circumcision at the Daily Dish

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Freddie

Freddie deBoer used to blog at lhote.blogspot.com, and may again someday. Now he blogs here.

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35 Responses

  1. Avatar kadzimiel says:

    I believe that is it Chris Bodenner, not Brodenner.Report

  2. Avatar E.D. Kain says:

    America is pretty unique in its affinity for circumcision (outside of Israel). Do we have lower rates of HIV than our largely-uncircumcised European neighbors?Report

    • Avatar Freddie says:

      There’s no statistically significant difference. Part of the difficulty in assessing such a difference is that the prevalence among non-IDU heterosexuals in North America, Western Europe and Australia and New Zealand is so low, something along the lines of 0.2 percent, and that doesn’t account for in utero transmission, transmission from blood transfusion, and false self-identification of the prevalent risk factors.

      It’s worth pointing out, by the way, that the divide here really is between sub-Saharan Africa and everywhere else, with a possible exception in Brazil. Even Northern Africa has extremely low rates of infection, and the rate is skewed upwards by Southern Sudan. The Caribbean, too, has had forecasts of infected population moved significantly downwards by UNAIDS this decade. Haiti, for example, is a country that was once estimated to have a 6 percent total infection rate but has since had the statistics revised downwards to be considered perhaps half that.

      I recommend James Chin’s book The AIDS Pandemic from a couple years ago on this issue.Report

      • I’m not sure if it’s statistically significant, but it seems worth pointing out that the US has a higher rate of HIV/AIDS prevalence than any European country outside of Russia and Ukraine.

        http://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_adult_prevalence_rate
        Interesting side note – I remember seeing some statistics a year or two ago that found that prostitutes in Western European countries with legalized prostitution had a lower HIV/AIDS infection rate than the general population.Report

        • Avatar Freddie says:

          Right, in terms of general infected population. Thanks. I am trying to draw clear lines between the generally infected populations and those who have attempted to be statistically sorted as non-IDU heterosexuals, because it’s really the central issue in the circumcision debate.

          Really, it’s a very interesting issue in general, the clash between epidemiological data which supports a reading of the virus as a disorder that affects one region and the homosexual population, and the conventional picture as described by (well-meaning, I know) AIDS advocates.Report

  3. Avatar Jaybird says:

    I don’t think that they’re being dishonest in the way you suspect.

    I think that they’re being dishonest in the “we can’t say that only sub-Saharan Africans need to do this” attitude. I mean, imagine coming out and saying “this is something that will work only for sub-Saharan Africans”. Flip it around. “This is a medical procedure that will work only for Northern Europeans.”

    That’s something that would get a *HUGE* backlash.

    So you advise it for everybody, no matter what color their skin.Report

    • Avatar Freddie says:

      That’s a very good point, Jay. To be clear, there’s no reason to suspect from the epidemiological data that sub-Saharan African people have a higher risk of infection, but that the unique logistical realities of sub-Saharan Africa, coupled with social and cultural practices that are not seen outside of the region, cause them to have an immensely higher chance of HIV infection. And, as with almost all communicable diseases, as the pool of infected in a region grows, the higher rate becomes self-reinforcing.Report

  4. Avatar Mark says:

    Freddie, you wrote “Statistically, we know that it is almost always the case that HIV infections in America are the product of sex between men, the sharing of needles, passage from mother to child in utero, and the (happily, now much rarer) through blood transfusion.”

    The stats you point to high-risk heterosexual contact (prostitutes and women who have sex with MSM) as responsible for 35% of new cases. In the past, IV drug use was a more common avenue, but heterosexual sex has passed it and is trending upwards. I agree that the numbers are small, but it’s a disturbing trend, and there’s a definite lack of concern relative to our initial fears about HIV 25 years ago.Report

    • Avatar Joe says:

      Mark, you said in your post that Freddie’s link indicates 35% of new infections are heterosexual. Are you combining Male and Female? I looked at the link Freddie provided, I believe the chart we are interested in is Estimated # of HIV/AIDS Cases, in 2007. For Males this was 4,551 and for Females it was 9,076 total cases was 13,627/35,180 ~=38%. For High-Risk Hetero Males though it was only 4,551/35,180 ~= 15%. The figures are also shown here (I checked the chart is the same as the CDC chart).Report

  5. Avatar Freddie says:

    Ah, but the new cases of HIV infection in the United States are now so low that minor swings in the data can produce factually accurate but functionally misleading readings of the data. Even if we take it on face value that all of the people who are reporting contracting HIV from heterosexual sex indeed contracted the disease that way– and, as you’ll see in the literature, men declining to report that they have sex with other men is a serious problem for compiling accurate statistics– the actual number of new cases from high-risk (sex with prostitutes and sex with women who have sex with MSM) is quite small, a small fraction of a small number of new infections in the United States of a disease that in total afflicts about 1.1 million people in a population of some 305 million.

