Harry’s Place

Hi– if your read this weeks issue of Science– you will see a suggestion that condoms are a waste of money.

Reassessing HIV Prevention
Malcolm Potts,1* Daniel T. Halperin,2*† Douglas Kirby,3 Ann Swidler,4 Elliot Marseille,5 Jeffrey D. Klausner,6 Norman Hearst,7 Richard G. Wamai,2 James G. Kahn,5 Julia Walsh1

Condom use. Condom promotion is effective in epidemics spread mainly through sex work, as in Thailand (7, 10, 11) and also, to some extent, among other high-risk groups such as MSM. Although condom use has also likely contributed to HIV decline in some generalized epidemics, there is no evidence of a primary role (2, 4, 10, 11). This is because consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion, to produce a measurable slowing of new infections in the generalized epidemics of Sub-Saharan Africa. When most transmission occurs within more regular and, typically, concurrent partnerships, consistent condom use is exceedingly difficult to maintain (2, 4, 7, 10).

Further you quote
Peter Piot, director of UNAIDS, stressed that the biggest “drivers” of the epidemic were “especially gender inequality, stigma and discrimination, deprivation and the failure to protect and realise human rights”.

whereas in the article I cite above they state– and forgive me the long quote but I believe it is interesting:

Some assumptions that drive current HIV prevention strategies are unsupported by rigorous evidence. The presumption, for example, that poverty increases vulnerability to HIV infection is challenged by studies such as an analysis of recent Demographic and Health Surveys (DHSs) from Africa, which shows a strong positive correlation between HIV prevalence and wealth in eight countries examined (3, 4). Among Kenyan women, HIV prevalence is 3.9% in the lowest economic quintile and 12% in the highest. A study of serodiscordant couples found that, across 12 African nations, the woman was the HIV-infected partner in 34 to 62% of these couples, which suggests that many infections are not, as is commonly assumed, brought into the relationship by the man (4, 5). African regions suffering from conflict, genocide, and rape, such as Rwanda, Congo, and Angola, are much less affected by AIDS than peaceful, wealthier, and more literate countries such as Botswana or Swaziland, which have the world’s highest HIV prevalence (6).

Where multiple sexual partnerships, especially concurrent ones, are uncommon, and particularly where male circumcision (MC) is common, HIV infection has remained concentrated in high-risk populations (7). Niger, a Muslim country where sexual behavior is relatively constrained and MC is universal, has an adult HIV prevalence of 0.7% (1), despite being the lowest ranking country in the Human Development Index. Botswana, the second wealthiest country in Sub-Saharan Africa, has high levels of multiple concurrent partnerships among both sexes and lack of MC (8), with an HIV prevalence of 25% (1).

So…whilst I agree Sheikh Mohamud Ali statements maybe unhelpful we shouldnt necessarily think that we know the best strategy in all cases. Abstinence may in many circumstances be a futile proposal too — but I wouldnt dismiss its promotion out of hand in all cases.

This is worth a look: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0040256&ct=1

The techniques used by the HIV denial movement are the same as 9/11 “Truthers” and other conspiracy theorists, except, as you say, HIV Denial is more than just playing parlour games with terrorist incidents or the moon landing (though the truthers can get quite nasty).

S, you quote “Although condom use has also likely contributed to HIV decline in some generalized epidemics, there is no evidence of a primary role (2, 4, 10, 11). This is because consistent condom use has not reached a sufficiently high level, even after many years of widespread and often aggressive promotion…”

Could a part of the reason for condom use failing to reach “sufficiently high level” not be because of the aggressive counter-promotion taken by the Catholic & Muslim clerics, and the general aversion to condoms, in part supported by social taboos deriving from conservative religious attitudes?

What the report seems to be saying is that condoms where they are used are very effective, but that the campaign hinging on condom promotion fails because of outside factors preventing the uptake of condoms.

Thus, it is not the condoms themselves which are inefficient (they are in fact very efficient at stopping HIV infection) but the fact that religious and social taboos, laziness, rumours and conspiracy theories block their effectiveness. The article you cite seems to be saying that investing too heavily in condoms promotion has limited effectiveness because of the opposition to condom use - not because condoms are ineffective.

