It’s usually safe to take time off in July to move house — in a previous existence in the newroom we used to call the European summer the “silly season”. In the weeks I’ve been painting walls, unpacking boxes and not blogging, we’ve had some HIV silliness, but some good sense too.
The IAS conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, South Africa produced its usual crop of second rate abstracts on issues currently fashionable in the HIV industry — gender, health systems strengthening, scaling up — along with the inevitable calls for more cash. The IAS also runs the biennial international AIDS conferences — giant circuses full of amusing but expensive set-pieces: protesting sex workers, singing orphans, earnest celebs. There’s so little science at those conferences that a lot of researchers have abandoned them in favour of low-key, high-science meetings such as CROI. It seems IAS is trying to claw its way back on to the scientific platform with the pathogenisis sub-conferences. Perhaps we’ll see more good sense from the organisation now that it is coming under the spell of the inimitable Robin Gorna.
Among the conference’s silliness was a study of the protective effect of circumcision in anal sex between men in Soweto. It’s hard to tell much from an abstract and this came from a good research team so perhaps I’m being unfair. This cross-sectional study (picked up by IRMA) reports results for men who only ever act as tops in anal sex with other men. Not one iota surprisingly, the results are exactly the same as for men who only ever act as tops in vaginal sex with women (i.e. all men who have vaginal sex): uncircumcised men are four times more likely to be infected with HIV.
What does that tell us? Almost nothing of any use in HIV prevention programming. Over 13% of the guys in the study had HIV. In the very high prevalence settings of Southern Africa, guys (and boys and infants) should be getting snipped regardless of their eventual sexuality. We don’t need more clinical trials of exclusively insertive MSM to prove that, especially since 80% of these blokes are also shagging women. But the South African study doesn’t mean gay guys in other parts of the world will necessarily be protected by circumcision. In this study, three quarters of respondents said they were only ever tops. (If you believe them, spare a thought for the remaining quarter; they must be getting poked painfully frequently just to make the numbers add up.) If you don’t believe them it may well be because that degree of role separation is unusual in many gay communities. Indeed one of the reasons HIV spread so rapidly among gay men is that the very people who are most likely to get infected (because they’re taking it up an orifice not designed for the purpose) are also most likely to infect others (because they give as good as they get). Heteros don’t have that flexibility, and that slows transmission down.
For practical purposes what we’d like to know from the Soweto data is: does circumcision protect men who have anal sex against HIV regardless of whether they are a top, a bottom, or “versatile”?
More silliness from Canada on needle exchange, but some good news from the States on that front, too. Of which more after I’ve unpacked more boxes. In the meantime, this comment on trafficking hysteria from another member of the Silliness Police over at Preipheries.