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Researchers Stop New Male Circumcision Trial In Uganda
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J.D.Regent
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
PS, why isn't the female condom used more? I don't know the answer because I, like everybody else, have never used it.
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kickingthecrap
07/17/09

@J.D.Regent: Well, really, who *doesn't* like fucking a plastic bag?
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Kirkat
07/17/09

@J.D.Regent: It's much more inconvenient than the male condom and it looks so stupid that it's a big mood kill. That's just my opinion on it, I'm sure other people have different ones.
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thePrototype
07/17/09

@Kirkat: Also add increased cost and lack of availability to that list.
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J.D.Regent
07/17/09

@kickingthecrap: is it that much more plastic baggy than the male condom?
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J.D.Regent
07/17/09

@Kirkat: what does it look like?
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J.D.Regent
07/17/09

@thePrototype: it COSTS more? god i love jezebel when everyone has all the answers.
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thePrototype
07/17/09

@J.D.Regent: The ones that I have seen are like a plastic bag with two rings, one that you insert inside and one that you leave on the outside (think of it kind of like a diaphragm wrapped in a baggy).

In the few sex stores that I have seen them, they cost an incredible amount more, but that could be because these are specialty boutiques and they overcharge for everything (including dental dams).
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J.D.Regent
07/17/09

@thePrototype: thanks, to me it doesn't sound that much weirder looking than a male condom, but the availability and cost features def. make sense.
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pinkynicejuice
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
In response to a number of commenters: Among other historical and socio-economic factors, high rates of HIV in Africa have to do with the complicated math of repeat exposure during the window of high viremia immediately after infection. not high rates of promiscuity, or lack of education.

i teach a class on this - and recommend Helen Epstein's book, _The Invisible Cure_ if you want to know more about why there are such high rates of HIV in some parts of Africa.
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labeled
07/17/09

@pinkynicejuice: Could you explain this: repeat exposure during the window of high viremia immediately after infection in layman's terms?
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Penny
07/17/09

@pinkynicejuice: Can you expand on that just a bit (it's interesting). I don't think you can really discount the education element, though, don't you think?
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Penny
07/17/09

@labeled: Heh, glad to see I wasn't the only one who had that reaction. I read it about 5 times and decided I was too stupid to understand. But, my interest is piqued.
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labeled
07/17/09

@Penny: I keep trying, but my brain has just started flashing confusing images of a snake swallowing its tail.
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Edited by labeled at 07/17/09 5:11 PM labeled was starred labeled was unstarred

Megan
07/17/09

@labeled: It means, in effect, that one is most likely to transmit the virus immediately after one has become infected.

I'm curious, however, if that holds in the absence of anti-retroviral usage or is a result of it (having not read the book).
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J.D.Regent
07/17/09

@pinkynicejuice: that makes sense, but aren't people repeatedly exposed during that window because of issues like multiple concurrent partners and lack of condom use? I would love for the answer to be no, by the way.
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labeled
07/17/09

@Megan: Thanks. So I understand, you are more likely to pass the infection along, if you repeatedly expose someone to it, right after you have been infected. Yes? Close?

Why would Africa be any different than anywhere else in the world, with regard to that?
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labeled
07/17/09

@J.D.Regent: That's what I'm thinking, as well. Unless prevention-education is ultimately an issue, why would it be any different?
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Edited by labeled at 07/17/09 5:16 PM labeled was starred labeled was unstarred

Elaken
07/17/09

@pinkynicejuice: I don't know about Africa as a whole but I can say in my experience promiscuity, the church, the lack of HIV specific education/awareness, in addition to lack of drugs were all big factors in Tanzania. I think to just ignore those things is very dangerous.
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pinkynicejuice
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
even if it reduces women's exposure by lowering rates in men, it now also may disincentivize men to use condoms, since they now feel protected by circumcision. since they control the condoms...
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Megan
07/17/09

@pinkynicejuice: That's a legitimate criticism, in many ways, but you have to also ask other questions. The question is: do enough people regularly use condoms to stop transmission (sadly, not really)? Are the ones who do the same ones who would use condoms (sometimes)? Is the reduction in men's risk of infection that high (studies indicate they are)?