It is a subtle distinction, but one worth making clear.

A similar scenario would be a case where police officers had a ‘macho’ objection to wearing bullet-proof vests. The vests are very effective - but not if the officers refuse to wear them. The options then become (a) more pointless promotion of vest use againts stupid intransigence; (b) training in dodging bullets; or (c) dissuading people from becoming police officers.

The best reason against condon use (and, by that, I mean rolling on the floor with laughter) was that the material contains inter-molecular spaces through which the virons could pass. Well, there are spaces, but even water molecules don’t pass.

Oh, and if there were no spaces, the condom would be of infinite mass and immediately collapse into a singularity. Hence the reason for not putting them on, I suppose.

The best reason against condon use (and, by that, I mean rolling on the floor with laughter) was that the material contains inter-molecular spaces through which the virons could pass. Well, there are spaces, but even water molecules don’t pass.

Oh, and if there were no spaces, the condom would be of infinite mass and immediately collapse into a singularity. Hence the reason for not putting them on, I suppose.

Singularity, Alec?

Maybe these idiots could come and have a visit at the college I work. We have posters up everywhere to encourage the use of condoms, I do not believe we are trying to spread AIDS amongst our students!

Brett:
In the first place we have really promoted condom use as a general strategy quite hard.

Secondly, whilst I’m not an expert in this field I believe the evidence is that condom use fails for other reasons than religious inhibition

here is another quote from a recent Lancet review
Ten myths and one truth about generalised HIV epidemics
James D Sheltona,
…
Condoms are the answer—Condom use, especially by sex workers, is crucial to the containment of concentrated epidemics, and condoms help to protect some individuals. But condoms alone have limited impact in generalised epidemics. Many people dislike using them (especially in regular relationships), protection is imperfect, use is often irregular, and condoms seem to foster disinhibition, in which people engage in risky sex either with condoms or with the intention of using condoms.8
…

Note that he does not mention religious inhibitions here.

Anyway it doesn’t really matter why it is failing (although note in risk groups such as sex workers it is effective)– there is a duty to pursue the best strategy.

Yeah, it was quite ironic, Steve.

I’d just like to add that the relationship between male circumcision and low rates of aids is completely false.

‘Studies’ have been done in Africa comparing ratres of HIV infection between cultures practising circumcision and those that don’t ‘t, but their methodology was, in part, religiously ( islamically) driven, and so the results are not to be taken all that seriously.

The circumcised cultures surveyed engaged in less promiscuous behavior and tended to have fewer extra-marital relationships, fewer visits to prostitutes etc, hence the lower rates of infection.

HIV infections, then, are ENTIRELY dependant on an individual’s sexual behavior, but in this day and age calls for personnal responsability are considered “unfashionable”.

In the 80’s, rates of HIV infection in British gay men ( most uncircumcised) were precisely the same as those of gay American men ( majority circumcised), and this because both groups engaged in identical sexual practices.

Circumcision, thus, has no benefits whatsoever when it comes to the prevention of venereal diseases, HIV included.

It all comse down to BEHAVIOR.

In December 2006, Peter Piot, director of UNAIDS, stressed that the biggest “drivers” of the epidemic were “especially gender inequality, stigma and discrimination, deprivation and the failure to protect and realise human rights”.
…..which are themselves largely a product of primitive superstitions, especially theism; particularly Catholicism and Islam.

Since Aids is not a huge issue in Muslim countries ( where in Africa the incidence of Aids is low, or non-existant) I think that Islam has a reasonable come-back against the liberal/libertarian ideas on sex, at least in Africa. Clearly AIDS is primarily spread by promiscuity, something that muslim and Catholic bodies preach against. So a campaign against promiscuity is as valid as a campagin for condoms, and if the argument is that we cant really expect people not to be promiscious these days - that it is unreasonable - the answer is that it is also unreasonalbe (as explained in the Lancet report ) to expect continually promiscious people to wear condoms. Thats the thing about passion, it’s in the moment; so putting on, searching for, trying to remember where the condoms are, destroys that moment, and loses the name of action. The answer is to control promiscuity - serial relationships are ok, actually, it is multiple concurrent partners that is the issue. This isn’t uniquely African, but it seems to be more prevalent ( as it was in San Francisco bath houses).

