The growth of evidence regarding the health benefits of male circumcision is behind the US Centers for Disease Control and Prevention’s proposal that doctors counsel parents of baby boys, teenagers and men about the benefits and risks of circumcision. From NPR:
“The compiling of the different data sources may really be sufficient for someone who is a heterosexual male to consider the benefit of circumcision,” Dr. Susan Blank, a pediatrician and chairwoman of the American Academy of Pediatrics’ circumcision task force, told Shots.
In 2012, the American Academy of Pediatrics said for the first time that the benefits of circumcision outweigh the risks, and that insurers should pay for the procedure.
But the pediatricians’ focus was on parents considering infant circumcision. The CDC’s proposal opens the door to circumcision becoming a topic of conversation any time an uncircumcised male goes to a medical appointment.
Although several surveys have found a decline in circumcision rates since the 1960s, the majority of men living in the United States were circumcised as newborns. The prevalence of the procedure varies widely, with big geographical and ethnic variations. It is typically less common in Asian and Hispanic communities.
Groups opposed to circumcision, such as Intact America, say the health benefits of circumcision in the U.S. remain unproven, and that the CDC is relying too heavily on studies done in Africa that may not be relevant here. The procedure, which removes the foreskin, has been criticized because infants can’t consent to it.
“Parents need to recognize that they’re effectively removing that decision from their son,” says Dr. Douglas Diekema, a bioethicist at Seattle Children’s Hospital who served on the pediatricians’ task force. “And there are some men who will grow up being unhappy with the decision that their parents made.”
The CDC’s draft recommendation, which is open for public comment for 45 days, suggests that teenage boys be counseled along with their parents on the option, which presumably would give boys the option to say yea or nay.
“I want to emphasize that it’s a voluntary procedure, and really requires conversation between the doctor and the patient,” says Dr. Eugene McCray, director of the division of AIDS prevention at the CDC. “Our role is to insure that physicians have the information that they can then use to counsel or inform patients about the risk and benefits.”
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Global Health and Development Beat
Rapid evolution of the human immunodeficiency virus is slowing its ability to cause AIDS, according to a study of more than 2,000 women in Africa.
The outbreak of the deadly Ebola epidemic in Sierra Leone has dwarfed the campaign against HIV/AIDS, to the extent that patients no longer go to hospitals and treatment centres out of fear of contracting the Ebola virus.
HIV was the third leading cause of natural deaths in South Africa in 2013, up three places from the previous year, and the second highest killer of young people, a survey by the national statistics agency showed.
Women make up the vast majority of people living with HIV in South Sudan, and face discrimination on a daily basis if they admit to having the illness, said the chairwoman of the National Empowerment of Positive Women United in South Sudan.
HIV, the virus that causes AIDS, frequently mutates. That has allowed the virus to bypass the immune system and infect about 80 million people over the last 35 years. However, researchers say the rapid evolution of HIV actually may be reducing its ability to cause AIDS.
Syrian refugees in Lebanon panicked over news that the United Nations suspended food aid to 1.7 million refugees due to lack of funds — a decision officials said threatens to starve thousands of families and add pressure on the already strained countries hosting them.
Bruce Springsteen and Coldplay’s Chris Martin tried to replace Bono’s legendary vocal cords in a surprise U2 concert in New York to rally support for fighting AIDS.
The South African doctor whose family was killed in a Taliban attack in Kabul is still working at an Afghanistan hospital.
A South African mother whose baby was accidentally swapped at birth said that hospital workers had mocked her when she insisted she had given birth to a girl, not a boy.
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Spotlight on PSI
A story on a new innovation in voluntary male circumcision was featured in the PSI Impact blog. Here is an excerpt:
The PrePex device consists mainly of three rings ‑ a hard plastic ring on the inside of the foreskin, an elastic ring placed against it on the outside and a third ring placed around it to hold everything in place ‑ working together to constrict blood flow. A health professional can apply it in about two minutes. It is then left in place for seven days. Once the foreskin tissue deadens and dries up , a health professional removes the rings and the foreskin in a few minutes.
Without the PrePex device, Trymore doesn’t think he could have gone through the procedure. “I can go to work from the very day they put it on,” he says. “There’s some mild pain but very manageable with painkillers.”
The PrePex procedure requires no locally injected anesthesia, stitches, nor sterile environment for application. It also carries far less risk of excessive bleeding or other complications that can occur with the standard surgical VMMC. “The great thing about the PrePex device is it’s very simple,” says Dr Karin Hatzold, PSI’s global expert on VMMC. “We can use it at lower-level healthcare facilities, with less infrastructure, and use broader groups of staff, such as primary care nurses , to administer them without the need for a surgeon or physician.”
Hatzold oversees VMMC devices trial studies conducted by PSI in four countries. “PrePex won’t replace surgical VMMC,” she says. “What we can do is explore where PrePex will support VMMC providers in reaching new markets, like rural areas where there aren’t enough physicians or among clients who don’t have time or desire for even a minor surgery.”
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Buzzing in the Blogs
The marking of International Day of Persons with Disabilities should serve as a reminder that not all groups are included support for the right to food, say Rachele Tardi and Hilal Elver. They write in the Guardian:
An estimated 1 billion people live with a disability, 80%of them in the global south. About 805 million people are chronically undernourished. Since many people with disabilities live in absolute poverty, these two large populations overlap to a considerable extent. These striking facts need to be remembered, especially on Wednesday, International Day of Persons with Disabilities.
A recent article in Paediatrics and International Child Health says: “Nutrition and disability are intimately linked: malnutrition can directly cause or contribute to disability, and disability can lead to malnutrition.”
People with disabilities face many challenges in realising their human rights, including the right to food. Although the need for good nutrition is often discussed in relation to preventing disability, it is vital to emphasise the human rights approach to food security for those who already live with a disability. Countries are particularly responsible to make sure that vulnerable and marginalised people can access adequate and nutritious food in a non-discriminatory manner.
The article says children with disabilities often lack equal access to adequate food and are more likely to suffer from malnutrition than other children. They may receive less food because the others are seen as having a greater chance of surviving and contributing to the household. Mothers of newborns with a disability are often discouraged from breastfeeding their babies for similar reasons.
Children with disabilities are often believed to be incapable of learning to feed themselves, and therefore become reliant on others who may give them less food because it takes time to feed them. The NGO Lumos reported last year that in Bulgarian institutions for children with disabilities, caretakers were spending less than two minutes on each child at mealtimes, even though those children needed help with eating and drinking. Among children with disabilities, girls are often discriminated against and given less food than boys.
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Capital Events
Thursday
10:00 AM – Media Matters: How Media, Connectivity, and an Open Internet are Changing the World – CSIS
12:00 PM – Living Through Extremes: Building Livelihood Resilience Across Sectors and Countries – Wilson Center
Friday
9:00 AM – Violence Against Women: Moving Towards Evidence-Based Solutions – IADB
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By Mark Leon Goldberg and Tom Murphy
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Disclaimer: Opinions presented in this email do not necessarily reflect the views of PSI.