It shows a lot - mainly, that "answers" is a blithering idiot...

And Africa has more HIV per capita than Iceland. Must be the temperature,
right? Or maybe permafrost is a big factor.
Moron.

Here is something that goes counter to what the skin freaks allege:

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HIV: the US/Europe argument

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If one follows circumcision related issues one would be aware of the
desperate denial among foreskin enthusiasts of the connection between
the lack of circumcision and a higher risk of HIV infection among the
uncircumcised and their wives/partners.

This denial continues despite the overwhelming and mounting evidence of
this connection.

This provides an excellent example of the disingenuous arguments used by
this fanatical single issue group and as such it would indeed be
dangerous to accept anything stated by these people at face value.

One of these arguments is to present the higher total rate of HIV
infection in the US (as opposed to Europe) as an indication that
circumcision may in fact promote HIV infection rather than provide a
protective effect against infection.

This is of course a nonsense and a deceit (but is unfortunately
indicative of disingenuous arguments these desperate people seem to be
reduced to).

Lets work through this aspect then … starting with a few statistics.

I refer you to the UNAIDS Global Report (1998)

Mode of transmission in the US (total to date):

Heterosexual ................. 13%

Homosexual ................... 52%

IDU (Intravenous Drug Use) ... 33%

Blood ........................ 2%

MTCT (mother to child)- (insigificant)

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The most recent figures for 1999 (CDC Sept 2000)

**Males 70% (females 30%)

Heterosexual ................. 15%

Homosexual ................... 60%

IDU ........................……. 25%

------------

Ok that put on the table we need to look at the % of infections that
occur through the penis.

All heterosexual infections and a % of homosexual (MSM) infections
involve the penis. With respect to MSM infections the insertive partner
is at 0.27 the risk of the receptive partner (Vittinghoff 1999) … the
circumcision status of the RECEPTIVE partner plays no part in his
infection (that is obvious).

So that gives us a total rate of infection through the penis in the US
of 30% of the total infections in the US (comprising all hetero and one
quarter of MSM infections).

So we are beginning to understand how wrong (and disingenuous) it is for
foreskin enthusiasts to make a "connection" between the overall
circumcision rate in the US and the incidence of HIV infection relating
to circumcision.

Certainly in order to establish an association with circumcision we must
surely use statistics relating to infections where the penis plays a part?

In the US that is 30% of the total infections.

So now we look at who comprises this 30%: (CDC figures again)

…………………....Men……….…….Women

White ………… 30% ……………… 18% ………... (82.3% of US population)

Hispanic ……20% ………………. 18% ……….. (11.5% of US population)

Black ………… 50% ………………. 64% ……….. (12.8% of US population)

(census detail: http://www.infoplease.com/ipa/A0762156.html)

So as we can see the rate of infection among ethnic groups with the
lowest rates of circumcision is disproportionately high as compared to
their % within the total US population.

Now lets take a look at the heterosexual factor in all this.

In the US the stats are as follows:

75% of female infections are heterosexual … women comprise 30% of total
infections.

15% of male infections are heterosexual … men comprise 70% of total
infections.

That gives the US an overall heterosexual rate of 34% (being 75/30 and
15/70)

Now we go to Europe.

In 1999 heterosexual infections in the UK surpassed homosexual
transmissions for the first time.
(http://www.aegis.com/news/bbc/2000/bb000110.html)

So now we compare 50+% heterosexual transmissions in the UK against 34%
for the US.

Why the difference?

Simple …. The answer lies in the efficiency of transmission from male to
female and from female to male.

It is beyond doubt that male to female transmission is more efficient
than female to male transmission … but there are differences in the rate.

In Italy (traditionally non-circumcising) it was found:

"we found that the efficiency of male-to-female transmission was 2.3
times greater than that of female-to-male transmission"

(Nicolesi, A; Corrêa Leite, ML; Musicco, M; Arici, C; Gavazzeni, G;
Lazzarin, A. The efficiency of male-to-female and female-to-male sexual
transmission of the human immunodeficiency virus)

In Northern California (where the % circumcised among adult men is high)
it was found:

"Male-to-female transmission was approximately eight-times more
efficient than female-to-male transmission"

(Am J Epidemiol. 1997 Aug 15;146(4):350-7. Unique Identifier : AIDSLINE
MED/97416464 Padian NS; Shiboski SC; Glass SO; Vittinghoff E; Department
of Obstetrics, Gynecology and Reproductive Sciences,; University of
California, San Francisco, USA. )

So what is it about (largely uncircumcised) Italian men that that gives
them a three to four times higher risk of female to male HIV infection?

Again quite simple … it is the foreskin.

It has been established that the Langerhans cells found in the foreskin
are the major epidermal cell type that is involved in transmission of
HIV infection to human lymphoid tissue. These mucosal target cells are
found under the foreskin.

(the latest in a number of studies to identify the role of the
Langerhans cells in HIV infection can be found at:

http://www.aegis.com/aidsline/2000/sep/a0091038.html

More evidence the role of Langerhans cells can be found at www.aegis.com
after a search under "langerhans cells".

That should suffice as a simple rebuttal of the disingenuous claims made
by foreskin enthusiasts in this regard … for those who wish to obtain a
greater understanding of the HIV/foreskin connection www.aegis.com has
an excellent database where searches under "circumcision", "foreskin"
and "langerhans cells" will be enlightening.

For those who wish to appreciate the global effect of the circumcision
factor the following article is worth a read:

Viewpoint: Male Circumcision and HIV Infection: 10 Years and Counting,
Daniel T Halperin, Robert C Bailey. The Lancet

http://hivinsite.ucsf.edu/InSite.jsp?doc=2098.4613