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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)

I don't understand how it can be reasonably claimed that a study on female circumcision and HIV is beyond the scope of an article on circumcision and HIV. The contribution by Ml66uk2 appears relevant and reasonable. Trying to assert that a thing is "beyond dispute" merely contradicts the assertion.

Over on the main HIV page we are treated to a WHO panel recommendation that some people should have pieces of their bodies cut off to benefit some other people, but there is no link to the genital mutilation page, from which it emerges that the WHO condemns similar practices in the case of female circumcision. These two types of mutilation provide context for each other, and for the issue of HIV transmission. Without this context, you don't have NPOV.68.178.59.178 (talk) 17:31, 9 July 2009 (UTC)

Maybe the terminology that some use to describe female genital cutting ("female circumcision") is confusing. For the purpose of this discussion, let's temporarily rename female genital cutting as apples and penile circumcision as bananas. Now, this article is about bananas and HIV. Stallings' presentation was about apples and HIV, so why is it relevant? Jakew (talk) 17:50, 9 July 2009 (UTC)

This article was created as a subarticle of Medical analysis of circumcision, (because that page was getting too long,) which is about male circumcision and which is itself a subarticle of Circumcision, which is also about male circumcision. I've edited the lead to make it clear that this article is about male cirucmcision. ☺Coppertwig (talk) 00:44, 10 July 2009 (UTC)

Uncertainty about efficacy

Given the overwhelming scientific evidence that male circumcision effectively reduced HIV infection, I have to wonder what editors here believe is scientifically proven in medical science? Is antibiotics effective? I am just curious about what standards relate to scientific inquiry here. For example, three RCTs that independently indicate significant efficacy should not be made dubious just because some people bicker about them- Leifern (talk) 19:09, 4 February 2012 (UTC)

1st it's not overwhelming, look at the study in uganda they stopped for "ethical reasons" because it showed circumsized people getting HIV more often than those uncircumsized.

More people get AIDS in Africa just because they're mostly poor there, uneducated, don't get sex education, plenty of prostitutionm around, their govts are too corrupt to pay for proper medical care for the people, etc. Why would skin being on the penis effect that. You have to be an idiot to believe this. 170.3.8.253 (talk)

Need to update

Several important papers have been published recently that are not mentioned. There is a need to update this article. Southdoc (talk) 19:25, 26 March 2012 (UTC)

I agree. This Nature article, dated 30 November 2011, says "For the past three years 13 countries in southern and eastern Africa at the heart of the HIV/AIDS epidemic have been on a mission to circumcise 80 percent of their men by 2015 in an effort to cut in half the rate of sexual transmission of the disease from 2011 levels. And a new series of nine papers, published online Tuesday in PLoS Medicine, assesses whether the ambitious goals could work—and whether they are worth it." It would be good to track down and cite those papers (if they are as relevant as seems likely).

This WHO page (viewed 16 July 2012 claims great certainty about the value of circumcision: "There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%." Unfortunately it doesn't tell you what the evidence is.

They could be referring to a newer Cochrane review Published Online: 7 OCT 2009, which reviews three large scale studies: "Results from three large randomised controlled trials conducted in Africa have shown strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex. At a local level, further research will be needed to assess whether implementing the intervention is feasible, appropriate, and cost-effective in different settings."

I have to confess to being uncertain as to how convinced I should be. I haven't studied this in detail; but I am aware that new treatments (including preventive treatments) often fail to live up to their initial expectations. Issues such as the Hawthorne effect and various forms of bias often make the treatments more valuable than one might hope; and things like Risk compensation effects can reduce the interventions' efficacy. But I also have a prejudice against what I consider mutilation - unnecessary cutting; so I cannot trust my instincts on this one. --peter_english (talk) 14:09, 16 July 2012 (UTC)

The WHO also tells us that cellphones cause cancer, although the statistical facts tell the opposite. If you take the time to read the original studies on circumcision and HIV-infection (especially the RTCs) and you have a proper understanding of scientific methods, you'll find that they're at best inconclusive. Further, the actual infection rates among circumcised men are higher in many African countries than for uncircumcised men. If reality doesn't fit your hypothesis, the latter is wrong --84.130.161.37 (talk) 14:02, 18 July 2012 (UTC)

Keratin Thickness

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0041271 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951978/

These seem to contradict the findings of McCoombe, Cameron, and Short. — Preceding unsigned comment added by Feathergun (talk • contribs) 21:01, 23 July 2012 (UTC)

Things look messy

So I happen to be going through this page, specifically the Observational Studies section, and I'm surprised by how many of the articles are poorly represented. For instance, most of the studies seem to be on high-risk African-based studies, but not all of them specify this in the body. Now I have no history with this topic, but is the "African-based" thing just a given? Should I have been assuming that these studies are mostly done in high risk areas to begin with? I only ask because I was confused while reading through the text and I'm sure others would be as well. I've since followed the citations and looked up many of the articles, so it is a bit more clear. But should this section maybe be subdivided into the different types of studies? Like, an African-based section, one for the General population studies, and one for cross studies? Just my brief look through some of the articles tells me that the results of the studies seem to vary a lot. Cheers! Ibanez Guy (talk) 18:40, 9 June 2013 (UTC)

There is tremendous variation in the southern African studies with some showing that the circumcised got HIIV more than the uncut. Conversely the big study was stopped for exactly the opposite result early on ethical grounds. There seems to be a big push to promote circumcision as a partial solution to HIV epidemics in Africa. Some other studies have shown that risk behaviour increases for the cut as some cut men think they have gained a sort of universal immunity and behave accordingly. There is a danger in extrapolating these results to other populations where HIV rates can be higher amongst circumcised too. It may be that some high risk multiple partner groups also have a cosmetic or aesthetic fondness for the cut and so any protective effect it may achieve may be masked in these cases. I agree with your suggestion of regionalizing results --— ⦿⨦⨀Tumadoireacht /_Stalk 19:40, 9 June 2013 (UTC)

Thanks for your input! I've now gone through all of the studies in that section and looked at the findings in a bit more detail (for those still accessible). While it is difficult to have a complete picture for every study, many of the comments in this article are misleading or very incomplete (especially with regards to geographic regions). Some of the parsing of the paragraphs also suggests connections between studies that aren't really there. Maybe we should start with a basic updating of the information for each study and then go from there. I'll try to sort something out and suggest it here before I change anything. Anyone else have any thoughts on how to make things more clear? Cheers! Ibanez Guy (talk) 21:08, 9 June 2013 (UTC)

I'd agree that this article is long overdue for an overhaul. At this point, only secondary sources should be used to support statements of fact about the scientific consensus regarding the effect of circumcision on HIV transmission. This is an extremely well-studied field and primary sources should not be cited at all. They may be interesting for a historical overview but still need to be used within the context of secondary sources, the history of circumcision and HIV is now very well-documented in secondary sources. To start, as with any other medical intervention, you should make use of resources like PubMed, the TRIP database, and up-to-date texts from medical libraries. The Misplaced Pages guideline governing the sourcing for medical content is WP:MEDRS so all the sourcing updates need to be compliant with that guideline. Zad68 02:15, 10 June 2013 (UTC)

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