how can this than happen? Oh, because it doesn't. This is just another ridiculous claim to not ban male genital mutilation.Élisée P. Bruneau (talk) 03:24, 31 January 2017 (UTC)

Guy is deleting my contributions also every single source I used were published in peer-reviewed journals[edit]

If the guy is deleting again, please contact an administrator. Here my contribution:--Élisée P. Bruneau (talk) 15:40, 11 July 2016 (UTC)

Criticism of Circumcision as HIV prevention[edit]

The scientific methods and arguments for circumcision as HIV prevention has been criticized by many scientists. Some scientists argue that circumcision even may increase HIV.[2]

Circumcision may increase HIV transmission in Africa[edit]

Brian D. Earp, a Research Associate to the University of Oxford, called the recommendation of circumcision as HIV prevention as "a fatal irony". The "AIDS epidemic in Africa may increase transmission of HIV" because of the "circumcision solution".[2][1]Distributing free condoms is 95% more cost effective and gives much better safety. Condoms reduce both female and male HIV with at least 80%.[3][4] The circumcision reduces the HIV risk with maximum 1.31% according to three dubious surveys. The "behavioral dis-inhibition" is another argument against circumcision as additionally treatment.[2] The risk of HIV infections is increased by circumcision due to the fact that it's promoted as "natural condom" and that the attention is divirted away from effective solutions (like condoms).[5][6][2]

Internal Validity[edit]

Experimental doubts[edit]

The argument for circumcision as HIV prevention is based on three studies from 2005-2007. An extensive analysis showed, that the circumcised group weren't allowed to have coitus in 6 weeks of the experiment and had additional schooling in HIV prevention (like how to use condoms), which the uncircumcised placebo-group didn't got.[7][2][1]

While the “gold standard” for medical trials is the randomised, double-blind, placebo-controlled trial, the African trials suffered [a number of serious problems] including problematic randomisation and selection bias, inadequate blinding, lack of placebo-control (male circumcision could not be concealed), inadequate equipoise, experimenter bias, attrition (673 drop-outs in female-to-male trials), not investigating male circumcision as a vector for HIV transmission, not investigating non-sexual HIV transmission, as well as lead-time bias, supportive bias (circumcised men received additional counselling sessions), participant expectation bias, and time-out discrepancy (restraint from sexual activity only by circumcised men).

— Gregory Boyle and George Hill [7]

Misleading results[edit]

The absolute decrease of HIV in the three studies give a reduction of 1.31%. The relative reduction was 60% due to the fact that two very small percentages were compared.[7][8][9][2][1]

What does the frequently cited “60% relative reduction” in HIV infections actually mean? Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive, so the absolute decrease in HIV infection was only 1.31%.

— Gregory Boyle and George Hill [7]

Questionable public health recommendations[edit]

The implementation of circumcision to prevent HIV is inefficient and the results can't be reproduced. The test subjects had "continuous counseling", "frequent monitoring" and the surgeries were performed by highly skilled, Western sanitary.[4][2]

Effectiveness in real-world settings rarely achieves the efficacy levels found in controlled trials, making predictions of subsequent cost-effectiveness and population-health benefits less reliable.

— Lawrence W. Green, DrPH, John W. Travis, MD, MPH, Ryan G. McAllister, PhD, Kent W. Peterson, MD, FACPM, Astrik N. Vardanyan, MA, Amber Craig, MA[4]

Distributing free condoms is 95% more cost effective and gives much better safety. Condoms reduce both female and male HIV with at least 80%.[3][4] The circumcision reduces the HIV risk with maximum 1.31% according to three dubious surveys. The "behavioral dis-inhibition" is another argument against circumcision as additionally treatment.[2]

The risk of HIV infections is increased by circumcision due to the fact that it's promoted as "natural condom" and that the attention is divirted away from effective solutions (like condoms).[5][6][2]

How rational is it to tell men that they must be circumcised to prevent HIV, but after circumcision they still need to use a condom to be protected from sexually transmitted HIV? Condoms provide near complete protection, so why would additional protection be needed? It is not hard to see that circumcision is either inadequate (otherwise there would be no need for the continued use of condoms) or redundant (as condoms provide nearly complete protection).

The argument that men don’t want to use condoms needs to be addressed with more attractive condom options and further education: [they need to be told] that sex without a condom and without a foreskin is potentially fatal, while sex with a condom and a foreskin is safe. No nuance is needed. Offering less effective alternatives can only lead to higher rates of infection.

[...] Rather than wasting resources on circumcision, which is less effective, more expensive, and more invasive, focusing on iatrogenic sources and secondary prevention should be the priority, since it provides the most impact for the resources expended.
— Robert S. Van Howe, Michelle R. Storms[6]
References

