Study finds no protective effect in gay men from circumcision, so why are the authors still promoting it?

The stock response in the last two decades to the realization that circumcision has little to no value in public health and can be demonstrated to harm newborn males as well as adult sexuality has been to repeat old saws that it's cleaner, all the kids are circumcised, and that it's "healthier" in some as yet undiscovered way. And so Zohar Mor, Charlotte K. Kent, Robert P. Kohn, and Jeffrey D. Klausner have dressed up nothing to look like something to reinforce the point in the misleadingly entitled article Declining Rates in Male Circumcision amidst Increasing Evidence of its Public Health Benefit. The only thing to recommend their nothing-new-to-report [pdf] article is that they conclude:

Our findings, showing no significant differences between circumcision status and the risk of HIV or syphilis infection, are consistent with the importance of non-penile, rectal acquisition of those infections (or oral infection in syphilis) among gay men in the U.S. [22], rather than penile acquisition as in heterosexual intercourse, during which the foreskin may be exposed to HIV infection. Because large proportions of gay men practice both insertive and receptive anal intercourse [23], the ability to differentiate between different risks for HIV infection associated with sexual practices versus circumcision status is limited.

So there you have the real take home point: penile acquisition of HIV is but one method of acquisition among the highest risk group in the United States that cannot be separated out from other methods of acquisition. And hence, no value is realized from circumcision due to the diversity of sexual behaviors among men who have sex with men. This is wholly consistent with the study presented in Sydney, Australia at the International AIDS Society conference earlier this year. Due to the low prevalence of HIV among American heterosexuals this conclusion effectively pulls the rug out from under the prime justification remaining for routine circumcision in the United States, i.e. disease control.

So why do these authors dress up truths as lies by continuing to advocate circumcision? Only they know for sure. But the public needs to be aware of these junk scientists' intentions, which may be neatly summarized in their own words:

In conclusion, while a majority of men attending the San Francisco STD clinic were circumcised, there were large and steady declines in circumcision across all racial/ethnic groups since 1960. There were significant differences by racial/ethnic groups suggesting important socio-cultural factors related to decisions to circumcise newborn males. Given the recent evidence demonstrating the substantial potential public health benefit of male circumcision [refuted a few short paragraphs before] and our observed declines in circumcision rates, national organizations that promote circumcision policy should review current practice guidelines in responding to those trends.

Direct your comments to: Jeff.Klausner@sfdph.org; zmor@sph.emory.edu

Comments

[IntactwhitemaleUSA]

I think it's this simple blindness to the research results that discredits Klausner et al as members of the scientific community. Science is the opposite of politics, you don't start with a conclusion and find the "facts" to prove it - just the opposite. A very unscientific zeal is the only thing that can explain what is motivating these men. They had best be careful - peer review has a nasty way tearing pride and prejudice assunder in this community. Their precious research funding might dry up with a quickness.
Gee, only being 30 years old, one thing I had learned about HIV almost from the begining was that it was common amongst gays in the USA in the 80's/early 90's because:
1. A significant number in the gay community were practicing unprotected penile-anal intercourse without protection and with multiple partners per year
2. Semen is a prime vector for HIV
Did these guys come from another country? Had they not heard of AIDS till it was linked with circumcision?

[Joe in CA]

"So why do these authors dress up truths as lies by continuing to advocate circumcision?"

One should inquire as to the circumcision statuses of these men, and/or women's husbands and/or children.

Says it all.

[J]

You see this is the kind of garbage that generates sensationalized headlines in places like the Post. There is just too much here to pick on any one thing. Since it was submitted in April I guess they didn't have time to consider the dutch work. And just to put their minds at ease there has been a sensible statement released by the Australian Federation of AIDS Organizations. The question that they should be asking is when are the relevant US organizations going to follow suit, drop these prophylactic games/claims, and classify male circumcision for what it is.

[J]

Figure 1 is encouraging though.