Wednesday, June 20, 2007

Male Circumcision Overstated as Prevention Tool Against AIDS

People have noticed that some circumcising countries have lower AIDS rates than non circumcising countries in Africa. However comparing USA (a circumcising country) to Europe, Japan, Australia (non circumcising regions) you get an opposite result.

Finally someone has made some sense of all this here.

It's a classic causation vs correlation confusion. Circumcision advocates were touting it as a great way to prevent the spread of HIV, seeing the correlation. However, in this study, they find that the biggest driver of HIV spread is really the infection rates of prostitutes, and the percentage of the population prostituting and patronizing prostitutes. The causation of the circumcision correlation is revealed to be that circumcising countries are generally more religious, so less women prostitute and less men patronize them, per capita.

So treating, educating, protecting prostitutes will net a far greater gain in HIV control than mass circumcision.

1 comment:

Hugh7 said...

This study has been rather overtaken by the three Random Controlled Trials, but
* they have problems of their own, most notably they were not double blinded, and everybody involved very much wanted circumcision to be effective. They were of course also very carefully controlled, and they only managed to halve the rate of HIV transmission in 21 months. Relying on that much protection is very like playing Russian roulette with one bullet in the chamber instead of two.
* this study has a rather simplistic view of what "prostitution" entails in Africa. A very common arrangement falls in a very fuzzy region: a woman is in a relationship with a man who supports her, but she may not be his only one (or he hers), and the relationship may not last for long. (It may be that safe-sex information aimed at prostitutes and their clients misses these people.) We always hear that the Luo of Kenya are not circumcised and have a lot of HIV. What we aren't told is that the Luo largely live in this region, work as fishermen, and have a "girlfriend" in every lakeside village, who may have a "boyfriend" on every boat.