We've seen the cart, now here comes the horse.
Aidsmap has recently reported on an emerging realization among HIV prevention researchers that asking about anal intercourse is important to rule out this confounding factor in prevention studies based in Africa.
Studies into sexual behaviour in Africa have often neglected to enquire about anal sex, and sex between men. There has either been an assumption that such behaviour was not prevalent, or a sensitivity to cultural taboos and prejudices means that investigators are reluctant to enquire about such behaviour. But studies are now suggesting that anal intercourse is common in Africa in both heterosexual and homosexual contexts and is an important mode of HIV transmission.
Excuse me, but could we get a do-over on those African circumcision trials?? This problem has been suggested before, but I think saying it out loud in the literature ought to get some attention. In studies where the numbers are small, but the difference in infection rate is great (precisely because the numbers are small), the problem of failing to account for all the confounding factors is greatly magnified. The African circumcision trials fall squarely into this trap. Now, will we hear calls to re-examine the studies? Unlikely, and as usual the responsibility to call them out on it will fall to the lay person. That would be most of you who read this blog.
In related news, Aidsmap is also reporting that HIV+ gay men with HPV, or ano-genital warts, have presented in Australia with abnormal cells in the anus that could indicate greater rates of cancer and/or HIV infectiousness. Combine this with the recent survey that demonstrated almost twice the rate of HPV among circumcised men in the USA, and we may be on to something.
What are you talking about. Anal sex is a GAY thing. Straight people don't have anal sex, and there's not a single gay man in Africa.
;-)
Posted by: Joe in CA | Thursday, April 24, 2008 at 07:21 PM