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Author Topic: This.. This is just wrong.  (Read 2170 times)

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Offline PaladinTopic starter

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Offline PaladinTopic starter

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Re: This.. This is just wrong.
« Reply #1 on: May 08, 2010, 01:59:40 AM »
This is if you want to take action. I know I'm going to.


http://equalitynow.org/english/takeaction/newsalert/urgentalert_us_20100429_en.html

Offline Kip

Re: This.. This is just wrong.
« Reply #2 on: May 08, 2010, 02:30:43 AM »
I searched out the actual position paper by the APA to ensure that the detail is correct and, while it is accurate, I think it is also misleading as it has far too narrow a focus and doesn't really give the broad picture of the position statement.  I won't link the statement here just because of the age issues (although it can be easily found through a search on the APA site) and such but I will say that the position paper is a well thought out piece that argues strongly against female genital mutilation.

I can understand the reasons that they give for the nick/prick/whatever even if I don't agree with them or condone them in any way.  I think that there is no need for such an act although I don't come from a background where a need was felt to circumcise males let alone females.  From that perspective, APA members deal with a cultural and ethical divide when such requests are made and I'd hope they'd make the same decisions I would but I know not all will. 

So, from my personal perspective - I don't support such an act in any way whatsoever but I can reluctantly see the logic behind the position of the APA.  I'd hope that the future is one where such acts aren't even sought....

Offline Trieste

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Re: This.. This is just wrong.
« Reply #3 on: May 08, 2010, 09:09:45 AM »
Mutilation of genitals except by an adult person's own choice is abhorrent, whether it be circumcision, gender assignment surgery, or simple nicking. The religious practice of male circumcision needs to be attacked with the vehemence of female circumcision.

So.

Offline Beguile's Mistress

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Re: This.. This is just wrong.
« Reply #4 on: May 08, 2010, 09:33:27 AM »
Female Genital Mutilation in any form is abhorrent.  In this case I believe the AAP is offering families a choice to have a minor procedure performed that will satisfy their religious needs but leave the girl child intact.  It's similar to one of the reasons so many fought to have abortion legalized, which was to afford women access to a safe and clean environment for the procedure.  While the fight against FGM goes on girl children who have this done are spared the pain and suffering and future humiliation of the radical procedure.

One sentence in the article stood out for me.

Quote
The AAP should promote awareness-raising within FGM-practicing immigrant communities about the harms of the practice, instead of endorsing an internationally recognized human rights violation against girls and women."

I believe that by taking the position that they have the AAP is helping to shed more light on the issue of FGM.  They may be creating a controversy by appearing to support FGM but it is moving the discussion into a more public forum.

I'm against FGM 100% but rather than condemn the AAP I prefer to support those who are trying to eradicate FGM from the world.

Offline PaladinTopic starter

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Re: This.. This is just wrong.
« Reply #5 on: May 08, 2010, 10:23:14 AM »
Well I will certainly be sending a letter to the APA telling them what I think of this practice they are doing. I am supporting the movement against FGM whole heartedly.

Offline Oniya

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Re: This.. This is just wrong.
« Reply #6 on: May 08, 2010, 10:48:25 AM »
Mutilation of genitals except by an adult person's own choice is abhorrent, whether it be circumcision, gender assignment surgery, or simple nicking. The religious practice of male circumcision needs to be attacked with the vehemence of female circumcision.

So.

For those interested in this:  http://mgmbill.org

Online Silk

Re: This.. This is just wrong.
« Reply #7 on: May 08, 2010, 11:16:14 AM »
All genetal mutilation is unessersary and abhorrent, unless there is a medical nessesity in regards to it, it should not happen. But again its just one of those cases of "its religious so its ok" types of bullshit that needs to be stomped out.

Offline Trieste

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Re: This.. This is just wrong.
« Reply #8 on: May 08, 2010, 11:22:26 AM »
Silk, did you even bother to read the posts before yours? I think not. :P

Offline DarklingAlice

Re: This.. This is just wrong.
« Reply #9 on: May 08, 2010, 01:52:56 PM »
Mutilation of genitals except by an adult person's own choice is abhorrent, whether it be circumcision, gender assignment surgery, or simple nicking. The religious practice of male circumcision needs to be attacked with the vehemence of female circumcision.

