Male Circumcision Overstated As Prevention
Tool Against AIDS
New study finds the key to understanding the global spread of
AIDS is the size of the infected prostitute community around the
world.
In new academic research published today in the online, open-access,
peer-reviewed scientific journal PLoS ONE, male circumcision is
found to be much less important as a deterrent to the global AIDS
pandemic
than previously thought.
The author, John R. Talbott, has conducted statistical empirical
research across 77 countries of the world and has uncovered some
surprising results.
The new study finds that the number of infected prostitutes in
a country is the key to explaining the degree to which AIDS has
infected the general population. Prostitute communities are typically
very highly infected with the virus themselves, and because of
the large number of sex partners they have each year, can act
as an engine driving infection rates to unusually high levels
in the general population.
The new study is entitled "Size Matters: The Number of Prostitutes
and the Global HIV/AIDS Pandemic" and is freely available
online at the PLoS ONE publication website at www.plosone.org/doi/pone.0000543.
The study has a number of important findings that should impact
policy decisions in the future. First, male circumcision, which
in previous studies had been found to be important in controlling
AIDS, becomes statistically irrelevant once the study controls
for the number of prostitutes in a country.
The study finds that the more Muslim countries of North Africa
do indeed suffer much less AIDS than southern and western Africa,
but this lower prevalence is not due to higher numbers of circumscribed
males in these Muslim communities, but rather results from the
fact that there are significantly fewer prostitutes in northern
Africa on a per capita basis.
It appears that religious families in the north, specifically
concerned fathers and brothers, do a much better job protecting
their daughters from predatory males than do those in the south.
A history of polygamy in these Muslim communities does not appear
to contribute to higher AIDS prevalence as previously speculated.
In a frequently cited academic paper, Daniel Halperin, an H.I.V.
specialist at the Harvard Center for Population and Development
and one of the world's leading advocates for male circumcision,
weighted results from individual countries by their population.
When this artificial weighting was removed Talbott found that
circumcision was no longer statistically significant in explaining
the variance in AIDS infection rates across the countries of the
World.
Second, to date, there has not been an adequate explanation as
to why Africa as a continent is experiencing an AIDS epidemic
far in excess of any other region of the world with some African
countries'
prevalence rates exceeding 25% of the adult population and tens
of millions dying from the disease on the continent.
Talbott's new study suggests that the reason is that Africa as
a whole has four times as many prostitutes as the rest of the
word and they are more than four times as infected. Some southern
Africa countries have as many as 7% of their adult females infected
and working as prostitutes while in the developed world typically
this percentage of infected prostitutes is less than .1%.
If these 7% of infected prostitutes in Africa sleep with five
men in a week that means they are subjecting 35% of the country's
male population to the virus weekly. The virus is not easy to
transmit heterosexually, but over time with multiple exposures,
infection is inevitable. These men then act as a conduit to bring
the virus home to their villages, their other casual sex partners
and to their wives.
The study has important policy implications. Several international
AIDS organizations have begun to provide funding for male circumcisions
as a deterrent to AIDS.
While male circumcision may indeed reduce the risk of transmission
by some 50% to 60% in each sexual encounter, reducing single encounter
transmission rates alone cannot control the epidemic.
The reason is that individuals in highly infected countries have
multiple contacts with the infected so reducing transmission rates
only defers the inevitable.
The real question is what can be done with the prostitute community.
Outlawing the world's oldest profession would most likely prove
to be ineffective. If the profession can be legalized and treatment
and care provided to the practitioners, there would be much more
reason
to be hopeful. But, and this is the key, programs of action can
not just be voluntary. Too many innocent people are dying and
there is too much disregard for human life among infected prostitutes
to leave
treatment decisions solely up to them. A program of testing and
treatment for prostitutes must be mandatory and those that refuse
treatment must be held liable.
Many international aid organizations are against such mandatory
treatment programs for prostitutes as they find them to be discriminatory,
violate the individual's human rights and are
perceived as an attack on female prostitutes who are viewed as
victims of gender and income inequality.
Such organizations do not properly weigh the loss of human rights
and life itself that this virus, unleashed on a community, is
causing.
This virus, itself, is a violation of human rights and we must
do everything in our power to stop it. To argue we should do nothing
about infected prostitutes during an AIDS epidemic because of
a fear of creating a stigma against the infected would be like
an animal rights activist claiming that a rabid dog must be allowed
to run free in a neighborhood regardless of how many men women
and children he infected and killed.
It is not surprising that computer models rarely show the virus
reaching epidemic proportions; it is very hard to transmit this
illness heterosexually. Only when model building researchers introduce
a highly sexually active infected subset of "prostitutes"
to their mathematical models does the infection spread exponentially
to the general population.
John R. Talbott is an author and a former investment banker for
Goldman Sachs. Previously he was a Visiting Scholar at UCLA's
Anderson School of Management in Los Angeles. He lives in New
York City and writes about finance, economics, politics, AIDS
and society. He has published important empirical academic research
concerning the significant role democratic and capitalist institutions
play in promoting economic growth and prosperity in both the advanced
and developing world. John has advised a number of developing
countries
including Jordan and Russia on how they might improve their economic
and political institutions to garner greater economic growth and
defeat poverty. John's latest book accurately predicted the current
downturn in the U.S. housing market.
Citation: Talbott JR (2007) Size Matters: The Number of Prostitutes
and the Global HIV/AIDS Pandemic. PLoS ONE 2(6): e543. http://www.plosone.org/doi/pone.0000543
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Source:
http://www.medicalnewstoday.com/medicalnews.php?newsid=74521
_______________________________
Jagdish Harsh
jharsh@hivatlas.org
www.hivatlas.org
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