Science journalists and circumcision

Professor Andrew Grulich of Australia's National Centre in HIV Epidemiology and Clinic Research (NCHECR) confirmed that at least with the ‘cut’ HIV infection can be down by 50/60 percent among men.

Are science journalists practicing what the science suggests? I started my investigations.

"I am Jewish so it was done at birth," said Kenny Goldberg from the National Public Radio affiliate KPBS-FM in San Diego, USA.

Abdul Basti Ashaba from The Emirates Evening Post in the United Arab Emirates (and seen here in the photo) said he was glad that, as a Muslim, he was circumcised: "it makes me feel safe when having sex even without a condom."

Basti's inaccurate comment appears to confirm a worrying trend mentioned by Dr Andrew Grulich of Australia's National Centre in HIV Epidemiology and Clinical Research (NCHECR) in a session at the journalist to journalist training run by the US National Press Foundation.

Grulich said doctors in one well-run Kenyan circumcision study detected a slight but statistically significant increase in HIV infections among circumcised men at the end of the study, when they seemed to have become overly confident that circumcision would protect them completely from HIV and did away with using condoms, despite the warnings of the study organisers. Despite the slight increase in the number of circumcised men who became infected with HIV, it should be noted that overall, far fewer of the circumcised men became infected, in comparison with the control group of uncircumcised men.

Safe sex is still important, circumcised or not, as another reporter pointed out. "I would not get circumcised if I had not already, just have safe sex," said Naimal Haq, a senior reporter with Bangladesh News 24 Hours website.

Hilary Bainemigisha is from The New Vision newspaper in Uganda, a country whose HIV prevalence was once controlled but is now going up. Bainemigisha said he had the cut after the research was published showing that it was circumcision, and not cultural practices, that was responsible for the lower HIV rate in Muslim African countries.

But was it for purely health reasons?

"Sometime last year I took the cut after reading about these study results but afterwards I failed to recognize it as my own,'' said Hilary. "My partners were singing louder praises for those that had it and I decided to take it,” he said.

“At this time of my age I can not do it because if I have not been infected by now I probably never will,” said 39-year-old Wandera Ojanji, science reporter with the Standard Group from Kenya.

And yet, Wandera's belief is not borne out by the facts. A presentation by Professor John Ziegler of Sydney Children's Hospital, using data from Botswana, showed quite clearly that people in Wandera's age range were dying of AIDS. And in the USA and other affluent countries, older citizens - some in retirement - are contracting AIDS because they somehow think that their age will render them immune.

The 40 percent of my informal study of 15 journalists who were not circumcised were willing to have it done. But they have not done so, for varying reasons.

Khin Zaw Win, a freelance consultant from Myanmar said he is not circumcised but would get circumcised for health reasons. "Two of my younger brothers were circumcised and that is OK."

Edner Boucicaut, with the Centre for Communications on AIDS in Haiti, said, "No I have not been circumcised but I would consider it because it is a good measure to reduce the incidence of HIV. But it is not OK to have the cut in some communities. I can imagine that people look at those who have it and laugh."

"I am not and I would not because most people in China are not circumcised. It is very private and people who do it do not talk about it. HIV is not caused by sex but infected blood," claimed Yu Chun, a journalist from Science and Technology Daily in China. Again, this is scientifically inaccurate: HIV is spread by sexual contact, and the virus is present in the bloodstream (and the lymph nodes, and in fact pretty much everywhere in the body.) Although it is true that infected blood donors and the reuse of equipment in blood donations has been responsible for a surge in HIV cases in China. So maybe it was a case of misunderstanding my question.

Robert Mukondiwa of The Sunday Mail in Zimbabwe tried to insist that physical confirmation was required. His word was not enough. "I did it and I do not regret it. It was for surgical reasons but I do not feel different because in Zimbabwe we do not have cultural or religious attachments. Anybody can do it,” said Mukondiwa.

"No I am not circumcised and I would not do it because it is not in our tradition," said Meelis Suld from Radio Estonia. "The research was not convincing enough. Some more information is needed if I have to do it," said Ansbert Ngurumo from Tanzania.

But at 50% protection, there is nothing better than circumcision right now for men.

OK, condoms work brilliantly. But people don't use them. (For example, Ansbert has two children, so presumably he didn't use condoms at least twice in his life. And look at all those men, circumcised or not, who were told to use condoms and didn't in the Kenyan study.)

With circumcision, a man doesn't have to remember!

- Esther Nakkazi. Additional reporting by Christina Scott

Lose that foreskin

African health departments should scale up male circumcision, according to this report by Esther Nakkazi, the Uganda-based science correspondent of the East African newspaper.
Andrew Grulich, the head of HIV epidemiology and prevention program at Australia's National Centre in HIV Epidemiology and Clinical Research (NCHECR) yesterday told the National Press Foundation training programme in Sydney that there was no reason to delay a circumcision roll-out in the developing world.
Studies in Kenya, Uganda and South Africa have proved that condoms can halve men's chances of contracting HIV infection. The World Health Organization (WHO) has already said that circumcision should be done under hygienic conditions and warned against adult males who undergo circumcision and then resume sex before complete healing of the wound six weeks later, as they may face an increased risk of HIV infection.
But whether governments have the resources to implement the WHO guidelines is another issue. It is not known how much cash-strapped African governments would spend on mass male circumcision if the WHO pro-circumcision policy is passed, although it would certainly be cheaper to do it on newborns.
However, Ugandan ministry of health officials have already recommended mass male circumcision. The letter C has already been added to the famous ABC - abstinence, be faithful and condomise. Now it's ABCC, in spite of Ugandan president Yoweri Museveni’s public skepticism about the strategy. Without giving it political support no one knows what will happen but the health workers are bent on convincing him.
As a result of study results, it would appear that more Ugandan men are heading to hospitals for the ‘cut’. Many hospitals are not prepared for the demand, with the exception of hospitals affiliated to religions, in particularly the ones for Muslims like Kibuli hospital in the national capital, Kampala.
Hillary Bainemigisha, the health editor of the leading daily English-language newspaper in Uganda said the practice was not widespread but that there were four groups of people currently practicing circumcision.”
“People from the east of Uganda, the Bagisu, practice circumcision but it is not safe, with the same knife being used,” he pointed out. ''In the Muslim population, Imams are licenced by the Supreme Muslim Council, a religious body, to carry out circumcision and there is no medical training.”
The New Vision editor said two smaller groups were those who volunteered for circumcision, generally as adults, and those who required it for medical reasons.
The point to remember is that circumcision is NOT instead of condoms. The mantra is circumcision AND condoms.
“It would be a complete disaster if men stopped using condoms after being circumcised. It would be a public health disaster everywhere,” said Grulich.

* Esther Nakkazi is the East Africa newspaper, a weekly business newspaper for Kenya, Rwanda, Uganda and Tanzania. She is also a member of the World Federation of Science Journalists' mentoring programme and later this year takes up a Knight fellowship at the Massachusetts Institute of Technology in the USA.