So.

An important distinction needs to be made here. We do not continue to practice male circumcision due to its embrace by the Abrahamic cult. From the standpoint of the medical community it is not a religious decision (and indeed no medical decision should be influenced by religion). Male circumcisions has been shown to provide a significant reduced rate of sexually transmitted viral infections most notably HIV and HPV.

Female genital mutilation, on the other hand, can not be shown to have any medical basis or benefit, and as such the APA's accommodationalist attitude is abhorrent. Equality Now is attempting to make this sound worse than it is: The recommendation is couched in a release that is generally quite negative towards FMG, and appears as a suggestion on how to phase it out. Further, this release does not change the current laws against it, does not give paediatricians the right to perform any 'nicking' and I doubt will provide significant weight in any legal battle. That said, the idea that the APA wants to accommodate this barbaric practice at all reveals a sickening lack of ethical standards, and I do believe that they should revise their report post-haste. Medicine should be based on fact. If parents are uncomfortable leaving their daughter's genitals intact, the are clearly unfit to raise her.

Offline Beguile's Mistress

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Re: This.. This is just wrong.
« Reply #10 on: May 08, 2010, 02:04:26 PM »
@DarklingAlice - I would agree with you completely if it weren't for the fact that a hard line attitude toward the AAP and dismissal of their proposed practice will probably result in the mutilation of girl children and their pain, suffering and humiliation.  Parents who are not offered this 'token' ritual may feel compelled to have the traditional rite performed on their daughters.  I don't agree with either choice but when considering the welfare of the girl child I think it's better to accept the lesser of two evils until such time as FGM is outlawed around the world.



None of us have the right to tell another what to believe or how to worship and it takes a lot of courage to stand up to a practice such as FGM.  However, if you are immersed in that religion and culture it takes the courage to risk your life and that of your daughter to accept the AAP procedure in order to allow your girl child to grow up into a fully functioning woman.

Offline Trieste

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Re: This.. This is just wrong.
« Reply #11 on: May 08, 2010, 02:07:43 PM »
An important distinction needs to be made here. We do not continue to practice male circumcision due to its embrace by the Abrahamic cult. From the standpoint of the medical community it is not a religious decision (and indeed no medical decision should be influenced by religion). Male circumcisions has been shown to provide a significant reduced rate of sexually transmitted viral infections most notably HIV and HPV.

Should note that you said what I meant about the religion part, only you said it better than I did (since I didn't elucidate, that's not hard!). However, proponents of female circumcision have been touting its medical benefits as well as social and moral benefits for years. I believe the site to which Oniya linked up there has resource links to such things, although I didn't peel through it very closely (the legislation is something I've already supported in my state). Unless the foreskin itself is infected or some such, it really is none of the parents' business taking it off. Personally, I find circumcisions on par with unnecessary tonsillectomies that used to be so popular...

Female genital mutilation, on the other hand, can not be shown to have any medical basis or benefit, and as such the APA's accommodationalist attitude is abhorrent. Equality Now is attempting to make this sound worse than it is: The recommendation is couched in a release that is generally quite negative towards FMG, and appears as a suggestion on how to phase it out. Further, this release does not change the current laws against it, does not give paediatricians the right to perform any 'nicking' and I doubt will provide significant weight in any legal battle. That said, the idea that the APA wants to accommodate this barbaric practice at all reveals a sickening lack of ethical standards, and I do believe that they should revise their report post-haste. Medicine should be based on fact. If parents are uncomfortable leaving their daughter's genitals intact, the are clearly unfit to raise her.

Vehemently agreed.

Offline Sure

Re: This.. This is just wrong.
« Reply #12 on: May 08, 2010, 03:03:47 PM »
Quote
An important distinction needs to be made here. We do not continue to practice male circumcision due to its embrace by the Abrahamic cult. From the standpoint of the medical community it is not a religious decision (and indeed no medical decision should be influenced by religion). Male circumcisions has been shown to provide a significant reduced rate of sexually transmitted viral infections most notably HIV and HPV.

