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peter kilmarx
@
PeterKilmarx
Bethesda, MD
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Infectious disease medical epidemiologist. Global health research, policy and programs.
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peter kilmarx
@PeterKilmarx
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5 h |
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Wrong. Across the 32-year period from 1979 through 2010, the national rate of newborn circumcision declined 10% overall, from 64.5% to 58.3%. cdc.gov/nchs/data/hest…
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peter kilmarx
@PeterKilmarx
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5 h |
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Sure. Let millions of men die of HIV infection. Thanks for your perspective.
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peter kilmarx
@PeterKilmarx
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6 h |
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“The data from this study strongly reject the hypothesis that circumcision affects sexual risk-taking. Risk compensation should not serve as an argument against increased and accelerated scale-up of circumcision in this and similar communities in South Africa.”
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peter kilmarx
@PeterKilmarx
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6 h |
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You misremember or he was mistaken. This is being carefully monitored. For example: journals.lww.com/jaids/Abstract…
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peter kilmarx
@PeterKilmarx
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6 h |
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More than a decade after the WHO recommendations. Hundreds of thousands of HIV infections prevented by male circumcision. No sign of a “disaster.”
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peter kilmarx
@PeterKilmarx
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6 h |
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1. We’re talking about South Africa. 2. Circumcision rates in the U.S. were in the 60s% range in the 1970s. Never 90s%.
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peter kilmarx
@PeterKilmarx
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7 h |
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*said
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peter kilmarx
@PeterKilmarx
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9 h |
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Where's the promotion in the USA? AAP and CDC say that the benefits outweigh the risks, but it's up to the parents.
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peter kilmarx
@PeterKilmarx
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9 h |
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1. Much less HIV in USA than Africa, so studies and implementation done there.
2. Most HIV transmission in U.S. through male-male sex, circumcision is not recommended.
3. Comparisons of multiple countries circumcision and HIV rates confirm protection: link.springer.com/article/10.118…
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peter kilmarx
@PeterKilmarx
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9 h |
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In this rigorous study published in a high-quality scientific journal, the annual HIV incidence was 0.5% in circumcised men 3.5-fold lower than in uncircumcised men (1.73%).
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peter kilmarx
@PeterKilmarx
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10 h |
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Actually, we do. "43% decline in the overall incidence rate between 2012 and 2017. Men experienced an earlier and larger incidence decline than women (59% vs. 37% reduction), consistent with circumcision scale-up and higher levels of female ART." nature.com/articles/s4146…
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peter kilmarx
@PeterKilmarx
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peter kilmarx
@PeterKilmarx
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10 h |
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Happy to explain difference between incidence and prevalence. The incidence of new HIV infections in South Africa has declined from 450,000 in 2007 to 240,000 in 2018. Circumcision is part of the decline. The prevalence increase is in large part due to decreased AIDS deaths.
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peter kilmarx
@PeterKilmarx
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10 h |
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It reduces the *relative* risk by 100%. It does not reduce the *absolute* risk by 100%. That would mean the man's risk of HIV infection was 100%, which it is not. Here's an explanation: catie.ca/en/pif/summer-…
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peter kilmarx
@PeterKilmarx
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11 h |
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We're making a difference. Infection rates in Eastern and Southern Africa are down 28% owing to multiple interventions, including male circumcision.
unaids.org/sites/default/…
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peter kilmarx
@PeterKilmarx
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11 h |
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Men shouldn't have sex without a condom with a potentially infected partner, and yet they do. If you could reduce the number of chambers with bullets by 60%, wouldn't you wan to?
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peter kilmarx
@PeterKilmarx
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11 h |
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If men wore condoms 100% of the time, we there wouldn't be a role for circumcision. But they don't. And there is. My logic is fine, which it why WHO and Ministries of Health in Africa are implementing.
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peter kilmarx
@PeterKilmarx
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12 h |
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If they are practicing abstinence, they aren't having intercourse! Per act risks of HIV infection: ncbi.nlm.nih.gov/pmc/articles/P…
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peter kilmarx
@PeterKilmarx
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12 h |
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Specious argument. Same issue as airbags and seat belts. Both reduce risk. If people were perfect condom users or abstainers, we wouldn't have epidemics of HIV and other STD, but they aren't, and we do.
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peter kilmarx
@PeterKilmarx
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12 h |
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The risk of *having* intercourse with someone practicing abstinence is zero!
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