Of receptor sex, foreskin interventions, and disappointed scientists

A reader writes in regarding an article on Medscape worth noting. It isn't that the findings are so earth-shattering. Rather it's that the article's author and apparently the researchers and commentators as well appear to want so badly for circumcision have some value. But apparently for gay men it offers nothing -- even in a study where the researchers clearly were hoping it would.

You can almost feel one Matthew Hogben's sullen mood, glimpsing his leaden face, eyes cast downward in disappointment, when he's says, "The Australian study showed that circumcision was not a factor one way or the other in whether [individuals] developed HIV, which probably makes sense."

The logical thing to do when a study fails to show any beneficial effect would be to abandon the avenue and look elsewhere. But not these scientist-advocates. Hogben says, "with the findings of the trials that ran in Africa, [researchers] might want to expand study of the association to see to what extent they could take advantage of those findings to look at secondary effects. It might be worthwhile to see whether there's less transmission or 'burden' with a foreskin intervention, but I suspect we would need more data, and more clean data, to confirm this."

Translation: This study failed. Let's do more.

These days, foreskin interventions are all the fashion.

THANK YOU to Scot Anderson for this contribution.

A fair use glimpse of Medscape article after the jump.

Circumcision Not Protective Against HIV Seroconversion in Homosexual Men

Circumcision status may have little effect on whether men who have sex with men go on to develop HIV, according to the results of a new study of more than 1400 homosexual men, presented here at the 17th Meeting of the International Society for Sexually Transmitted Diseases Research. Although several recent randomized controlled trials of heterosexual men have found that adult circumcision reduces the risk of HIV acquisition by 50% or more, little is known about the association between circumcision and HIV risk in homosexual men, said the study's chief author, David Templeton, MD, from the University of New South Wales, Sydney, Australia.

"The data on circumcision and heterosexual men are compelling, but there are few data on circumcision and HIV risk in homosexual men," said Dr. Templeton. "We found no relationship at all between circumcision and HIV seroconversion in this cohort." That lack of association or protective effect, he added, may be because most HIV occurs "following receptive rather than insertive intercourse," but further studies would be needed to confirm that theory.

"Based on these findings, we cannot make a recommendation for circumcision in homosexual men" as a protective measure against HIV seroconversion, Dr. Templeton said.

The longitudinal study of 1427 initially HIV-negative homosexual Australian men, initiated in 2001, found that in the 49 who developed HIV, circumcision status appeared to have no effect (risk ratio was 1.07, with a confidence interval of 95%). At baseline, 66% of participants reported being circumcised, mostly as infants, and circumcision was more prevalent among men aged 45 or older (83%) than in men aged 25 or younger; only 50% of the latter group reported being circumcised. Circumcision status in all participants was later validated by physical examination.

Although the Australian study's results showed no benefit in circumcision for homosexual men as a means of protecting against HIV, the association might merit further study in light of the findings of larger African trials about the potentially protective effect of circumcision overall, said Matthew Hogben, PhD, a research scientist from the Centers for Disease Control and Prevention's National Center for HIV, STD, and TB Prevention, Atlanta, Georgia.

"The Australian study showed that circumcision was not a factor one way or the other in whether [individuals] developed HIV, which probably makes sense," said Dr. Hogben, who moderated the session. He added that although "receptor sex" was "clearly was the manner of acquisition," in the Australian study, it's understandable that "with the findings of the trials that ran in Africa, [researchers] might want to expand study of the association to see to what extent they could take advantage of those findings to look at secondary effects. It might be worthwhile to see whether there's less transmission or 'burden' with a foreskin intervention, but I suspect we would need more data, and more clean data, to confirm this."

Dr. Templeton and Dr. Hogben report no relevant financial relationships.

17th Meeting of the International Society for Sexually Transmitted Diseases Research: Abstract 215. Presented July 30, 2007.

Reference

Darves, Bonnie. Circumcision Not Protective Against HIV Seroconversion in Homosexual Men. Medscape Online. August 2, 2007.

http://www.medscape.com/viewarticle/560823 [Subscription required.]