Actually, that's debatable at best. There are a number of studies saying it decreases the chances, a number saying it increases, and a number saying it does nothing. The same is true of FGC, there are studies saying it decreases chances, some saying it increases, some saying it does nothing. In both cases it has to be properly performed, of course. The AAP, AMA, AAFP, and AUA all say MGC may be beneficial but the evidence is not strong enough to outright state there are any benefits, or to recommend the procedure, and in all cases state there are risks that people must be made aware of. Which seems to be what this is saying, at least in part.

The prevalence of MGC is, I would have to say, purely cultural. And personally I feel anyone who supports MGC but finds FGC abhorrent is showing a form of cultural bias.

Honestly, so long as MGC is practiced, I can't really have a problem with FGC being offered, regardless of what I think of the two practices taken together. I really don't see the difference between the two. They are both procedures which may or may not prevent disease, which change the way a person experiences sex, are endorsed by a religion, and which are done without the consent of the individual most of the time.

Offline Oniya

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Re: This.. This is just wrong.
« Reply #13 on: May 08, 2010, 03:21:25 PM »
Actually, FGC is far more invasive than MGC (using your terms for clarity).  In FGC, the clitoris is removed, which would be the equivalent of cutting off the glans of the penis, not the foreskin.

Offline DarklingAlice

Re: This.. This is just wrong.
« Reply #14 on: May 08, 2010, 03:22:01 PM »
Should note that you said what I meant about the religion part, only you said it better than I did (since I didn't elucidate, that's not hard!). However, proponents of female circumcision have been touting its medical benefits as well as social and moral benefits for years. I believe the site to which Oniya linked up there has resource links to such things, although I didn't peel through it very closely (the legislation is something I've already supported in my state). Unless the foreskin itself is infected or some such, it really is none of the parents' business taking it off.

You well know that proponents of anything can tout medical benefits without that making them true (e.g. homoeopathy, colloidal silver, snake oil, etc). To the best of my knowledge there is no reputable research linking female genital mutilation to a medical benefit (if anyone knows of any I would be interested to read it). And social benefits (which I doubt exist) and moral benefits (which I know don't) cannot be the basis for medicine.

On the other hand, male circumcision can reduce HIV transfer rate by up to 50%. Further, male circumcision is far less physically debilitating than female circumcision. Even if there was a medical benefit to female circumcision, we would have to make a quality of life analysis that would differ for each practice. The level of threat is also different in different parts of the world. Despite being far too high for comfort, the risk of HIV exposure in the United States is far less than that in Africa of Asia, thus male circumcision for the prevention of HIV is of a commensurately lesser benefit.

In cases where there is a clear medical danger I believe that it is not only a parent's business, but also their duty to protect their child from that. I would see it as no different from getting any number of childhood vaccines. And I support the efforts of the several medical institutes attempting to introduce and popularize the concept of male circumcision in regions where the risk of HIV transfer is critically high.

Personally, I find circumcisions on par with unnecessary tonsillectomies that used to be so popular...

Personally, I would draw the parallel to the parenteral polio vaccine. A procedure children underwent at the decision of their parents which leaves a life-long scar. There is a time and place where medical benefits outweigh the disfigurement, but there is also a time when they do not. Maybe, America has moved past the need for male circumcision as it has moved past its need for the IPV, but it is apparent that there is a time and place where it is medically beneficial.

It is one of the most difficult areas of medical ethics to determine what procedures a parent can force on their child. And I am really not trying to advocate one way or the other here (in the case of the America and Western Europe). I just want a firm line drawn between male circumcision which is a procedure with a positive medical benefit, albeit one that incurs a life-long scar and minor loss of sensitivity, and female genital mutilation, which is a piece of superstitious nonsense whose quality-of-life impact far exceeds the cosmetic.

References:
Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A: Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2005,2(11):e298.

Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, Williams CF, Campbell RT, Ndinya-Achola JO: Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007, 369(9562):643-656.

Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ et al: Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007, 369(9562):657-666.