References

  1. ^ a b c d Rizvi, Ali A. (2009-09-03). "Male Circumcision and the HIV/AIDS Myth". The Huffington Post. Retrieved 2016-07-11. 
  2. ^ a b c d e f g h i j Earp, Brian D. (2009-09-03). "A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV". University of Oxford: Practical Ethics. Retrieved 2016-07-11. 
  3. ^ a b Weller SC and Davis-Beaty K, “Condom Effectiveness in Reducing Heterosexual HIV Transmission” (2002) 1 Cochrane Database of Systematic Reviews Art No CD003255.
  4. ^ a b c d [Male circumcision and HIV prevention: Insufficient evidence and neglected external validity.]. Green et al. (2010). American Journal of Preventive Medicine.
  5. ^ a b Cite error: The named reference Goyle was invoked but never defined (see the help page).
  6. ^ a b c [http://www.zimeye.org/wp-content/live_images/2012/01/44-419-1-PB.pdf How the circumcision solution in Africa will increase HIV infections]. Robert S. Van Howe, Michelle R. Storms. Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Marquette, MI, USA. Cite error: Invalid <ref> tag; name "PagePress" defined multiple times with different content (see the help page).
  7. ^ a b c d Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. Boyle, G. J. and Hill, G. (2011). Journal of Law and Medicine.
  8. ^ Welch, H. Gilbert (2012-06-21). "The Problem Is Relative". The Huffington Post. Retrieved 2016-07-11. 
  9. ^ Garenne, Michel; Giami, A.; Perrey, C. (2012-04-11). "Male cicumcision and HIV control in Africa : questioning scientific evidence and decision making process". Horizon (in French). pp. 185–210. Retrieved 2016-07-11. 
  • blogs, the Huffington Post and fringe journal articles are not WP:MEDRS (or even WP:RS) for the serious aspects of this topic. Please familiarise yourself with Wikipedia's principles. You also appear to be publishing links to illicit copies of copyrighted material, which is a problem. Alexbrn (talk) 15:46, 11 July 2016 (UTC)
Oh, yes, clearly. Despite the fact that 4 of my 6 sources are peer-reviewed and published in journals with great reputation:
  • [Cochrane Database of Systematic Reviews Art No CD003255]
  • [American Journal of Preventive Medicine]
  • [Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Marquette, MI, USA]
  • [Journal of Law and Medicine]
  • [Horizon (in French). pp. 185–210 (a French research database)]
  • [Global Public Health: An International Journal for Research, Policy and Practice: Volume 10, Issue 5-6, 2015]
And I have not used "blogs", I have only used one blog. And it was not a "blog", but an article written by a Researcher at the University of Oxford and the article was published at the blog of Oxford University. And I only used one Huffington Post article. You try to censor this article, that is clear. Not to mention that the 2 sources are all covered by peer-reviewed articles. And do you know what? Read the article and you see, that most sources are published in mass media - like Huffington Post. My material is research and peer-reviewed. Still you deleted my submission, despite the fact that I am the guy with the best sources. Nice done.--Élisée P. Bruneau (talk) 16:18, 11 July 2016 (UTC)
Please read WP:MEDRS and maybe WP:WHYMEDRS for background. Peer-review alone means little. Cochrane reviews can make great sources, but you appear to be using them for the purposes of WP:Original research to discuss condoms. Alexbrn (talk) 16:29, 11 July 2016 (UTC)
We have newer sources that say something different. Doc James (talk · contribs · email) 11:29, 31 January 2017 (UTC)
@Alexbrn: Please read WP:MEDRS and maybe WP:WHYMEDRS for background. Peer-reviewed sources in top academic magazines shouldn't be good enough? I am sure that you can explain how Oxford Medical Journal isn't a good enough source for Wikipedia. Oh, wait. You can't.--Rævhuld (talk) 01:32, 19 July 2017 (UTC)

Bias[edit]

It seems like some users here try to bias the article. While some scientists claim that circumcision reduces AIDS risk, other scientists are highly critical. According to WP:POV both point of views should be included. There are high quality peer-reviewed articles on it.[1] If scientists who published in Oxford University owned journals aren't count as reliable, I think that no one is. --00:46, 27 June 2017 (UTC)

References

  1. ^ Mehta, Supriya D.; Moses, Stephen; Agot, Kawango; Parker, Corette; Ndinya‐Achola, Jeckoniah O.; Maclean, Ian; Bailey, Robert C. (2009-08-01). "Adult Male Circumcision Does Not Reduce the Risk of IncidentNeisseria gonorrhoeae, Chlamydia trachomatis,orTrichomonas vaginalisInfection: Results from a Randomized, Controlled Trial in Kenya". The Journal of Infectious Diseases. 200 (3): 370–378. ISSN 0022-1899. PMC 3081655Freely accessible. PMID 19545209. doi:10.1086/600074. 

— Preceding unsigned comment added by Rævhuld (talkcontribs) 00:50, 27 June 2017 (UTC)

We don't WP:GEVAL give both sides but weight in favour of the best sources. The source you cite is not a WP:MEDRS. Alexbrn (talk) 03:04, 27 June 2017 (UTC)
Removed the tag per Alexbrn. Doc James (talk · contribs · email) 03:08, 27 June 2017 (UTC)
@Alexbrn: Oxford Medical Journal (peer-review) is not a reliable source? Bullshit! Maybe you can explain why it isn't a reliable source? According to the article you link to, it IS a reliable source.--Rævhuld (talk) 01:30, 19 July 2017 (UTC)
Because it's an RCT i.e. primary research. Alexbrn (talk) 07:36, 19 July 2017 (UTC)
Exactly the same as the research made by the WHO.--Rævhuld (talk) 00:24, 20 July 2017 (UTC)
There is a difference between primary sources and secondary sources. Doc James (talk · contribs · email) 08:48, 20 July 2017 (UTC)