I am not religious, by the way. but this is a dialogue of the deaf. One side blaming the other, one for encouraging promoscuity, the other for banning condoms. Arguably the religious side have more logic. Were everyone follow the Catholic way entirely, remain a virgin until marriage, then - condoms or not - there would be no spread of Aids. ( In fact Aids does not correlate with Catholic countries in Africa, there are few majority Catholic countries anyway, it has it’s greatest per-capita inroads in the old German and British Empires).

“…..which are themselves largely a product of primitive superstitions, especially theism; particularly Catholicism and Islam.”

Both huge in Botswana, Swaziland, and South Africa, of course.

Surely the problem over condom non-use is that clerics are preaching to the converted. No macho African man is going to happily limit his personal enjoyment of prostitutes by using condoms, or rein in his stud-like promiscuity any more than we do.

If even free condoms are not being used, what do you now suggest, sex-police?

At least the misanthropes of the Green movement will be happy.

Get the T-shirt
http://www.cafepress.com/jmoshop.110593258

whilst I’m not an expert in this field I believe the evidence is that condom use fails for other reasons than religious inhibition
Yup that’s a fair one, it may not be PC to say so, but using a condom for some of us, is like driving a sports car in boxing gloves and roller skates. It’s possible, but rather distinctly detracts from the experience!

Femidoms are better….to follow the analogy… more like driving in football boots and gardening gloves.

John Palubiski
I find your assertion that circumcision is not protective highly surprising. I would be interested to hear what your source is?

Why are you just blaming Islam and Catholicism? Here’s a report concerning a US evangelical abstinence campaign in Malawi:

In the country of Malawi in Africa in the late 1980’s, Dick Day and Josh McDowell (authors of “Why Wait”) were touring and ministering on the topic of abstinence while presenting the Gospel. The Minister of Education in Malawi approached Dick Day and asked if curriculum could be created based on this message to be taught in the schools. Campus Crusade responded and the ministry CrossRoads was born.

…”Your world view determines your values, which determines your behavior,” Day notes. “We’re engaged in ideological warfare,” he says. “Are we evolving animals? Or is there a God-given dignity that can be expressed in our sexuality?”

McDowell is a prominent exponent of “Creation Science”. I’ve got more on the evangelical angle here. The role of Janet Museveni (first lady of Uganda) is of particular note.

Paul — Brett
Campaigns that have been based around changing sexual behaviour (not necessarily abstinence) have had success e.g. amongst US gay men in the 80s. Most of these however have not been religious– but based around getting the message across that you are endangering yourself. Indeed the reductions in HIV incidence in Kenya and eastern Zimbabwe were accompanied by large drops in multiple partners probably largely as a spontaneous reaction to fear.

which are themselves largely a product of primitive superstitions, especially theism; particularly Catholicism and Islam

Is AIDS rampant in Spain, Italy and Poland?

Campaigns that have been based around changing sexual behaviour (not necessarily abstinence) have had success

Uganda experienced a huge drop in the spread of AIDS using exactly this approach. Of course, the government acknowledged it was a behavior problem considerably earlier than other countries.

I would have thought it fairly uncontentious that the widespread adherence to religious conservative values (although equally uncontentiously, excluding polygamy) would be more effective at inhibiting the spread of STDs (and all manner of other societal degradation) than would any form of artificial contraception.

I think that quote above is absolutely spot on

…”Your world view determines your values, which determines your behavior,” Day notes. “We’re engaged in ideological warfare,” he says. “Are we evolving animals? Or is there a God-given dignity that can be expressed in our sexuality?”

I believe that, in addition to the example of Uganda, “ABC” (ie First, and most important: Abstain. Second, and second most important, Be Faithful; and only last, use a condom) programmes have had a fair degree of success, and, unlike the explictly eugenist-contraceptive-promoting programmes, do assume a certain amount of human dignity (and free will, and capacity for restraint and decency) on the part of those addressed

Since Aids is not a huge issue in Muslim countries

It also smacks of a deeply paternalistic and borderline racist attitude for the West simply to inform Africans that they must not have sex any more, whilst blithely carrying on themselves.

