It's the routine, regular health care, stupid. Not the STI.

HIV/AIDS is becoming more like the circumcision debate of old by the month. Remember when circumcision was discussed in terms of lower incidence of urinary tract infections in infants and fewer cases of penile cancer in very old men? Back then, the brain dead press would chirp that parents are just trying to protect their babies dot, dot, dot "just in case." Never mind that blood and erogenous tissue of another, and not of the decision maker's own, and some $108,600 in health care spending (181 NNT x $600) were wasted to prevent one UTI, treatable at a cost of $30. Never mind that penile cancer is so rare, it really is statistically absent.

Now, we have this study [Aidsmap] that proclaims that "managing" sexually transmitted infections is "cost-effective" in "HIV control." Has it occurred to these blinkered researchers that perhaps attention to health generally is the antidote to behaving irresponsibly? If you're treating STIs, you're also educating the patient. You're also providing the kind of routine health care that can catch a new HIV infection early, which incidentally is when the newly infected is most infectious. You could say that treating drug addiction would have the same effect because paying attention to the welfare of the individual is the preventative. It's why single payer health care countries are healthier countries: they pay attention to the patient and leave the bottom line to bureaucrats (not a dirty word, btw).

The researchers got on this bandwagon while trying to figure out why circumcision correlates with lower incidents of HIV in West Africa compared to East Africa (but not when comparing intact vs. circumcised within the individual countries). Their theory however has been debunked already in the several trials to check whether treating herpes would reduce the rate of infection in those affected. It didn't. So what we really have here is a case of regular health care, not managing STIs, as the protective practice. Doesn't this sound suspiciously applicable in the case of circumcision and the control groups of the African studies?

So how is this like that old debate between the circumcision junkies and intactivists? Well you see, the bigger picture just isn't important to those who want to make a point justifying something they've been doing for so long. Doctors treat symptoms, not people. And if a hammer has been used to swat flies for several generations, it's hard to abandon the sturdy, heavy feel of a hammer for the light, flimsier feeling, but more efficient and less damaging fly swatter.

Reference

White RG et al. Treating curable sexually transmitted infections to prevent HIV in Africa: still an effective control strategy?. J Acquir Immune Defic Syndr 47: 346 – 353, 2008.

Comments

[Joe in CA]

Articles singing the praises of circumcision seem to conveniently and willfully ignore that theories behind circumcision and certain diseases have already been debunked.

The penile cancer excuse, for example, has long been debunked by none other than the American Cancer Society itself.

http://www.fathermag.com/health/circ/acs/

Yet, I consistently continue to find "penile cancer prevention" on foreskin hitpieces. Some of them still dare to gratuitously coin the UTI excuse.

Even articles whose focus is supposed to be circumcision as a possible HIV prevention method, can't seem to come to a close without non-challantly plugging the circumcision of infants (who's risk for HIV and/or any STD for that matter is ZERO by the way...) and the obligatory UTI and Penile cancer excuses for it.

Maybe the authors of such articles feel they must? "...just in case?"