    This is similar to when people say things like, “the fastest growing rate of infection is among heterosexuals!” This is, often enough, literally true, but deeply misleading. If the non-IDU heterosexual rate of infection increases from 0.15% to 0.3%, possible when dealing with rates so small and the margin for statistical error, then, yes, the rate has double, and that doubling is going to be higher than the percentage change in the rate of homosexual infection. But that’s only ultimately a reflection of the tiny number of non-IDU heterosexuals who contract HIV and the much larger existing population of HIV-infected homosexuals.Report

    • Avatar Freddie says:

      Additionally, it’s worth pointing out that even within the low probability of heterosexual transmission, male to female transmission is a greater risk than female to male transmission. As the study I posted demonstrates, circumcision does not reduce the risk of infection from man to woman. What’s more, this lack of symmetry in odds of infection based on gender is part of what helps make the infection rate among non-IDU heterosexuals so low. Women, though still incredibly unlikely to contract HIV from heterosexual sex, do have a higher chance to catch the disease from men than vice versa. Because of this, the pool of heterosexual men who might spread the disease to more women remains small, which reduces the possibility of wider infection.Report

  6. Avatar James says:

    I reckon that any good which would be done by male circumcision in Sub-Saharan Africa, on the grounds that it’s going to be nigh-on impossible to promote this sort of a thing without people imagining themselves immune, or feeling they’ve somehow “earned” unprotected sex. Additionally I do not consider this to be a matter of parental choice, as only the subject is suitable to make a subjective decision. This includes religious grounds, which I do not deem exceptional against the above.

    I suppose that this renders me an “anti-circumcision zealot”. So be it.Report

    • Avatar James says:

      *any good which would be done by male circumcision in Sub-Saharan Africa would be negligible, or outweighed by the bad,Report

    • Avatar Freddie says:

      I don’t think you’re a zealot, and again, I am opposed to any notion of forcing circumcision on any parents. I do think parents have the right to make health choices for their children. What I consider to think is the best, most humane and most common-sense solution is to present circumcision as an option to adolescent boys prior to their becoming sexually active. There’s many advantages to that and no disadvantages.Report

      • Avatar James says:

        It’s an interesting idea, although unprecedented. Generally the options are as followed: either the procedure is performed at birth, or as a manhood ritual which there is a considerable degree of coercion involved in (if you don’t have one, you bring shame upon yourself & your family. In some particularly barbaric areas you’re expected to have it performed upon you without flinching). The latter is found in Israel, America & some Arab countries, the latter in areas of Africa. A middle option is it being performed during mid/late boyhood as in the rest of the Muslim world, Indonesia or Turkey.

        For the majority of the world, though (75-85%), it simply does not occur save for therapeutic reasons. This is true of the entirety of China, much of South East Asia, most of India, all of Europe & always has been throughout these places forever, save in Britain where it’s been true for a mere 60 years after a slight blip inspired by the Victorians. &, I suppose, Spain courtesy of the Moors. It is rapidly becoming/has become true of Canada, Australia & New Zealand. (IIRC a region of Australia outlawed the secular non-therapeutic practice quite recently, Canada’s single Province that offered it via free healthcare dropped it a little while ago. It’s rate is 9% & falling fast. Britain also kicked the habit after the foundation of an NHS, thank you socialism.)

        Throughout these areas the notion of removing a section of the male genitals from a healthy man/boy/infant simply does not arise. In no country I know of is it offered as an option to adolescents: it is required culturally for full membership of society & people are obliged to consent to it, it is performed upon the unconsenting by force, or it does not occur at all & never occurs to most people to perform.