Driving a sports car in boxing gloves? Since for some of us driving a sports car would be a solitary pleasure, masturbating with boxing gloves would probably scan better. In fact, might not ‘driving the sports car’ be a euphemism?

Seriously, Femidoms must be an answer. If women say (not without reason) that along with the pill, they are yet another male contrivance aimed at passing responsibility onto the woman, it has to be postulated that they *are* the more responsible of the sexes.

John Palubiski
I find your assertion that circumcision is not protective highly surprising. I would be interested to hear what your source is?

I used to work for an AIDS outfit back in kthe 80’s which was where I first encountered this.

Suffice it to say that the rates of infection among mostly uncircumcised British gays are vitually identical to those of circumcised American gays.

Those African studies were biased. The “researchers” methodology had a religious agenda, and so they set about comparing infection rates of highly monogomous cultures that just HAPPENED to practice cirucmcision with those of a highly promiscuous culture that just HAPPENED not to.

As a result the “divine” origins of the Koran’s timeless wisdom were proven!

In fact, all those studies really measured were rates of promiscuity.

I find it completely irresponsable, if not downright dangerous, to suggest or even HINT that circumcision plays any role whatsoever in the prevention of venereal diseases and HIV infections.

That’s akin to suggesting that femaled genital mutilation is a form of contraception.

Urban myth.

It’s an urban myth, and what’s more, the circumcison-as-HIV-prevention canard imbues individuals with a false sense of security, and may thereby actually serve to INCREASE rates of infection.

If circumcision had any effect whatsoever on HIV rates, one wonders why millions of circumcised males are nonetheless infected.

It’s all about BEHAVIOR.

Behavior, behavior, behavior.

…..which are themselves largely a product of primitive superstitions, especially theism; particularly CATHOLICISM and Islam.

Now, now!

The Church runs many AIDS hospices in Africa and elsewhere,, whereas the victims in the islamic world are largely shunned, or their existence denied altogether.

That’s a big difference.

Furthermore, Catholics are not engaging in any sort of hypocisy by promoting monogomous, one-man, one-women, relationships.

It’s their official doctrine, as a matter of fact.

As pointed out above, promoting the use of condoms is mostly uneffective.

On the other hand, reducing the number of sex partners reduces the chances of HIV infections, just as a reduction in doughnut consumption reduces ones waistline.

The present age is not condom “skinny”, it’s promiscuity obese.

Perhaps one problem with condom usage is that they do not protect users who are already infected but not symptomatic. The often long lag time before an infection and serious symptoms can make condom use a difficult sell in some environments. It’s a difficult message in the West as well, as we find out from time to time.

In line with the Science article, is Pisani’s conclusion:
http://entertainment.timesonline.co.uk/tol/arts_and_entertainment/books/article3866928.ece
“HIV is largely a sexually transmitted infection, so there must be something different about sex in Africa. Yet you can’t say that without appearing to be racist. So campaigners have come up with other reasons that HIV is worse in Africa: poverty, ignorance, men having more power than women. All politically correct, but not epidemiologically correct.

The truth is that a society in which many people have two or three partners on the go at any one time will produce a bigger epidemic than a society where people may have 10 partners in five years, but only one at a time. And it’s a fact that in parts of Africa, it’s more common for both men and women to have two or three simultaneous relationships than to have serial partners. Do people behave in this way because they are poor and ignorant? Not in Bangladesh, or Bolivia, or dozens of other countries where incomes and literacy are low. Indeed, in Africa, the incidence of HIV infection is highest in the richest households and the richest countries.”

JP: Furthermore, Catholics are not engaging in any sort of hypocisy by promoting monogamous, one-man, one-women, relationships.
That specific pont, I’ll grant you. But hypocrisy is an historic house-specialty, for the Catholic church.