Comments

[SunkenShip]

FORESKIN "INTERVENTION"???

And people accuse intactivists of misleading people by calling circumcision mutiliation, but now it has been downgraded to an "intervention"? These people never cease to amaze me.

[Joe in CA]

It's usually the case that if you're looking for a CURE for a disease, you try something and if it fails, move on.

In the case of circumcision, it's the cart before the bull: advocates are looking for something that circumcision can cure.

The only reason there are "studies" in Africa that have "worked" is because "researchers" like Auvert and Bailey have been working on coming up with such a "study" for years. They were looking since the mid-80s, and only now, in the 2000s did they finally come up with numbers that worked.

These "studies" are well-published, but why don't they show the Brewer Study published in March 2007, where it was concluded that circumcision in Kenya, Lesotho, and Tanzania actually INCREASES the transmission of AIDS?

That's right. Because the media doesn't want to publish something devastating to the pro-circumcisionist cause. Nothing is wrong with studies that show circumcision prevents AIDS, but EVERYTHING is wrong with studies that show it DOESN'T.

[Joe in CA]

Indeed, the latest studies that every pro-circumcision activist and their grandma touts were stopped EARLY.

Could it be that the "researchers" stopped the "studies" early, while the going was good?

The dirty little secret is that while intact men were off having sex, the circumcised men were told to abstain from sex while their wounds healed(4 to 6 weeks). Moreover, they were given CONDOMS, while the intact group was NOT.

http://www.circumstitions.com/HIV-SA.html

Of COURSE the results will be favorable to the pro-circumcisionist "researchers."

[Joe in CA]

http://www.trinidadexpress.com/index.pl/article_features?id=161191863

"For just over a decade researchers have actively investigated why the virus hadn't managed a strangle hold in those African countries where circumcision is widely practised."

You mean it hadn't already happened???

"Bailey admitted that the studies in South Africa, Uganda and Kenya found an increase in the number sexual encounters, less consistent condom use and an increase in unprotected sex respectively among the circumcised. But he said that with repeated study visits and intensive behavioural counselling there were eventually reductions in risk behaviours."

It was the circumcised group of men who got study visits and intensive behavioral counselling. The real reason the results came out as they did.

What cheek that they keep leaving out that tiny little detail when they mention these studies.

[Hugh]

Joe in CA wrote:

"Moreover, they were given CONDOMS, while the intact group was NOT."

Where do you get that information? I think you'll find condoms were equally available, but those being circumcised (the experimental group at the beginning of the studies, the control group at the [premature] end) were given much more encouragement to use them. And since the studies were not and could not be double-blind, and the control groups were not given a placebo operation (which would have required as much hygienic care as circumcision) the circumcised men had much more incentive to use them. How long that incentive lasted after the healing period is one of the big unknowns of these studies. Having part of your duck cut off is likely to be a powerful inducement to think about where you're putting it.

[J]

Joe in CA said:
"...
"Bailey admitted that the studies in South Africa, Uganda and Kenya found an increase in the number sexual encounters, less consistent condom use and an increase in unprotected sex respectively among the circumcised. But he said that with repeated study visits and intensive behavioural counselling there were eventually reductions in risk behaviours."
..."

This statement is particularly disturbing, I can see in a study like this safe sex being re-enforced as participants come in from time to time to report which probably leads to the: "...repeated study visits and intensive counseling there were eventually risk reductions in risk behaviours..." Some how I get the feeling that these "repeated study visits and intensive counseling" will not be part of the program implemented en mass. Instead it will likely be a hour or two presentation, a chop, a handful of condoms, a trifold pamphlet (that will end up in the street), and no return visit for re-enforcement.

Then of course we have the hat-trick/trifecta: "...increase in the number sexual encounters, less consistent condom use and an increase in unprotected sex respectively among the circumcised..." What did you say David, 40% minimum bound?

Why don't more people see this as a slow motion train wreck?