Those of us in the skeptical community are no strangers to whacko medical theories. It seems every week there is another quack promoting a new "naturalistic" diet or treatment. By far, though, the brunt of a skeptic's time is dealing with denialism – groups of individuals denying that contemporary medical practices don't work or are even dangerous. In the last few years, the anti-vax denialists have been in the media spotlight due to their elaborate campaigns and the outspoken celebrities like Jenny McCarthy who have taken up the anti-vax fight. But there is another camp of deniers festering away in the underbelly of alternative medicine. These people are the AIDS deniers; people who claim that AIDS is not caused by the HIV virus, but rather that it is actually caused by drug use. Some even go so far as to claim that HIV does not exist! Given the horrifying prevalence of AIDS in third world nations and even its alarming proliferation in developed nations, increasing support for AIDS denialism is not simply worrying but outright dangerous.
AIDS denialism has been known to me for some time, having learned about it from reading about Nobel Prize winner Kary Mullis, who is one of AIDS denialism's best known proponents. Though, given Mullis' colorful personality I figured he was just a lone crank. It was not until this past week when a good friend of mine, SofiaRune, began to get comments on a Youtube video she produced about debunking the link between HIV infection rates and male circumcision. A user by the name of "mykoolaidtastesfunny" made a variety of claims about how AIDS and HIV are not linked, and how HIV has not been shown to exist. He also posted a video by a variety of AIDS "skeptics" repeating his points. Immediately we began to investigate these claims. In the following series of posts, I'll address the claims of the AIDS "skeptics". In Part I, I will focus on the video that started it all…
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I'd be really interested to hear your views on male circumcision and HIV prevention. It seems to have become a really hot topic since the US introduced PEPFAR which includes male circumcision as an preventive method against HIV infection. I know the original trials had some serious flaws, including ethical questions raised by behavioural changes in circumcised men. I know it's not so much denialism as it is potentially a red herring but I'd love to hear your opinion nonetheless.
ReplyDeleteHi
ReplyDeletemy views on Male Circumcision (MC) for HIV prevention...ok...
1. The evidence that MC prevents HIV transmission from women to men is beyond compelling.
2. The reduction in risk is probably around 50%..an amazing amount of protection.
3. If every male baby in southern Africa were to receive MC we would see a huge reduction, dare I say near elimination, of HIV in a couple generations. But that will never happen and it is foolish to think that it could. MC has huge cultural, religious, social, and personal aspects that cannot be ignored..although some people have ignored them.
4. There is a considerable problem with circumcised men who correctly believe they are partially protected from HIV stopping use of condoms (100% protective). This is called risk compensation and it is what my research group has been studying.
5. A mistake would be to think that MC alone is the answer to HIV prevention, and no one is really saying that.
So in summary, MC prevents HIV transmission, but it will not stop HIV epidemics...No one prevention strategy will. Behavioral counseling can enhance the effects of MC buy reducing risk compensation.
I wrote commentary in PLOS Medicine about neonatal MC that may be of interest...
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000219
Sofiarune.
ReplyDeleteReally, asking Kalichman to comment on circumcision is akin to questioning his religious faith, of course he's going to recommend it.
Try looking at Doctors Who Oppose Circumcision. All qualified M.D's, all believers in HIV/AIDS and all opposed to circumcision as it DOES NOT prevent the transmission of the virus.
http://www.nocirc.org/statements/hiv2003.php
Perhaps they are circumcision denialists? most likely they just ain't Jewish. Now who originally proposed this theory?
Aaron J. FINK M.D. and of what faith would you think he is?
Kalichman has perpetual trouble sorting fact from fiction in his faith based science beliefs. But then that's not uncommon in his fantasy world.
Yes, that is right.
ReplyDeleteI am biased in my interpretation of 20 years of epidemiological research and three randomized controlled trials because I am Jewish. It is the medical establishment, run by Jews, that is conspiring to promote male circumcision for HIV prevention. It is no coincidence that the leading circumcision researcher is named Moses. Yes, I want every male child circumcised because that will make them Jews and we can take over the world, not just the Liberal Media and banks.
Now that I am talking Crazy, do you understand me better?
You AIDS Deniers are your own worst enemy. No one can explain how insane you are better than you can and do.
Good job, and thanks again!
Can anyone confirm.. I heard that Kary Stockley's CMV analitis has returned and she is in the hospital again. Is she still refusing HIV treatment? Does she need more surgery? How grave is her condition?
ReplyDeleteCat got your tongue or you just censoring again? Atypical behaviour of the AIDS Junta.
ReplyDeleteDidn't mean to start a bit of a spat. I actually didn't know that Seth was Jewish so his religious background is irrelevant to me. I sincerely wanted to know what his opinion on the RCTs in Africa was. The data are what the data are.
ReplyDeleteI disagree with him (kind of) but it's not because I think his Jewish background is clouding the issue. We both come from academic backgrounds and I'm confident that we could discuss the concept in a purely scholarly way. I'll probably follow up via email but I've been pretty busy and now I've managed to get sick so it might take me a while.
I offer my apologies Seth, I didn't mean for Jewish conspiracies to be triggered via my comment. :P
What is the spread on who's going to kick it first- Bannon or Stokely? I'd put Stokely in at 2:1 odds...
ReplyDeletesofiarune
ReplyDeleteNo problem at all.
I appreciate your asking.
No apologies needed.
You are correct about my interest in MC for HIV prevention, particularly the behavioral aspects. If you are familiar with the RCT's, then you can see that the data suggest behavioral problems like risk compensation far more than the authors conclude. Especially the Kenya and South Africa trials.