Fortunately, many, if not most European and American Catholics, are less inclined to be excessively deferential towards Catholic clergy. Many are sophisticated enough to be somewhat a-la-carte in their adherence to Catholic dogma, even if it is a tad hypocritical!

The relationship of the representatives of the Catholic church in 3rd world communities is more apt to be rather more traditional.

Anyway as has been pointed out. The countries with the highest infection rates are mainly in the South of Africa and are mainly Protestant, at least nominally. So we can’t hang this at the foot of Islam or Catholicism

The absurdly high HIV infection rates - between 20-40% …yes really!…in Southern Africa - are mainly due to the lifestyle of the various black communities; many of whom indulge in extreme high-risk behaviour.

This includes very high degrees of heterosexual and bisexual promiscuity, the common practice of heterosexual anal sex, a catalyst effect of very high non AIDS STD rates; this often goes undiagnosed in women and serves to massively exasperating transmission rates. All this lot is leveraged by a significant number of mobile workers acting as a conduit for the transmission of the HIV virus. Additionally, and especially poignantly, transmission of HIV rates from mother to infant as a result of breast feeding, are simply horrific.

In the black population of Southern Africa there is a lifestyle problem, and ignorance problem - and we all know that ignorance all too often results in poor lifestyle choices. But there is also an impulse control problem. The underlying cause of this, is partly the poverty trap, but that can’t be the vast bulk of it, or else we’d see the same horrific HIV rates reflected in poor populations everywhere, and we don’t!

I recall a TV documentary on TV concerning AIDs in Zimbabwe (or perhaps it was Tanzania, don’t recall exactly). The soldier who being interviewed was asked what he was going to do now that he had just been diagnosed with AIDS. He replied he would inform his wife and dismiss three of his four girlfriends.

In the black population of Southern Africa there is a lifestyle problem, and ignorance problem - and we all know that ignorance all too often results in poor lifestyle choices. But there is also an impulse control problem. The underlying cause of this, is partly the poverty trap, but that can’t be the vast bulk of it, or else we’d see the same horrific HIV rates reflected in poor populations everywhere, and we don’t!

Agreed. It’s the lifestyle and sexual habits that contribute the most to HIV transmission. South Africa has benefiited from widespread campaigns promoting condom use, but it doesn’t appear to have had much impact. Black South Africans, particularly the males, need to tone down their sexual promiscuity and place more emphasis on monogomous relationships.

Fortunately, many, if not most European and American Catholics, are less inclined to be excessively deferential towards Catholic clergy. Many are sophisticated enough to be somewhat a-la-carte in their adherence to Catholic dogma, even if it is a tad hypocritical!

Yes they are more sophisticated, but then there’s always the confessional, a tool designed specifically to culpabilise the à-la-carte crowd thereby keeping them more-or-less in line.

All pracitising Catholics I know who’ve finished having children use contraception, and do so all the while “understanding” why The church condemns it.

John Palubiski
If you think you have any evidence to back your beliefs please send it to a scientific journal– because noone else believes this.

There are over 40 epidemilogical studies of circumcision that point to an effect. There are also 3 very large randomised control trials published in PLOS Medicine and the Lancet in which I’m guessing they would have balanced these effects. Two of the studies contrary to your assertion are from single sites in any case.
I’m also pretty sure that the authors are unlikely to have religious agendas

1. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, Williams CF, Campbell RT, Ndinya-Achola JO.
Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL 60612, USA. rcbailey@uic.edu

2. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ, Sewankambo NK, Wabwire-Mangen F, Bacon MC, Williams CF, Opendi P, Reynolds SJ, Laeyendecker O, Quinn TC, Wawer MJ.
Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21215, USA. rgray@jhsph.edu

3. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial.Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A.
Hôpital Ambroise-Paré, Assitance Publique-Hôpitaux de Paris, Boulogne, France. bertran.auvert@apr.aphp.fr

“Suffice it to say that the rates of infection among mostly uncircumcised British gays are vitually identical to those of circumcised American gays.
Those African studies were biased.”

You are comparing a personal anecdote about gay men to your personal opinion about several studies about straight men. Not the best science.

