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15 June 2014

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Paulus - thanks for your very knowledgeable comments.

There is also a religious dimension to this which is somewhat disturbing. Certain evangelical groups think circumcision is ordained by God and therefore should be enforced.

I believe decisions should be made on the basis of medical evidence, not superstition.

As Paul says, "For neither circumcision counts for anything nor uncircumcision, but keeping the commandments of God."

Peter, This issue has been discussed on PNG Attitude before.

There is compelling evidence that circumcision protects against HIV. If you read the wording of the WHO statement it recommends it in areas where there is high prevalence.

This is important because how much of an impact this has depends on the background prevalence of the disease, i.e., how many people in the population suffer from the disease.

All three studies (these are the randomised control trials which have the highest degree of evidence) were very well done in almost every way. They were performed in southern Africa in populations that had a prevalence of almost 30% (that is 1 in 3 people had HIV).

In such a population of say 10,000 men 3,300 men (30%) are likely to have or get HIV. If you circumcise them then you will have 60% protection rate which means almost 2000 men will be prevented from getting HIV.

Consider PNG where the prevalence now is thought to be 2%. In a population of 10,000 sexually active men only 200 men are likely to get HIV. If you get a 60% protection rate you will prevent 120 men from getting HIV.

This is still a great reduction but consider the costs. In Africa they would need to circumcise 6 men to protect 1 person from getting HIV. In PNG you would circumcise 83 men to protect one person from getting HIV. (Epidemiologists call this the number needed to treat (NNT)).

It would therefore be a great addition to the arsenal for the campaign against HIV but one has to be careful that certain interest groups do not hijack this to be their only weapon against HIV (for instance condoms).

The debate in PNG is essentially studies into the acceptability of the practice. I imagine the Health Department wants to err on the side of caution and if the prevalence of HIV rises it may wish to discuss the possibility of introducing circumcision.

There are other considerations, e.g,. whilst it prevents male acquisition of HIV it does not prevent male to female transmission and there is no evidence that this protection is long lasting.

In Australia the debate is entirely different issue altogether and I would not presume to venture into this.

The image has been coloured (as it probably originally was) but is genuine. It was found in an Egyptian tomb built for Ankhmabor in Saqqara and dated to around 2400 BC.

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