Actually, that's debatable at best. There are a number of studies saying it decreases the chances, a number saying it increases, and a number saying it does nothing. The same is true of FGC, there are studies saying it decreases chances, some saying it increases, some saying it does nothing.

Evidence? Would you care to provide some?
« Last Edit: May 08, 2010, 03:24:13 PM by DarklingAlice »

Offline DarklingAlice

Re: This.. This is just wrong.
« Reply #15 on: May 08, 2010, 03:35:36 PM »
@DarklingAlice - I would agree with you completely if it weren't for the fact that a hard line attitude toward the AAP and dismissal of their proposed practice will probably result in the mutilation of girl children and their pain, suffering and humiliation.  Parents who are not offered this 'token' ritual may feel compelled to have the traditional rite performed on their daughters.  I don't agree with either choice but when considering the welfare of the girl child I think it's better to accept the lesser of two evils until such time as FGM is outlawed around the world.



None of us have the right to tell another what to believe or how to worship and it takes a lot of courage to stand up to a practice such as FGM.  However, if you are immersed in that religion and culture it takes the courage to risk your life and that of your daughter to accept the AAP procedure in order to allow your girl child to grow up into a fully functioning woman.

And I really wish that there was a better option. I honestly don't know the single best course of action to take in dealing with this cultural issue. However, I want to re-iterate my point that it is a cultural issue and not a medical one. It is not the AAP's place to make cultural decisions. No procedure should be performed by a physician within their office as a medical professional that is not backed up by medical necessity. If this 'nicking' is really such a necessity for the quashing of the practice of FMG (and I do not believe that it is, even the AAP notes that zero-tolerance policies and letting families know that their children will be permanently removed in the case of infraction have been shown to be successful), then set up a cultural office with training and professional standards whose duty it is to perform it. This is not medicine, it should not be performed by doctors. That is where I have to draw the line.

Offline Jude

Re: This.. This is just wrong.
« Reply #16 on: May 08, 2010, 04:36:22 PM »
An important distinction needs to be made here. We do not continue to practice male circumcision due to its embrace by the Abrahamic cult. From the standpoint of the medical community it is not a religious decision (and indeed no medical decision should be influenced by religion). Male circumcisions has been shown to provide a significant reduced rate of sexually transmitted viral infections most notably HIV and HPV.
Last I heard the science was split on that, actually.  It keeps going back and forth according to the studies I've read/heard discussed by the Science podcasts I listen to.

EDIT:  I know Wiki isn't a credible source, but was the simplest description of the study that the WHO uses to claim that circumcision helps to prevent the transfer of HIV that I could find:
Quote from: Wikipedia
Experimental evidence was needed to establish a causal relationship between lack of circumcision and HIV, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors.[155]  Trials took place in South Africa,[156]  Kenya[157]  and Uganda.[158]  All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group.[157]  The results showed that circumcision reduced vaginal-to-penile transmission of HIV by 60%, 53%, and 51%, respectively.[159]  A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and that 72 circumcisions would need to be performed to prevent one HIV infection. The authors also stated that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit.[160]
Sounds like a study based on pure correlation which alternative explanations could be offered for.  I'll dig up a study which claims the alternative and edit it in next...

EDIT2:  Concerning this study...
Quote from: The Lancet
""The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early. In a systematic review of RCTs stopped early for benefit, such RCTs were found to overestimate treatment effects. When trials with events fewer than the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11--73). The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation. We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done.".

EDIT3:  These seem to imply that if there is a benefit, it's not much.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960998-3/fulltext
http://jama.ama-assn.org/cgi/content/short/300/14/1674
« Last Edit: May 08, 2010, 04:47:34 PM by Jude »

Offline Sure

Re: This.. This is just wrong.
« Reply #17 on: May 08, 2010, 05:11:15 PM »
Quote
Actually, FGC is far more invasive than MGC (using your terms for clarity).  In FGC, the clitoris is removed, which would be the equivalent of cutting off the glans of the penis, not the foreskin.