Hi, first time I’m posting here, but I think that the argument here is a little to simple. I’ve recently read Helen Epstein’s “an invisible cure” and it suggests a few interesting things.
As many societies in Sub-Saharan Africa, where the epidemic is particularly devastating are set up in ways that encourage simultaneous relationships (rather than the Western style serial monogamy), creating a dense network of relationships, which allow the virus to travel so fast in the community.One example that I can remember (can’t recall page number and don’t have book here) is that of South African miners, far away from home. In that town there was a high incidence of HIV in sex workers. But the number of “normal” women, that is women not involved in the sex industry was also far higher than expected. The explanation was simple. Most of these miners, far from home, created new stable relationships in the area, preferring them to using prostitutes, while also keeping their wives in their home towns and villages. In such “proper” and longterm relationships men and women are reluctant to use condoms, as this implies a lack of trust and reduces the chances of having children. These circumstances created a network of relationships that accelerated the rate of infection.
In these circumstances, maybe reducing the number of such relationships is one of the things that may help more than condoms, which may be unavailable and are often disliked. It’s not the religion, it’s the byproduct that may perhaps help.
Which is not to say that lying about the benefits of condoms should not be condemned, but maybe promoting their use works better in other sets of social circumstances

“S”, all of your studies come from Africa and more than likely dso not place much emphasis on sexual behavior.

Simply taking an inventory of number of circumcised males infected vs the figures for infection rates among uncircumcised males, without allowing for differences in culture, mores and sexual promiscuity is not, IMHO, scientific at all.

The circumcision canard is a form of ‘counterknowledge’….a myth and has been invoked in previous years ( particularly Hollywood in the 20s and 30s) as a panecea for V.D.

Frank Capra, noted director, bought into it as a “prevention” for V.D. back in the 30s. He ended up with a dose of clap anyways.

The fact is there are MILLIONS of circumcised men with HIV.

And there are many, MANY AIDS cases in countries where circumcision is practically universal, so what does that tell us?

In fact, millions of cicumcised males have died of HIV…does anyone really doubt that?

And even supposing, at the outside chance, that circumcision could mildy reduce infection rates, the effect is so minimal and the risk reduction so tiny, that talk of circumcision as AIDS ‘prevention’ would still remain dangerous and counterproductive….criminal even…. and would lead to a spike in infection rates.

In my opinion cicumcision is invoked because people don’t want the bad news. They want an easy way out, a way that would allow continued promiscuity with fewer risks.

However circumcision does NOT prevent the spread of V.D. anymore than it reduces rates of HIV infections.

The only valid study would be one in which rates of infection among promiscuous circumcised men are compared to those of monogamous circumcised men.

Or, conversly, the rates of infection among uncircumcised promiscous men versus uncircumcised monogamous men.

Onwe has to compare apples with apples.

One other thing, cicrumcision became almost universal among newborn boomers in America following WWII. Yet it is precisely this SAME generation ( the gays ) that has experienced the highest fatality rates from HIV.

So we need a study about circumcision?

No, we need a study highlighting the impact of SEXUAL BEHAVIORS/PROMISCUITY/DRUG USE, on HIV infections, and nothing more.

That’s the honesty we need.

As many societies in Sub-Saharan Africa, where the epidemic is particularly devastating are set up in ways that encourage simultaneous relationships

Or maybe these societies have been promiscuous from the beginning, and it only became problematic when AIDS came on the scene.

These are the areas in which the contribution of religious leaders has been the worst. In every sense, the interference of religious leaders both causes the problem and frustrates rational and effective solutions to it.

Yeah! And I suppose it was the ‘interference’ of religious leaders that first ’caused’ the AIDS crisis!

Moonbattery indeed.

John Palubiski
The trials I cite are balanced for sexual behaviour, age, partners, medical history and even religion– and most imporantly 2 of them are from individuals from the same location. In the 80s and early 90s people found the idea that circumcision would be potective quite surprising. Nobody is in any doubt that this is the case now. Foreskin cells are simply rich in langerhans cells which are a prime entrypoint for HIV virus.

I have avoided being rude till now but quite simply you are talking balls… and should desist. It is really quite irresponsible to spread falsehoods about public health matters.