        I think that this is quite telling. It seems that Rabbi Maimonides was quite correct.Report

        • Avatar James says:

          Oh yes, & American Exceptionalism fans take note of this – America is entirely alone in being a country which performs circumcisions upon most male infants for secular reasons. This Victorian habit, which spread throughout the Anglosphere over a matter of decades, was a historical aberration of the first order, which the majority of parents within the countries afflicted with have since abandoned. It’s entirely atypical of the rest of history, which places religion behind infant circumcisions & manhood behind adult ones.

          The closest to America left is Turkey, which has circumcisions performed upon young adolescents. That’s infused with Islamic tradition, but occurs after the latest date proscribed by the Hadith, which is 7 (the Koran fails to mention circumcision of either gender). In this sense it’s secular, with a religious grounding. I have hopes that Turkish integration to the EU will kill of this practice but, again, I’m something of an optimist.

          Thankfully America is set to fall below 50% by the end of this decade, or certainly the end of the next, should present trends continue. This is assuming that the CDC doesn’t fuck everything up. So there’s hope. It still does baffle me that “Land of the Free” still has quite so much catch-up to do when it comes to letting people do as they please with their own bodies, though…Report

  7. Avatar DdR says:

    Call the procedure what it is: The ritual mutilation of male infant genitalia!Report

  8. Avatar Jim says:

    “I do think parents have the right to make health choices for their children.”

    1. This is one example of how a language can fail you. In this case there is an ambiguity in English on the word “child” – it applies both to actual minors and to a person’s first generation descendant. Yes, a parent has the right to make medical decisons for a minor. No a parent does not have the right to make medical decisions for a child fo theirs who is older than 18. And in this case this is a real diffenrence, becasue presumably most children don’t start with sex until they get pretty near 18 – I know, I know, there are plenty of little rut-monkeys out there, but I still think a lot of kids are lying to a lot of credulous researchers – so parents are not really making a sexual decision for soem minor child in their care.

    2. Calling this a medical decision is just jumping over one of the main points of contention. As others have pointed out, there is no more justification for routine circumcision as a medical procedure as there is for routine excision of girls’ nipples at birth – in fact less, because breast cancer is probably more prevalent.

    “Oh yes, & American Exceptionalism fans take note of this….”

    This is a big part of the problem. One major component of American Exceptionalism is the Puritan self-identification with Ancient Israel – Manifest Destiny, nation with a special mission from God, all those OT personal names and a load of other crap, and then this crap in the middle of the 19th century – which BTW is a little strange in an American context to call Victorian.Report

    • Avatar James says:

      It began in England, I believe. While Queen Victoria was upon the throne. There certainly were hugely successful home-grown circumcision advocates, but the frenzy which Victorian culture worked itself up into over masturbation was the source of early eagerness to remove as much pleasure as they could from boy’s bodies. In the last League thread on this I quoted & linked to Maimonides arguing that it was valuable for much the same reasons, I shall do so again:

      http://www.cirp.org/library/cultural/maimonides/

      In short: the aim is to remove as much pleasure as can be done without impairing generative function. This then stopped being a sex-fear thing & started being a class thing (rich could afford to render their children “clean”, poor could not, aspiring would if they could). Then the NHS came into existence, refused to cover the procedure & a single study seemingly killed the popularity of infant circumcision overnight, by demonstrating circumcisions did far more harm than good.

      Contrastingly, the drafting of the US military resulted in circumcisions of troops. Aside from the militarisation of culture, the industrialisation of medical care, which unlike in the UK was still profit-driven, included (amongst many other approaches to maternity care we’d find shocking today) routine circumcision without asking for the permission of parents (or even informing them that this was happening). It’s for this reason the black population has lower circumcision rates: their healthcare wasn’t as effectively industrialised, owing to segregation. Any male babe that did end up born in a hospital, though, received a routine infant circumcision as a matter of course. This continued until the 1970s, when some lawsuits rendered it untenable.

