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Male Circumcision Overstated as Deterrent to Global AIDS Pandemic

While previous research has suggested that circumcision 'significantly' cuts HIV risk in men, a new study has found that it is much less important as a deterrent to the global AIDS pandemic than previously thought.

Author John R. Talbott who conducted statistical empirical research across 77 countries of the world conducted the study.

He found that the number of infected prostitutes in a country is the key to explaining the degree to which AIDS has infected the general population.

Prostitute communities are typically very highly infected with the virus themselves, and because of the large number of sex partners they have each year, can act as an engine driving infection rates to unusually high levels in the general population.

He also made two important discoveries.

First, male circumcision, which in previous studies had been found to be important in controlling AIDS, becomes statistically irrelevant once the study controls for the number of prostitutes in a country.

The study finds that the more Muslim countries of North Africa do indeed suffer much less AIDS than southern and western Africa, but this lower prevalence is not due to higher numbers of circumscribed males in these Muslim communities, but rather results from the fact that there are significantly fewer prostitutes in northern Africa on a per capita basis.

In a frequently cited academic paper, Daniel Halperin, an H.I.V. specialist at the Harvard Center for Population and Development and one of the world's leading advocates for male circumcision, weighted results from individual countries by their population. When this artificial weighting was removed Talbott found that circumcision was no longer statistically significant in explaining the variance in AIDS infection rates across the countries of the World.

Second, to date, there has not been an adequate explanation as to why Africa as a continent is experiencing an AIDS epidemic far in excess of any other region of the world with some African countries' prevalence rates exceeding 25 percent of the adult population and tens of millions dying from the disease on the continent.

Talbott's new study suggests that the reason is that Africa as a whole has four times as many prostitutes as the rest of the word and they are more than four times as infected.

Some southern Africa countries have as many as 7 percent of their adult females infected and working as prostitutes while in the developed world typically this percentage of infected prostitutes is less than .1percent.

If these infected prostitutes in Africa sleep with five men in a week that means they are subjecting 35 percent of the country's male population to the virus weekly. The virus is not easy to transmit heterosexually, b ut over time with multiple exposures, infection is inevitable. These men then act as a conduit to bring the virus home to their villages, their other casual sex partners and to their wives.

The study has important policy implications. Several international AIDS organizations have begun to provide funding for male circumcisions as a deterrent to AIDS.

The research is published in the online, open-access, peer-reviewed scientific journal PLoS ONE.


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