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 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 http://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, b ut 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.
More information:
 Contact: John Talbott
johntalbs@hotmail.com
Public Library of Science
www.plos.org
|
