Circumcision & HIV/AIDS IN PNG.

I am not sure if it is alright to come out publicly and tell
everyone that every sexually active male should have a circumcision done.

On one side we are advocating condom use and safe sex. Now I just read in the Post Courier that a doctor is advocating circumcision. I have nothing against circumcision. Many studies has shown that circumcision DOES REDUCE RISK AGAINST HIV INFECTION. The thing is – Can we do one thing at time? Or if we are doing all these many ways to try and reduce HIV/AIDS in PNG, can we do in a more co-ordinated way rather than each person preaching their own message?

We had a recent discussion on this very topic on PNG Doctors Internet Group. I have posted some of the discussion that we had and you can make up your mind.

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By Dr Sioni Sialis

I think from all the awareness that has been done, it may be still difficult to control the epidemic, and I believe in the “mind controls the body” principle.

I don’t think the approach should be so much awareness driven, but should be more on behavioural change through having control over the mind. There has to be some strategies that looks into efficient ways to change behaviour. I personally do not believe that awareness alone will change behaviour. As we all know that a person will continue his/her habit until he/she decides to change. But what can cause someone to personally decide to change?

Behavioural change I think is an exciting field, because almost anything in life is determined by it. If we can change behaviour then we can achieve a lot of things, not only for HIV but also for lifestyle changes in cases of diseases like diabetes and high blood pressure.

We have had massive media coverage in awareness, with big bilboards, TV advertisements, radio advertisements etc, but I do not believe it has changed much.
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By Dr Eric Ungil

Thanks for bringing up the issue again. Doctors are so knowledgeable and have read about so many studies etc, but the simple message to the ordinary people of PNG should be: “No extra/premarital sex, or other wise, use condoms” – to be safe from HIV. It is simple to explain and the people can absorb that.
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By Dr Gunzee Gawin

A conflicting message is being put to the public now. Those against condom use will use this information to make their arguments more convincing.

Although studies have proven that circumcision has reduced the incidence of HIV transmission and cancer of the cervix, condoms are still superior to any interventions. One may reduce the risk of catching HIV by 10% when circumcised, however, if this circumcised person uses condom, that 10% risk is reduced to less than 1%. So regardless of all kinds of interventions, CONDOM is still tops.

My concern is, those illiterate public will not understand this. We have just build a brick-wall against the HIV/AIDS awareness campaign.

So the message should be but one only; STAY FAITHFUL and LIVE LONGER.
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By Dr John Tonar

Regarding circumcision in sexually active man, it is one of the many modalities of reducing or limiting HIV transmission. You may recall Prof. Mola’s letter to the editor 3 or so weeks ago, highlighting circumcision and its significance plus others including condom use. The concept of dipping an intact skin or any part of male sex organs, in this case intact penis (circumcised or not) into a bucket of HIV viral infested blood would not even enable HIV to transmit to this intact penis. Only when there is mucosal abrasion or crack/break in the epithelial layers would allow HIV to slip in.

The point is HIV will never enter intact skin unless there is a break, as you all know. The offer of adult male circumcision yet another offer put forward by the health facilities and really it is up to any concerned individual to decide.

We have to put forward all modalities we know that worked to reduce HIV transmission. Certain modalities that suit one may not be true for others, hence a wide arsenal of preventative measures ie. condom, safe sex, pamphlets, education, religious and customary restrictions, formal education, whatever modalities possible at the same time so population can choose which method suits them.

Main thing is: The Mind controls the Body. If efforts are made to
educate the mind, then the rest is a matter of choosing the right
approach guided by an educated mind.

I see anyone out there concentrating his mind on the tip of his dick is doomed for failure and so be it. Cos, no one can teach an adult how to take it up and go dipping.

We have to safeguard the innocent. Hence all male newborn/infant be circumcised. I would agree with that.
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By Dr Willie Mol

I think the reality is, we as health workers, we don’t dictate but to tell the facts to the public and they will have to make their own choice. Behavioural change (abstinence and sticking to one partner) and condom are sure ways but we are only talking and we don’t know what’s going on out there in reality. As for circumcision, we are not just talking but really doing something to reduce the chances of HIV contraction. Another important thing we are forgetting is prompt treatment of other sexually transmitted infections (STIs). With the presence of other untreated STIs the patients are very vulnerable to HIV.
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So circumcision does reduces the risk of HIV transmission (plus other health benefits) according to three big studies done in Africa. However, according to Prof. G. Mola of UPNG, the WHO has invited experts to review these studies and determine whether circumcision has a place in certain countries. Read his letter the Post Courier. So should you go and get a circumcision done? It`s really up to you and it`s your decision.

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About rodney itaki

I am a medical doctor from Papua New Guinea. My posts focuses on current and emerging health issues in PNG.
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5 Responses to Circumcision & HIV/AIDS IN PNG.

  1. tlctugger says:

    Where in this discussion is the recognition of the value of a whole, functional body? The foreskin possesses over half the sensual nerve endings and affords a wonderful frictionless rolling/gliding mode of stimulation which amputees cannot enjoy.

    Circumcision makes a man less likely to use a condom for two reasons:
    – He is misled by the media into thinking he is immune from STDs (even though 450,000 US men who were cut at birth have died of AIDS), and
    – His impaired sensitivity makes further desensitization by covering himself very undesirable.

    Infants don’t have sex. Infant circumcision is risky cosmetic surgery on an unconsenting minor. To cut an infant, one must first tear the still-fused foreskin away from the glans and then contend with working on a very small-scale specimen where every mm of imprecision will be magnified as the victim grows. Nobody could know how much the victim will grow, so every infant circumcision yields a mystery result later, which the victim didn’t choose. About one in five infant circumcisions give distinctly unintended results. A good number cause real damage like curvature, glans gouges, skin bridges, adhesions, bulgy veins, numb zones, jagged scars, skin tags, etc. http://www.noharmm.org/IDcirc.htm. Hundreds die every year.

    A condom costs the U.N. about 3 cents to give away. How many condoms could one distribute for the cost of a medicalized circumcision?

    Every mammal on earth and in the sea evolved a foreskin before there was surgery or even soap. It shows remarkable arrogance to be of a mind that this creation can be improved upon.

    By the way, Dr. Tonar, a circumcised penis is never described as intact. To learn more about the natural penis in 20 minutes than US med students have been told upon graduation, view this video: http://www.doctorsopposingcircumcision.org/video/prepuce.html

    HIS body, HIS decision.

  2. rodney itaki says:

    It is true that the prepuce does has physiological role and we can not deny it.

    How can we explain the statistics showing a low risk associated with circumcision?

  3. Helen says:

    wow! interesting!

  4. Anthony John Jnr says:

    Very interesting. Wonder if our traditional practices have any links to this findings or was it just practised for male ego. Have you got any data on where male circumcision was practiced in our country? hear from soon.

  5. rodney itaki says:

    I know that in West New Britain Province, male circumcision was part of the initiation process. I do not have data on other parts of PNG. If other PNGeans read this can put their input.

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