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HIV/AIDS topics

First of all, beautefully done, Jakew. To me, what you just did is magic! I added a See Also section. I hope this time there are no issues with it? Anyway, there is a HIV/AIDS topics template(I think?) with many links to HIV/AIDS related articles. I think this article belongs with them but am not sure, and have no clue how to make it happen in any case. --Nakerlund (talk) 17:38, 23 March 2009 (UTC)

Thank you, Nakerlund. The template is {{AIDS}}. It would be straightforward to include it, but I'm not sure whether this article should be included in the template. I've requested input from other editors at Talk:HIV#Input requested. Jakew (talk) 18:48, 23 March 2009 (UTC)

FGC/Stallings

This edit, which introduces a conference presentation by Stallings, is problematic, for several reasons.

First, every source in this article discusses the relationship between penile circumcision (that is, the removal of the penile foreskin) and HIV. Stallings' paper, in contrast, is about female genital cutting. Thus, there is no logical reason for including this material here.

Second, the edit appears to be very poorly thought out. For example, the material was placed in the section entitled "Langerhans cells and HIV transmission", in spite of the material having no obvious connection with that subject.

Third, the edit is misleading. For example, it begins "Stallings (2005) cited 3 prior studies which showed a correlation between female circumcision and a lower risk of HIV...". The words "showed a correlation" imply that a statistically significant correlation was observed. Slide 11 of Stallings' presentation, however, shows the opposite to be true: the 95% confidence intervals for the odds ratios for all three studies include 1.0, so in fact it would be more accurate to say "...showing no correlation...". (To be precise, one shows a non-significant association between FGC and lower risk of HIV, the other two show a non-significant association between FGC and higher risk.) Further, the conclusions are quoted somewhat selectively. For example, the following conclusion (from slide 38) seems rather important: "As no biological mechanism seems plausible, we conclude that it is due to irreducible confounding."

For these reasons, I'm reverting the change. Jakew (talk) 15:57, 17 June 2009 (UTC)

The title is "Circumcision and HIV", rather than "Male Circumcision and HIV", and the Stallings paper mentions both "circumcision" and "HIV" in the title. You might regard male and female circumcision as being fundamentally different, but many people don't, including most of the people who actually practise female circumcision. I know this isn't something we're going to agree on any time soon, but I placed the Stallings study there because the preceding paragraph discusses FC/FGC/FGM: <<Dowsett (2007) questioned why it was just males that were being encouraged to circumcise: "Langerhans cells occur in the clitoris, the labia and in other parts of both male and female genitals, and no one is talking of removing these in the name of HIV prevention.">>

You're right about the 3 prior studies not showing a significant correlation. My mistake. The Stallings paper itself does though, and whilst it doesn't mention Langerhans cells, I think it belongs there. Either that, or maybe there should be a separate section or even a new page for "Female Circumcision and HIV" (or "FGC and HIV" or "FGM and HIV").

I don't think it makes much difference whether the correlation is explained away as a "conundrum" or due to "irreducible confounding".

I have made another change, and I would like this to be moderated by a third party rather than just reverted. I know we have very differing views on circumcision, but I hope we can find something for the Wiki page we can both agree on.

regards, Mark --Ml66uk2 (talk) 16:50, 17 June 2009 (UTC)

Stallings may well mention both "circumcision" and "HIV", but that's a very poor basis for randomly inserting material about a different procedure into the article. This is suppossed to be an encyclopaedia article, not a collection of sources that mention at least two words. The fact that circumcision and FGC are different is really beyond dispute. Some people believe that there are similarities between the two, but I think that nobody would deny that they are performed with different methods, on different anatomy, and with different consequences. Thus, female genital cutting is a far more appropriate place for this material.

Dowsett made a comparison between circumcision and FGC within the context of Langerhans cells. Such a comparison cannot be used as an excuse to include otherwise unrelated material; see WP:SYN.

Thank you for acknowledging your mistake about the 3 studies cited by Stallings, but your apparent solution (deleting all mention of the other studies) is — if anything — worse. Including Stallings findings, we know of a total of four studies of FGC and HIV, and all but one of these found no statistically significant difference. Knowing this, why on earth would we want to cite an anomaly? This is actively misleading to the reader, because it creates the impression that such an association exists, when the majority of the literature that we know of is to the contrary. If FGC and HIV is to be discussed anywhere, then we should cite all known studies to avoid giving undue weight to anomalous results.

Similarly, selective quotation still remains. It paints a misleading picture to quote "A lowered risk of HIV infection among circumcised women was not attributable to confounding with another risk factor in these data." but not "As no biological mechanism seems plausible, we conclude that it is due to irreducible confounding." Jakew (talk) 17:14, 17 June 2009 (UTC)

"The fact that circumcision and FGC are different is really beyond dispute."

You know that's not true. Whether you like it or not, "FGC" is also referred to as "female circumcision", and there is much debate as to how different they really are. I personally feel that there are many similarities, especially with the lesser forms of female circumcision. One form of FC/FGC is removing the female prepuce, so directly analogous to the usual form of male circumcision. Just because you don't see any similarity between FC/FGC and male circumcision, doesn't mean you can pretend it's not an issue. Most of the English-speaking people that cut females also refer to it as "circumcision" and regard it as similar to male circumcision. The terms "FGM" and "FGC" are relatively recent as you know.

The Stallings study is later than and appears to have been a lot more rigorous than the other studies, and in my view carries a lot more weight.

I chose that quote because it is actually in the abstract which was cited. Anyway, why would a biological mechanism be plausible for cutting parts of male genitals off, but not for cutting parts of female genitals off?

I'm disappointed that you and Avraham seem to be excluding discussion of female circumcision (aka FGC/FGM) and HIV from a page on circumcision and HIV, and regard it as a sign of bias. --Ml66uk2 (talk) 19:14, 17 June 2009 (UTC)

Seriously? You come back after ostensibly a 6 month hiatus and jump into a discussion that has been going on for years? Perhaps you can take a look at the 40+ pages of Circumcision archives? -- Avi (talk) 19:44, 17 June 2009 (UTC)

I know this has been going on for years, and it will go on for years. I've also read some, though by no means all of the Wiki talk pages on circumcision. That's why I was surprised to read that "The fact that circumcision and FGC are different is really beyond dispute." I regard them as very similar, but I'd never claim that to be "beyond dispute". I find it very sad that a paper titled "Female circumcision and HIV infection in Tanzania: for better or for worse?" is excluded from a page on circumcision and HIV. What do you think the English-speaking people who practise FGC call it? Do you think they see much of a difference between male circumcision and "FGC"? The people who blog about circumcising their daughters get furious if you call it "mutilation" btw.

What exactly do you mean by "ostensibly"? I haven't been posting on circumcision-related issues from another account if that's what you're suggesting. --Ml66uk2 (talk) 20:47, 17 June 2009 (UTC)

I'm sorry that my comment surprises you. To clarify, nobody seriously argues that the two are one and the same (if that were the case then every true statement about one would be a true statement about the other); what is generally disputed is not whether they are different, but how great are the differences. Some (like yourself) believe the differences to be small. Others believe the differences to be substantial. The terminology used is of little help in this respect, as identical terms are sometimes used to describe wholly different concepts (consider, for example, the use of the term "heavy metal" to describe both a class of chemical element and a type of rock music). Jakew (talk) 09:15, 18 June 2009 (UTC)