Circumcision does not prevent HIV transmission among gay men of color, says new US study

You might remember my reaction a few months ago when I first heard of plans by the New York City Department of Health to promote circumcision among the city's gay and bisexual Latino and African-American men as a means of HIV prevention.

This, based on a studies in Africa showing that "circumcision was shown to lower a man’s risk of contracting the virus from heterosexual sex by about 60 percent" according to an article in The New York Times which first broke news of the City's alleged plans.

“This is not something that has a lot of buzz,” said the City's Health Commissioner Thomas R. Frieden in discussing the study then but, as the Times noted, "he added that even 1,000 circumcisions in the right subgroups might slow the spread of AIDS."

At the time, back in April, I balked at the way the Department of Health seemed ready to promote public HIV prevention policies aimed at gay men of color in New York based on studies of heterosexual males in Africa.

As you might also remember Dr. Frieden later released a letter staring that the New York Times had misrepresented his words and that the Department of Health had no such plans in the pipeline and then appeared at a public forum where he said it was just a "discussion" on whether it made sense to explore such a policy.

Now comes word of a study published in the December 15 issue of the Journal of Acquired Immune Deficiency Syndromes that seems to indicate that the Department of Health was wrong in trying to extrapolate results from the African study to argue that it might make sense to circumcise gay men of color in New York.

The full text of the study is only available to subscribers but the abstract posted online ("Circumcision Status and HIV Infection Among Black and Latino Men Who Have Sex With Men in 3 US Cities") says that the study engaged 1,154 black men who have sex with men and 1,091 Latino men who have sex with men in New York, Philadelphia and Los Angeles found that:

Circumcision status was not associated with prevalent HIV infection among Latino MSM, black MSM, black bisexual men, or black or Latino men who reported being HIV-negative based on their last HIV test. Further, circumcision was not associated with a reduced likelihood of HIV infection among men who had engaged in unprotected insertive and not unprotected receptive anal sex

In short, "there was no evidence that being circumcised was protective against HIV infection among black MSM or Latino MSM."

Turns out that Brazil got it right from the start.

In any case, some good news on the eve of World AIDS Day for uncut gay and bisexual men of color in New York: You may keep your hoodies! Merry Christmas and Happy New Year!

[h/t: LifeLube]

Updates: Chad Ferreira, circumcision, Alvaro Orozco, Colombian 'asylum tragedy'

Chad Ferreira: The Bay Area Reporter continues it's coverage of the altercation in San Francisco's Castro district that led to the death of Chad Ferreira (pictured) in January of 2006.

Last week reporter Ed Walsh described opening statements made at a trial that will determine whether 26 year old Kyle Adams committed manslaughter by beating Ferreira so hard that he caused Ferreira to fall and fracture his skull when his head hit a sidewalk curb or if he is, as he claims, innocent and just acting in self defense.

Today, the Reporter describes Adams turn on the stand and his side of the story, some of which differs with witness statements and includes details were not originally provided to the police department when he was first charged.

The paper says that closing arguments after the print edition of the Reporter went to press and that the case went to the jury at 3:10pm yesterday.

Circumcision as HIV prevention: The New York City department of Health and Mental Hygiene held it's community forum on the issue of male circumcision as a possible HIV prevention tool. I was not able to attend but both Gay City News and the New York Blade covered the arguments and the reaction.

Alvaro Orozco: In February we told you about a decision by Canada's Immigration and Refugee Board not to grant asylum to a young Nicaraguan gay man, Alvaro Orozco, partly because they argued that if Orozco wasn't sexually active when he left Nicaragua at the age of thirteen, he could not assert that he knew he was gay then. The Orozco case and his ongoing efforts to appeal that decision receives a coverline in the current issue of The Advocate. For more on the case and on how you can help, please visit his website.

In United States political asylum news, Arthur Leonard calls an April 25th ruling that turned down an asylum application by a Miami-based Colombian gay man "Another asylum tragedy." Leonard says that the court not only denied asylum but also outed him in the process and now is sending the man back to Colombia despite having arguably shown credible evidence of fear of persecution if sent back.

Meetings, we've got meetings...

Not sure I can make it to any of tonight's two meetings or even next week's meetings but...

Calling it the Queer Justice League (asterisk*) might be inappropriate because some people have reservations about the (*) name and it was supposed to be an interim name (*) anyway, but there's a bunch of people meeting at 7pm tonight at the LGBT Center on 13th Street. It's the 2nd meeting since a speech by Larry Kramer riled up the masses. I can't promise that the issue of whether to use Robert's Rules of Order will be resolved by meeting's end. Do try to take a chill pill beforehand so you can be in the right mood to deal with different levels of oppression and the tension level that a few hundred e-mail messages have ratcheted up. Maybe, just maybe, something will come out of it. If there seems to be consensus on one thing it's that they want some freakin' direct action, NOW! So at the very least maybe you too can throw your pet cause into the ring and see if it sticks. It's been billed as a "working meeting" to address some remaining process issues with a "full meeting" to follow at 8pm on April 26th, also at the Center. For updates click here [NOTE: Gay City News has more on what went on druring the first meeting here].