Yours is also a good argument for increasing access to female condoms, which is also occurring and seeking methods (like carageenan and nonoxynol-9, which were proved ineffective) that can reduce women's risk without running up against stigmas about condom usage, such as the ones promoted widely in Catholic Africa by the Church.
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Edited by Megan at 07/17/09 5:03 PM Megan was starred Megan was unstarred

thePrototype
07/17/09

@pinkynicejuice: Hear Hear!! I hear the same argument about HPV, and go really??? so now that they think they are safe they will not worry about it.
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Megan
07/17/09

@thePrototype: Well, but that in and of itself is a very poor argument against the HPV vaccine, since the lack of a vaccine hasn't exactly encouraged people to be more careful about not catching it. It is an argument for more education about it. But the two things should not be mutually exclusive, and one does what one can to reduce the incidence regardless.
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thePrototype
07/17/09

@Megan: I agree 100% about HPV education, how many people out there a. know about it, and b. know of its possible effects. But the idea of circumcision as prevention, imo, can be dangerous because it can give a false feeling of safety.
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Edited by thePrototype at 07/17/09 5:23 PM thePrototype was starred thePrototype was unstarred

specials
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
sex is very often transactional for women in Africa. it's not necessarily services for cash, it's what many women have to do for survival. and you are less likely to receive money or things you need if you ask him to use protection, it's just not that kind of relationship. from my experience, i think economic independence is the solution we need to aim for.
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Megan
07/17/09

@specials: While I agree that giving women more autonomy and economic independence are probably the best ways for women to have control of their reproductive health, that is probably an even longer-term goal than reducing the stigmas against and logisitcal concerns with condom usage.

Obviously, all of this is occurring in an imperfect world.
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specials
07/17/09

@Megan: absolutely. and the book mentioned elsewhere in comments here is excellent: Helen Epstein's _The Invisible Cure_
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tonightineed is actually Mrs. Ziegler-Spock
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
922 men, 163 female partners. Okay, either:

1. Some of these men had no partners
2. They only followed the partners who were in a continual relationship with the men.
3. They only followed some of the women
OR
4. .....uh, sharing? I jest, I jest.

It's strange to me that there is such a difference in numbers. Even if you take into account the number of men "too young" for partners, there is still a huge gap. Fascinating.
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Megan
07/17/09

@tonightineed is actually Mrs. Ziegler-Spock: All the men in the study were already HIV infected, so the likelihood was that they were not too young for sexual activity given that the main vector for transmission in Uganda is heterosexual activity and experimenting on minors is generally discouraged.

I would assume that the number of women who they followed was some sort of combination of factors included that the men were known to be infected with HIV, the difficulty isolating the source of HIV infection among women who had multiple partners, and the willingness (on either the man's or woman's part) for the woman to participate in the study.
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labeled
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
Does anyone remember a couple of weeks ago when a commenter got disemvoweled & presumably banned for making the "What's up with the whole continent, seriously?" comment? I do NOT agree with that sentiment.

I do wonder what's up with the whole fucking world, seriously. You are risking death and murder. Fucking virgins, or babies will not cure you or prevent disease. Witchcraft will not cure you or prevent disease.

BE FUCKING CAREFUL. It might not cure you, but it might either save someone else, yourself, or an entire goddamned generation of orphaned children who are all but doomed to repeat this godforsaken history.

It is sad beyond words.
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Penny
07/17/09

@labeled: There are plenty of educated people in the west who don't understand how certain STDs (hello, Herpes) can be transmitted, so it doesn't surprise me that there are so many misconceptions in poor, developing areas of the world.

Education, education, education, all the way.
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labeled
07/17/09

@Penny: Even when it seems not to be working on a large/quick enough scale, I definitely agree with you: education, education, education.
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ZemarSea Urchin
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
uh oh. I do believe the pot has been stirred...let the great pro-circ v. anti-circ debate begin. On a serious note I would say that the pro group just lost its main argument and as a casual observer of this long standing debate I am curious to see how the pro peeps will now defend their stance or if any will go over to the anti side now.
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thePrototype
07/17/09

@ZemarSea Urchin: well from what I understand the study did confirm that it reduces the reception of the virus, just not the transmission.
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rhymeswithfeather
07/17/09

@ZemarSea Urchin: I'm on the fence, but they didn't lose their argument -- circumcision is still shown to be effective protection for MEN -- they just said it isn't effective at preventing the transmission of HIV to women, which I never realized was listed on the "pro" side. But they did say it would probs reduce cases overall, thus helping women, too.
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labeled
07/17/09

@thePrototype: Female to male transmission as well. The hope was that male-to-female would be affected thusly.

