September 2009 Newsletter

"Leap and the net will appear!"

Officials Weigh Circumcision to Fight H.I.V. Risk
By RONI CARYN RABIN

Public health officials are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.
The topic is a delicate one that has already generated controversy, even though a formal draft of the proposed recommendations, due out from the Centers for Disease Control and Prevention by the end of the year, has yet to be released.
Experts are also considering whether the surgery should be offered to adult heterosexual men whose sexual practices put them at high risk of infection. But they acknowledge that a circumcision drive in the United States would be unlikely to have a drastic impact: the procedure does not seem to protect those at greatest risk here, men who have sex with men.
Recently, studies showed that in African countries hit hard by AIDS, men who were circumcised reduced their infection risk by half. But the clinical trials in Africa focused on heterosexual men who are at risk of getting H.I.V. from infected female partners.
For now, the focus of public health officials in this country appears to be on making recommendations for newborns, a prevention strategy that would only pay off many years from now. Critics say it subjects baby boys to medically unnecessary surgery without their consent.
But Dr. Peter Kilmarx, chief of epidemiology for the division of H.I.V./AIDS prevention at the C.D.C., said that any step that could thwart the spread of H.I.V. must be given serious consideration.
“We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic,” Dr. Kilmarx said. “What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.”
He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, because it spreads through different routes and because the health systems are so disparate as to be incomparable.
Clinical trials in Kenya, South Africa and Uganda found that heterosexual men who were circumcised were up to 60 percent less likely to become infected with H.I.V. over the course of the trials than those who were not circumcised.
There is little to no evidence that circumcision protects men who have sex with men from infection.
Another reason circumcision would have less of an impact in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.
But newborn circumcision rates have dropped in recent decades, to about 65 percent of newborns in 1999 from a high of about 80 percent after World War II, according to C.D.C. figures. And blacks and Hispanics, who have been affected disproportionately by AIDS, are less likely than whites to circumcise their baby boys, according to the agency.
Circumcision rates have fallen in part because the American Academy of Pediatrics, which sets the guidelines for infant care, does not endorse routine circumcision. Its policy says that circumcision is “not essential to the child’s current well-being,” and as a result, many state Medicaid programs do not cover the operation.
The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics.
He said the academy would probably stop short of recommending routine surgery, however. “We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,” he said. But, he said, the value of circumcision for H.I.V. protection in the United States is difficult to assess, adding, “Our biggest struggle is trying to figure out how to understand the true value for Americans.”
Circumcision will be discussed this week at the C.D.C.’s National H.I.V. Prevention Conference in Atlanta, which will be attended by thousands of health professionals and H.I.V. service providers.
Among the speakers is a physician from Operation Abraham, an organization based in Israel and named after the biblical figure who was circumcised at an advanced age, according to the book of Genesis. The group trains doctors in Africa to perform circumcisions on adult men to reduce the spread of H.I.V.
Members of Intact America, a group that opposes newborn circumcision, have rented mobile billboards that will drive around Atlanta carrying their message that “circumcising babies doesn’t prevent H.I.V.,” said Georganne Chapin, who leads the organization.
Although the group’s members oppose circumcision on broad philosophical and medical grounds, Ms. Chapin argued that the studies in Africa found only that circumcision reduces H.I.V. infection risk, not that it prevents infection. “Men still need to use condoms,” Ms. Chapin said.
In fact, while the clinical trials in Africa found that circumcision reduced the risk of a man’s acquiring H.I.V., it was not clear whether it would reduce the risk to women from an infected man, several experts said.
“There’s mixed data on that,” Dr. Kilmarx said. But, he said, “If we have a partially successful intervention for men, it will ultimately lower the prevalence of H.I.V. in the population, and ultimately lower the risk to women.”
Circumcision is believed to protect men from infection with H.I.V. because the mucosal tissue of the foreskin is more susceptible to H.I.V. and can be an entry portal for the virus. Observational studies have found that uncircumcised men have higher rates of other sexually transmitted diseases like herpes and syphilis, and a recent study in Baltimore found that heterosexual men were less likely to have become infected with H.I.V. from infected partners if they were circumcised.
Copyright 2009 The New York Times Company

Video letter from Australian filmmaker

(Nicole was one of the organizers of Elena's workshop in Bellingen, Australia (see Elena's April newsletter in 'archives' on the home page of www.birthintobeing.com for the detailed blog about her magical adventures in OZ)

She made a splash by "Nappy Free" - a documentary promoting elimination communication, a diaper free infancy, where Dr. Sarah Buckley, was also interviewed, among many other moms and enthusiasts of common sense.

Here is the url for a video letter that was sent off today by Nicole, Lowanna and Olivia, three members of the Bellingen, Mid North Coast community to 20 Australian Parliamentarians:

  Watch Video

We hope that the politicians who watch it may be influential in positively shaping the legislation, keeping Homebirth legal.

New documentary "Reducing Infant Mortality"

New documentary "Reducing Infant Mortality" by Debby Takikawa, Director and Shelly Campbell, Producer - available to watch here: www.reducinginfantmortality.com

This is a free film. Please use it, show it, put it on your website, link to it, and most of all, send the link to policy makers. Send it to your State and National Senators and Representatives. Until the end of August, your representatives and senators are in their home offices. This is the perfect time to make an appointment to see your legislator and talk to them personally. Can you imagine if 10 people from your district insist on having an appointment to talk about maternal/infant health care in the next 2 weeks? What if we continue on,. making appointments and showing up to talk to their aides after they return to Washington? What if they each have many copies of Reducing Infant Mortlaity on their desks, and showers of emails with letters about the rights and needs of infants and women and links to the film? I can imagine this. Can you? This is one way we can make a material difference.
Send it to your local Health Department. Send it to your local Hospital. Send it to your State  Department of Health! (In Georgia, they requested a copy!) Link to it on Facebook and My Space! Post it on your favorite networking sites. It is open source which means you can use it any way you like as long as you don't change it or delete the credits. We are counting on you to use this film to help your voice to be heard.

To embed or share the video
go to www.vimeo.com and search "Reducing Infant Mortality" The thumbnail of the film comes up. Click on it and it goes full size. Put your cursor on the video and look on the right upper corner of the video and you will see the icons for embed and share. Click the one you want and follow directions. For support if you have trouble, call me 805-688-9877.

Take your passion outside the box!
Recruit people who don't yet know that they care. Most important of all send it to the people who need to know that you care:  your legislators.
The time has come for us to speak for our babies.
The time has come for us to support pregnant and birthing women.
The time has come to make the changes in our birthing policies that will allow women to safely give birth at the location of their choosing.
The time has come to care enough to see to it that all women receive the knowledge, support and respect they need to have a healthy baby.
The time has come for us to offer healthy choices to women and babies.
The time has come for us to stop unnecessary suffering. This is something that we can do.
With gratitude
Debby Takikawa
Director