Not to be confused with the (non-asterisk *) ACT-UP meetings that still take place every Monday at 8pm also at the Center.

Tonight, though, ACT-UPers and ACT-UP allies can also head over to the City University of New York for "CLAGS LGBTQ Studies Panel: Discussions Around the History of ACTUP." That also takes place at 7pm tonight (not sure if some asterisks * will make it should the meeting at the Center end up early). What is the CLAGS meeting about?

"To mark the 20th anniversary of ACT UP, this round table discussion features Sarah Schulman and Jim Hubbard, co-coordinators of the ACT UP Oral History Project and co-founders of the MIX New York Lesbian and Gay Experimental Film Festival, and invited guests. The conversation will focus on the early history of AIDS activism in New York City, the birth and history of ACT UP, and the needs in/for AIDS activism today."

It's free and open to the public and will take place at the Skylight Room (#9100) of the Graduate Center at CUNY, 365 Fifth Avenue (at 34th Street) in Manhattan. Need more info? Call 212 817-1955 or click here.

Speaking of April 26th, you might want to make it to the Center a couple of hours earlier before the 3rd Queer Justice League (asterisk *) meeting: The New York City Department of Health and Mental Hygiene's Bureau of HIV/AIDS Prevention and Control and the Bureau of Sexually Transmitted Diseases (whew! THEY should have an asterisk!) is presenting "A Community Discussion on Male Circumcision and HIV Prevention."

If it turns out to be half as interesting as the one a few of us held with them a few days ago in the wake of this, it should be a hoot.

NYC Health Commissioner: The Times "misrepresented" comments on circumcision

[NOTE: This statement was sent out to community activists in .pdf form earlier today. I have not been able to find a direct link to the statement at the Health Department's site but the LifeLube blog also received the document and has uploaded and made it available for download here]

THE CITY OF NEW YORK DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Michael R. Bloomberg, Mayor
Thomas R. Frieden, M.D., M.P.H., Commissioner

nyc.gov/health

April 9, 2007

Dear Community Member:

Recent media reports misrepresent the Health Department’s response to recent studies showing that circumcision significantly reduces HIV transmission in some contexts. We do not yet know what impact circumcision could have on HIV transmission in New York City, and we have not suggested or planned any initiative or campaign. Quite to the contrary, I indicated in an interview with the New York Times (the source of the misrepresentation) that I very much doubted that even 1% of men at high risk in NYC would undergo the procedure.

As a result of rigorous studies, we now know that circumcision reduces risk of female-to-male spread of HIV by about 60%. There is some evidence, but no proof, that circumcision may reduce male-to-female transmission. There is also some evidence, but again no proof, that it may protect men who engage in insertive anal sex from male-to-male transmission.

Our goals are the following:

• Inform the community of the facts regarding what is known and what is not known about circumcision’s effects on HIV transmission;
• Promote discussion among community groups and health care providers to explore how circumcision may be relevant in New York City;
• Increase access to circumcision for men who want the procedure.

The need for new effective prevention methods is urgent. But even if circumcision is as effective in preventing male-to-male transmission as it is in preventing female-to-male transmission, it does not by any means eliminate the risk of becoming infected with, or spreading, HIV. Any new approach, including circumcision, needs to be seen as an addition to our existing portfolio of proven HIV prevention strategies, including reduction of unsafe sexual encounters and consistent condom use.

There will be a community forum in the next few weeks to discuss these issues and we hope you can attend.

Sincerely,
Thomas R. Frieden, M.D., M.P.H.
Commissioner

Brazil: Circumcision not an HIV prevention tool for gay men

If it wasn't for Vivir Latino on my blog roll, I might have missed this tidbit from Spain's 20 Minutos.

Turns out that even before NYC health commissioner Thomas Frieden spoke to The New York Times on plans to promote circumcision as an HIV prevention method for men "at high risk" of HIV transmission in the city, the head of another health department a few thousand miles away had pretty much rejected that same idea based on the same studies that Frieden used to support his push.

On March 28th, the World Health Organization and UNAIDS released a joint statement recommending that "male circumcision should be part of a comprehensive HIV prevention package."

In the statement Dr. Kevin De Cock (love the name), Director of the HIV/AIDS Department at WHO, said:

The recommendations represent a significant step forward in HIV prevention. Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment.

In addition the statement warns that before implementing the plan among other populations further research was needed:

In countries where the HIV epidemic is concentrated in specific population groups such as sex workers, injecting drug users or men who have sex with men, there would be limited public health impact from promoting male circumcision in the general population.