It doesn't strike me as your average pro/con circumcision debate, at all.
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Penny
07/17/09

In reply to Researchers Stop New Male Circumcision Trial In Uganda
My knowledge of reproductive biology is limited, granted, but I don't understand how they thought male circumcision would reduce HIV transmission. How long does the virus live in semen outside of the body? I assume because an uncircumcised penis has additional folds of skin semen is more apt to be "trapped" after ejaculation? Someone needs to enlighten me.

It seems that pushing educational programs would be a more effective strategy.
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CurtCole
07/17/09

@Penny: I thought it helped males not contract it from females, now I am thoroughly confused.
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tonightineed is actually Mrs. Ziegler-Spock
07/17/09

@CurtCole: But if it were to help men not contract it from females, how would having less skin on the penis help?

I would imagine that if the contact occurs with long enough duration to transmit the virus the foreskin or lack thereof would make very little difference. I'm missing something.
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colormeroutine
07/17/09

@tonightineed is actually Mrs. Ziegler-Spock: Generally speaking, men are less likey to contract it from woman than the other way around, because the small amount of vaginal fluid that actually gets inside the male urethra would be expelled on ejaculation. In uncircumcised men, however, it can get stuck under the foreskin, where the virus can stay alive for a while, and make its way in
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Megan
07/17/09

@Penny: My impression, having not read the entire paper, is that it was predicated on the theory that since the foreskin cells are more susceptible to the virus, removing them might reduce transmissibility, albeit slightly.
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Svenskasweetie
07/17/09

@CurtCole: Yes, that's my understanding - it prevents men from contracting it from women. This was an experimental treatment to see it it also helped prevent the infection of women from infected men and they found that it didn't. There is some interesting research coming out of Malawi about attempts to change sexual habits so that people engage in oral sex instead of intercourse because women are far less likely to contract AIDS this way. Unfortunately, it's a hard road, particularly in the areas that are more heavily monotheistic, like Malawi, to encourage these types of changes in relationships. Basically, the situation sucks (not intended as a pun), particularly in developing countries, and no one has come up with a feasible and implementable plan to reduce the spread of HIV/AIDS. Ok, now I'm sad and feel like I should be doing public health research.
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Megan
07/17/09

@Penny: Also, part of all these studies is that participants are counseled to use barrier protection, but most continue not to despite the counseling.
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tonightineed is actually Mrs. Ziegler-Spock
07/17/09

@colormeroutine: Ohh, I see, I see.

Thank you.
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J.D.Regent
07/17/09

@Penny: I know it always sounded fishy to me too. However I am in no way an expert on the evidence so have kept my trap shut.
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Penny
07/17/09

@Megan: Thanks for the clarification, Megan.

Still confuses me as it seems like a lot of resources thrown into something that would have such minimal positive results, you know?
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Megan
07/17/09

@Penny: Well, minimal positive results would be better than either of the two large-scale trials I mentioned, one of which actually increased the rate of HIV transmission and one of which showed no effect.

The lack of any potential avenue for women to protect themselves outside of condom usage (which, as discussed, is expensive and socially problematic in some societies) is actually a huge problem, so I get the sense this was a potential Hail Mary pass, so to speak.
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J.D.Regent
07/17/09

@Penny: I think it is attractive because it is something that could be implemented population-wide and doesn't require cultural shifts as large as the ones that are actually necessary to reduce HIV transmission generally (empowerment of women, changes in attitudes of men toward women and sex, development of health infrastructure, etc.)
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Penny
07/17/09

@J.D.Regent: Great points JD (and Megan--I don't know how to respond to multiple people)....thanks :-)
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Artemis47
07/17/09

@Penny: To really get into the biology, one of the only types of cells HIV *cannot* infect is skin. When you cut away the foreskin, the secretory cells on the head of the penis convert to being more like hard skin cells, and HIV can no longer get in that way. Ta da: reduced infection rates when men have unprotected sex with infected partners.
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labeled
07/17/09

@Artemis47: Very interesting. Thanks for adding that.
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