Any way, do not mind the nut cases that have chimed in here. I post their comments so that readers can see for themselves how insane AIDS Denialists are. You did nothing to provoke the crazy Jewish comment. They are not equipped to have a legitimate discussion of a real issue in HIV/AIDS, like the merits and meaning of MC for prevention. They believe there should be a debate about whether HIV exists and in the mean time miss the real debates that are happening in the field...
We must remember what the great philosopher Joe Walsh once said.."You can't argue with a sick mind".
People like you bring substance to my blog. People like Bill, Clark Baker and the other Deniers who try to comment here are purely entertainment.
Thanks again
How's that global warming going up there in Connecticut Seth?
ReplyDeleteAh, that's right the worst blizzards in history are proof that the planet is warming, silly me.
Wow you have all of them here don't you? Global warming denialists, Jewish conspiracies... I could start a game called "Guess the next nutjob" every time I come to your blog haha.
ReplyDeleteSo who are you and what is your problem? Do you live under a rock? This AIDS bullshit is just that, BULLSHIT, and how many people have been killed by the drugs, not to mention suicides after they tested positive on the phony HIV test. Get real. The time is coming, little by little people are becoming aware of this massive hoax.
ReplyDeleteYes sofiarune
ReplyDeleteYou will find them all here.
It is like a nut farm. As you can see, they are quite the bunch. As ignorant of climate change as they are HIV/AIDS.
Crazy is as crazy does...
I would like to point out to "anonymous" that "Global Warming" is a misnomer and shows your extreme ignorance. The real science focuses on Climate Change which is a much better description of what is happening. Perhaps you should do a little more studying and spend less time on your Tin Foil Helmet.
ReplyDeleteAh, that's right the worst blizzards in history are proof that the planet is warming, silly me.
ReplyDeleteActually it is. There's not a lot of ice up in the Arctic right now. The Arctic Oscillation is in a negative phase which sends cold air south.
If that doesn't convince you, consider the drought in the Amazon rain forest, or the floods in Australia linked to warmer ocean temperatures.
Don't try convincing Clarkie Baker that climate change is happening. Clark is uneducated and tries to compensate for his low station in life by posting silly rants online. He is an example of the crossover of AIDS Denialism/Climate Change Denialism/ 9-11 Conspiracy Theorists - and other idiotic whackjobs.
ReplyDeleteSeth Kalichman, you may be an epidemiologist, but your statements are either exaggerated, unproven, or plain incorrect. You said:
ReplyDelete1) "The evidence that MC prevents HIV transmission from women to men is beyond compelling."
NO, the evidence that MC prevents HIV is NOT proven, although there is SOME evidence that it helps to reduce HIV transmission via heterosexual sex. The three RCTs found a 50-60% reduction over about 18 months (in real terms, not particularly good). However, the RCTs may be much more context-specific than you imagine, and their results are evidently not projectable onto other countries, particularly developed nations. The HIV pandemic is now of 30 years' standing, yet there is still absolutely no evidence that uncircumcised men in any developed nation (e.g in the USA) have statistically more HIV infection than the circumcised men of that population.
Physiology: According to research by de Witte, published in the Lancet (2007), foreskin Langerhans cells DESTROY invading HIV viruses (by releasing the viricide, Langerin, and also by stimulating an immune response against the viral invaders). However, if the exposure to HIV is VERY HIGH (or above a certain threshold), then presumably immune, protective cells can get overwhelmed, and in that scenario, the foreskin would present as little more than extra surface area for HIV invasion. In practical terms, this means that circumcision may confer some small protection on men who indulge in promiscuous sex with, for example, Sub-Saharan prostitutes (who have very high HIV infectivity). The corollary, however, is that the foreskin could confer NET PROTECTION against HIV if the exposure to HIV is within a more normal or lower range, in which Langerhans cells are effective. This scenario, or hypothesis, would help to explain why non-circumcising Europe and Japan have the LEAST incidences of HIV in the world (lower than the 80% circumcised USA). HOW DO YOU EXPLAIN THE VERY LOW HETEROSEXUAL TRANSMISSION OF HIV IN THE INDIGENOUS POPULATIONS OF EUROPEAN NATIONS, SOME OF WHICH HAVE STATISTICALLY NO MORE HIV THAN ISRAEL? (See: "cia world fact book hiv/aids adult prevalence rate"). As many epidemiologic studies show, the prevalence of HIV is related statistically to socioeconomic factors, probably not circumcision status.
Even within Africa there is much conflicting data, e.g. metanalyses performed by Garenne (2008), Van Howe (1999), Way (2006), Connolly (2008), and others in Africa have failed to validate circumcision as protective against HIV.
2. You said: "The reduction in risk is probably around 50%..an amazing amount of protection."
As an epidemiologist, you should know that a relative risk reduction of 50% is poor, and remember, it has only been found over a period of about 18 months (duration of the trials). This means that if a circumcised man continues to indulge in unprotected promiscuity, he will come down with HIV regardless. He may be protected a little longer than if he were not circumcised - but that's all! It is unscientific and senseless to compare circumcision to a vaccine (not you).
3). You siad: "If every male baby in southern Africa were to receive MC we would see a huge reduction, dare I say near elimination, of HIV in a couple generations."
That is a ridiculously unscientific statment, not predicated on any facts! Based on a relative reduction of only about 50%, you have no grounds to come to that conclusion. The only way to eliminate HIV is safe sex practice. Circumcision is the LEAST protective method, and appears to be be ineffective in many environments.