Not heeding those caveats, the Times says that Frieden told them that "it is logical to assume that circumcision would offer protection in some types of gay sex."

Enter Brazil: Known for their groundbreaking HIV prevention programs, particularly in gay populations, Mariángela Simao - the technical advisor of the Brazilian health ministry - told news agency EFE that the studies did not provide any data that circumcision reduced the risk of HIV transmission among gay men.

She also pointed out that the recommendations only were applicable in countries where HIV incidence reached more than 15% of the population which would leave out every Latin American country.

Simao expressed concern that circumcised men might get the message that it is OK for them to have unprotected sex without any risks of HIV transmission and said that she feared that, based on the recommendations, developed countries would now devote current international HIV treatment funding towards circumcision surgery procedures instead of proven methods.

In other words, Brazil has officially rejected circumcision as an HIV prevention method amongst gay men - until specific studies are done - and says that they would rather concentrate their prevention funding on promoting condom use and the free availability of HIV treatments for those that test positive.

Updates: In his statement to the New York Times Commissioner Frieden said that he had consulted gay rights and helth service organizations before speaking to the Times but in the April 6 edition of The New York Post, Tokes Osubu, Executive Director of Gay Men of African Descent says "For anyone to think there is going to be a long line of men in their 20's lining up to have part of their anatomy chopped off, it's ludicrous" and Michael Robinson of People of Color in Crisis says "I can't imagine us going around encouraging adult men to have adult circumcision. It's just too painful."

If these are the reactions of two top gay African-American leaders in the city I wonder which gay advocacy and health service organizations the Commissioner did reach before speaking to media. An April 7 New York Post editorial criticized Dr. Frieden for the proposal (but it should be said that the Post has previously assailed Frieden for some of the City's sound health policy projects including the indoor public space smoking ban and a proposal to ban trans-fats from being used in restaurants throughout the city).

On April 6, the New York Times printed a follow up article in which Mayor Michael Blooberg seemed to distance himself a bit from Frieden's statements.

The Agenda blog also points out that the New York City Department of Health and Mental Hygiene posted a brief response to some of the criticism that sprung over at the New York Times political blog, The Empire Zone (read comments here).

In the brief statement Geoffrey Cowley, a spokesman for the Department of Health, denies that agency is ready to launch a campaign to promote circumcision as an HIV prevention tool in New York City but says that, considering the results of the research in Africa, the possibility is worth exploring.

The Department of Health has also said that they will be organizing community town-hall meetings on the issue to get some feed-back.

Uncut men of New York: Your foreskin is in danger!

Let's say that earlier yesterday I had an interesting con- versation with someone that read somewhere that few people in Colombia, my home country, were circumcised. This in light of a report earlier this week from the World Health Organization and UNAIDS recommending that "countries with rampant AIDS epidemics should begin offering free or subsidized circumcisions in hopes of preventing millions of new infections and deaths" (according to the Washington Post).

The person, who shall remain anonymous, expressed interest in "discussing" whether it made sense to formulate campaigns in Colombia to make people aware of the HIV transmission risks for uncut men and encourage them to get circumcised or, pushing it a bit, whether there should be campaigns to get Colombian immigrants in the United States on the same path to circumcision.

Let's just say that I thought this person was kidding.

"But the research shows...!" the person said, and I knew it wasn't a joke.

Let's clear up some things: No, I am not circumcised. No, I don't have anything against people who are. No, I don't get why some fret so much about not having foreskin. And no, I don't get people who seek foreskin reconstruction either. In plain terms, dick is dick! Enjoy what you have and don't fret so much!

But it turns out that the person who made the comments is also indirectly related to the New York City Department of Health which now makes me wonder if he knew more than he was letting on: Today the New York Times reveals that "New York City Plans to Promote Circumcision."

Hm. All of a sudden it does not seem as random a conversation. Still, I am aghast that the NYC DOH would seek to promote invasive surgical interventions for adult males as an HIV/AIDS prevention strategy.

Yesterday I tried to argue that there were other variables such as country-specific hygiene practices and HIV prevention strategies that had to be taken into account. Colombia might have a high number of uncircumsized men but it lags behind some African and Asian countries in terms of HIV incidence.

But when it comes to public policy and HIV prevention sometimes a bad idea just captures the imagination and becomes, for lack of a better word, "fashionable" to fund. As with other bad ideas, this one will probably take a couple of years to run its course before a new hot topic arrives.

In the meantime, where are those other prevention dollars? No need to get rid of foreskins. Just fund programs that make men at risk - and particularly gay or bi men (whether uncircumcised or not) - feel that they are worth something which is at the core of a person's ability to protect themselves from HIV/AIDS.

UPDATE: Joe.My.God readers have left a few choice comments as well here.