Circumcision and AIDs/STDs

For the purposes of this blog I will only be talking about AIDs. The information available about other STDs as they pertain to circumcision is very limited. Also, the debate about whether or not circumcision should be mandatory is largely due to AIDs. Throughout the last 30 years of the twentieth century, medical associations all over the world were in agreement that there is no medical reason to circumcise. Almost all medical associations still believe this to be true. However there is a new study done that has opened the debate once more. Just do a simple search of circumcision on the WHO's website. You won't see anything about cancer, UTIs, phimosis, or other STDs. All they talk about is the heterosexual acquisition of AIDs.

There were three major studies done in the past decade to determine the effect of circumcision on HIV. The studies finished early due to the success, and resulted in a relative risk reduction of 53% 55% and 60%. The first reaction is to say, SWEET!!! Circumcision can be used to prevent AIDS. Everyone should be circumcised. Well like everything else in life its a little more complicated than that.

First it is important to know what this study says and what it does not say. This study makes the assertion that circumcision can prevent HIV acquisition of males who engage in heterosexual sex. There is zero evidence that circumcision protects women in any way, or men who engage in homosexual sex.

While the relative risk of circumcision looks to be beneficial on that scale, it hasn't worked out that way in large countries. The first row is a list of countries with the percentage of adults living with AIDS. The 2nd row is other countries where most of the population is intact with the rates of AIDs. (3) Information from CIA world factbook.

United States 0.6% Iran 0.2% Israel 0.1% Saudi Arabia 0.1% UAE 0.2%

Germany 0.1% Chile 0.3% U.K. 0.2% Australia 0.2% China 0.1%

As you can see, there isn't a lot of difference. With the exception of the United States, the uncircumcised figures are slightly above the circumcised countries. However, the circumcised countries tend to be the most sexually conservative societies on earth. Furthermore, with the exception of the United States, all countries that circumcise more than half of the men are almost entirely Muslim or Jewish.

Another aspect to consider is the reality of AIDS outside of Africa. In Western cultures, AIDs is mostly a phenomenon of gay men and drug users. In 2006 in Australia there were 854 new HIV diagnoses for men, of which only 77 (9 percent) were for men who were infected through sex with women. (1) In the United States only 11 percent of those diagnosed with AIDS were in men who had contracted HIV through sex with women.(4) This is significant because even if these studies are accurate, circumcision would only help to protect roughly 10% of those who are at risk of becoming HIV positive. As the relative risk was quoted at 60%, only 6% of those who are at risk would be protected. As the study covered a time span of less than two years, the percentage of those protected becomes less and less until it is statistically insignificant.

Alright, so something has gone seriously wrong. This study that was supposed to be this great cure for AIDS really isn't working very well. Even in the United States where historically the vast majority of males have been circumcised, the rate of AIDS in still abnormally high. In fact, the United States has the highest rate of AIDS in the world with the exception of Africa.

Let's go back and take a closer look at these studies. Oddly enough, the only place I have been able to find the raw data is from an anti circumcision site. You would think that the pro circumcision sites with be parading the raw figures around as this is their main argument. This blog isn't very friendly to big tables so the table can be found near the bottom of this page. The first thing that stands out to me is out of 11,000 people tested, only 73 were "protected" from HIV. The reason for this is the number quoted is the relative risk reduction, not the total risk reduction. 2.49% of the control group became HIV positive during the test. 1.18% of the circumcised males became HIV positive during the test. This resulted in an absolute risk reduction of 1.8%.

The most famous study was conducted by Auvert. This is the one that found the 60% relative risk. In his study conducted over 21 months, 49 circumcised males and 20 intact males contracted HIV. In theory, 29 people were protected. Using this study, Auvert concluded that he could prevent "(1.1−3.8) million new HIV infections and 0.3 (0.1−0.5) million deaths over the next ten years in sub-Saharan Africa." (5) So as a result of 29 people not getting HIV, partially due to abstinence, you can extrapolate to prevent half a million deaths? I'm not buying it.

One of the major problems with this test it some of the testing procedures used were flawed. For the first several months the circumcised group was instructed to abstain from sexual activity while they healed, giving the intact group a head start in getting infected. After several months the rates of infection were becoming closer. Suddenly when the rates stabilized, the study was called off early. (6) Another aspect to consider is that the HIV test doesn't check for the HIV virus. It checks for antibodies for the HIV virus, which can take months for your body to produce. If one member circumcised group waited 3 months to heal, and became infected 2 months later, the test would not come back with a positive result until one full year after the study started. A study in New Zealand simply took a sample of males born between 1972 and 1973 and tested them for STDs. They found no statistical difference between circumcised and intact males whether or not they adjusted for socioeconomic status and sexual behavior. (7) This supports the claim that circumcision is probably not beneficial in the long term.



(1) John Murray, Circumcision no barrier to HIV, "The Australian"

(2) Circumcision and risk of sexually transmitted infections in a birth cohort

(3) CIA world factbook

(4) CDC.gov

(5) findings

(6) See table in the other blog or here.

(7) New Zealand study