      That was after a good few decades of automatic circumcision, however. The answer to why circumcision is just considering something which is done in America is that, for many years, it just was.Report

  9. Avatar jj says:

    I would like to point out that circumcision plays a role in preventing penile cancer which develops on the foreskin. This is a very rare cancer in the U.S. but in certain populations around the world where circumcision is not the norm, it is much more prevalent.Report

  10. Avatar Jim says:

    “It began in England, I believe. While Queen Victoria was upon the throne. There certainly were hugely successful home-grown circumcision advocates, but the frenzy which Victorian culture worked itself up into over masturbation was the source of early eagerness to remove as much pleasure as they could from boy’s bodies. ”

    Circumcision in an Anglo population you mena. Yes. Also, wasn’t that an era when there was still a vigorous Dissenter-type religious community or some continuation of it in Britain, that may have had the same self-identification as US Protestants did with Ancient Israel?

    I was only saying that it is a litle strange to refer to any period of US hisotry as Victorian.Report

  11. Avatar Hugh7 says:

    “I additionally, of course, believe that ultimately parents are empowered to make the decision, whether for religious observation or whatever else.”

    Why do you say “of course”? There isn’t another healthy, non-renewable part of the human body it is legal for parents to have cut off, whether for religious observation or whatever else. (In fact there are laws giving extra protection to the exactly corresponding parts of girls’ and women’s bodies, and religious and cultural whatever elses are specifically excluded.)

    One way this exception came about was by devaluing and denigrating the foreskin. But it’s actually a mighty cool thing to have – Nature’s French tickler for the ladies, and with joys of its own for its owner. Now, thanks to the Internet, men are able to come out and say “Hey, I never gave MY consent” or “…out of my cold, dead hands”, depending.

    Once you shift male genital cutting from “medical procedure” (or “religious ritual”) into the field of human rights issues, the landscape changes: whose body is it? Whose rights?

    Some ten years ago I was struck by the bizarre and often contradictory nature of “whatever else” and began collecting what I call “circumstitions”. I now have more than 390 of them! You can see the full list at http://www.circumstitions.com/Stitions&refts.html

    So yes, you’d probably call me an anti-circumcision zealot, but we call ourselves Intactivists.Report

  12. Avatar Hugh7 says:

    “These studies are demonstrating a clear advantage in fighting a terrible disease,”

    If you look at the actual studies, they’re not so so impressive. In three different parts of Africa, they circumcised a total of 5,400 men and left a similiar number intact. After less than two years (they cut the studies short – stopping while they were ahead?), 64 of the circumcised men had HIV, and 137 of the control group. That (73 men who might have got HIV if they hadn’t been circumcised) is the sum total of the much touted “60% reduction in HIV” to date. (It’s actually an absolute reduction of 1.8% and a Number Needed to Treat of more than 40.) Meanwhile, 327 circumcised men dropped out, their HIV status unknown, so it’s entirely possible no men at all were protected.

    And the Uganda study of circumcised HIV+ men was stopped when 18% of their partners had HIV, compared to only 12% of the HIV+ controls’ partners. They blamed the victims for resuming sex too early, but it almost looks at though circumcision itself could increase the risk to women. (It would have been no less ethical to continue, since they’d established that circumcising the controls wouldn’t help.)

    Circumcision has been a “cure” looking for a disease for a long time.Report

  13. Avatar Jim says:

    “London was the capital of the world, Jim.”

    That is so true. I guess that’s why that woman never went to Beijing to render the appropriate obeisance to the Son of Heaven. Makes sense now.Report

  14. Avatar Joe says:

    In a newly published summary statement, The Royal Australasian College of Physicians unequivocally stated that routine infant circumcision is not necessary. Read more here. Full literature review will soon follow.Report

  15. Avatar Quiddity says:

    I agree with everything that Freddie posted. Especially this line: “In a very well-intentioned but ultimately harmful way, those pushing for AIDS awareness in the early and mid-90s ended up developing many myths about HIV and AIDS, particularly the size of the disease here in America (HIV is most certainly not a pandemic in the Western world) and of who catches the disease.”

    I’ve been PO-ed about the “everybody’s at risk for AIDS” meme that was hyped in the 1990’s. Remember that 1992 piece of garbage movie, “Something to Live for: The Alison Gertz Story” where the protagonists gets AIDS from a one-night affair with a bartender? Moralistic prudes loved it. So did the media. Aieee! Fear sells. Remember, this was in 1992, ten years after the basics of transmission were understood.

    In the back-and-forth on this topic, Hanna Rosin has demonstrated her innumeracy as well as a cavalier attitude towards irreversible surgery on minors.Report