You know, AIDS could end entirely and instantly.

Just test everyone and tattoo the people who are infected.

Then mandate periodic testing on a decreasing frequency.

It’s sometimes illuminating to acknowledge the extent to which our problems are due to self imposed limitations.

JP wrote:

Yes they are more sophisticated, but then there’s always the confessional, a tool designed specifically to culpabilise the à-la-carte crowd thereby keeping them more-or-less in line.
The Catholics are masters with long standing, at leverage guilt; I’ll grant that!

The confessional, the Visa card approach to religion - sin now pay later.

I’m sure I’m not the first to notice how this hyper guilt, conditioed into kids at a tender age - quite seriously emotionally damages and scarres a goodly proportion of those raised Catholics.

Hi guys. Its been a while. Nice site.

Moonbattery?

“The Muslim leaders want to stop the provision of condoms and instead promote “observance of Islamic teachings such as fasting, regular prayer and shunning extramarital affairs.” They also advised men to “avoid looking at women”.”

What great advice. We all expect Muslims to follow Islam when we believe it tells them to kill, behead, xyz, but not when it tells them to fast, pray, and not “hook up.”

Promiscuity is bad for your health and your soul.

Bikhair, your sort always expects that the religious edicts which have been ineffective in the past will somehow magically become effective in the future. As if human nature is due to change.

The AIDS denialist movement is in reality a fragmented and often contradictory block comprised of a wide variety of factions. Some are backwards, conservative and reactionary. But it’s also worth noting that others come from a different perspective, whether or not one agrees with their scientific conclusions. ACT-UP San Francisco for example, came to splinter with the rest of the ACT-UP federation of groups and pursued a line arguing that fear and paranoia was being used by people who wanted to punish Africans and gay men, piggy backing their heterosexual moralism atop an epidemic. As an analysis, it summarises much that is common to both “liberal” as well as conservative writing on the subject. Horror of horrors, people are still having sex. And surviving. That irks a lot of moralists - whether Islamo medievalists or Guardian reading apocalyptics.

The only valid study would be one in which rates of infection among promiscuous circumcised men are compared to those of monogamous circumcised men.
Or, conversly, the rates of infection among uncircumcised promiscous men versus uncircumcised monogamous men.
One has to compare apples with apples.

Yes, one does. Perhaps it might be worth your while reading the studies and then coming to a reasoned conclusion on the basis of the evidence?

A fair study would be a randomly selected cross-section of men, half of whom are circumcised and half of whom are not. The rates of HIV infection over a period of a few years can then be measured and compared.

I believe those studies cited did exactly that. You can find lots of information on the Internet about what does and does not consitute a valid scientific study.

Yes, one does. Perhaps it might be worth your while reading the studies and then coming to a reasoned conclusion on the basis of the evidence?

With all due respect, Mrs Trellis, millions of circumcised men have succumbed to HIV.

No one should need a study to be aware of that.

The current flak over circumcision is, in fact, a red herring designed to deflect from the fact that promiscuous sexual behavior is the main factor in the dissemination of aids.

No one wants to look that in the face, perferring instead to blame the epidemic on various body parts , or the weather in china….whatever.

I dare any circumcised male here to go out and engage in risky sexual behavior with inidividuals who are potentially HIV positive.

The circumcision/non-circumcision “debate” is rooted in junk science, on the one hand, and on the other, by a desire to escape personnal responsability.

Being circumcised will not save yer ass.

This issue reminds me of those old wives tales wherein it was said that a girl could avoid an unwanted pregnancy by jumping up and down 20 times immediately after intercourse.

Promiscuity is bad for your health and your soul.

True, but false prophets and randy Bedouin paedophiles are much worse, Bikhair.

Beware of false prophets, ok?

N.inS.A.: The Catholics are masters with long standing, at leverage guilt; I’ll grant that!

Actually The church manages guilt and sexual repression so that it re-emerges like a smooth sensual latté.

The entire nation of Italy is one big work of art, and carnival in Rio is baccnalian in tone.

Christianity didn’t kill Eros, Nick, it just put him a suit and tie.

I’d love to say more, but am feeling too guilty!