How is it that they are equivalent? If you are saying it is because they are both glans then yes, but the two systems are apples and oranges. The clitoris and foreskin can both be removed without major damage to the functions of the organ from a reproductive and waste disposal standpoint, while the same is not true of the glans penis. Both also contain dense clusters of nerves, and reduce sexual pleasure.

And anything involving the female genitals will inherently be more invasive since male sexual organs aren't inside the body.

Quote
Evidence? Would you care to provide some?

About what, exactly, may I ask? I am not sure exactly which of my claims you are asking me to defend.

Offline Oniya

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Re: This.. This is just wrong.
« Reply #18 on: May 08, 2010, 06:38:54 PM »
How is it that they are equivalent? If you are saying it is because they are both glans then yes, but the two systems are apples and oranges. The clitoris and foreskin can both be removed without major damage to the functions of the organ from a reproductive and waste disposal standpoint, while the same is not true of the glans penis. Both also contain dense clusters of nerves, and reduce sexual pleasure.

The foreskin is just that - a sheath of skin.  The manner in which it affects male pleasure is by shielding the rest of the shaft from everyday stimulation, (which leaves it more sensitive when the foreskin is retracted) and by producing lubrication.  The corresponding portion of the female anatomy would be the 'hood' of the clitoris, or 'prepuce'.

Most women (something like 65%) are not capable of achieving orgasm without some clitoral stimulation.  Men, on the other hand, seem to be quite capable of achieving orgasm without a foreskin.

Offline Trieste

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Re: This.. This is just wrong.
« Reply #19 on: May 08, 2010, 06:46:31 PM »
... debating the merits of whether to amputate a body part sans consent of the person owning it based on whether or not it can produce an orgasm seems slightly misguided.  ::)

Offline Zakharra

Re: This.. This is just wrong.
« Reply #20 on: May 08, 2010, 06:55:40 PM »

On the other hand, male circumcision can reduce HIV transfer rate by up to 50%. Further, male circumcision is far less physically debilitating than female circumcision. Even if there was a medical benefit to female circumcision, we would have to make a quality of life analysis that would differ for each practice. The level of threat is also different in different parts of the world. Despite being far too high for comfort, the risk of HIV exposure in the United States is far less than that in Africa of Asia, thus male circumcision for the prevention of HIV is of a commensurately lesser benefit.

In cases where there is a clear medical danger I believe that it is not only a parent's business, but also their duty to protect their child from that. I would see it as no different from getting any number of childhood vaccines. And I support the efforts of the several medical institutes attempting to introduce and popularize the concept of male circumcision in regions where the risk of HIV transfer is critically high.

 How can male circumcision cut HIV transmission? The male is still going to go out and have sex. Transmission occurs anyways. In fact, a circumcised male, thinking he is protected, would be likely to have more sex. Thereby increasing his chances of catching HIV.

 If this is puushed by a religion,  it's full of crap.

 Religion/church: 'Cut off the foreskin of your penis and you willl be protected'

 [two possible reactions]
 1;   Male:  'Oh yeah! Chop it off!'  *proceeds to screw as many women as he can after he's healed, thinking he's protected*

 2;  Male: 'You want to do what with my cock? GTFO of here!'

Offline Sure

Re: This.. This is just wrong.
« Reply #21 on: May 08, 2010, 07:10:30 PM »
The foreskin is just that - a sheath of skin.  The manner in which it affects male pleasure is by shielding the rest of the shaft from everyday stimulation, (which leaves it more sensitive when the foreskin is retracted) and by producing lubrication.  The corresponding portion of the female anatomy would be the 'hood' of the clitoris, or 'prepuce'.

Most women (something like 65%) are not capable of achieving orgasm without some clitoral stimulation.  Men, on the other hand, seem to be quite capable of achieving orgasm without a foreskin.

You are partially incorrect. The foreskin does indeed correspond to the clitoral hood.

However the foreskin is not just a sheath of skin, it is packed with nerves far beyond what normal skin has and the band along the tip has some very unique features about it, distinct from the glans. The systems are not the same, and the comparison is apples to oranges.

And the only study I've ever seen about FGC and orgasms showed that, in a five year period, 90% of the women who were having regular sexual intercourse but who had undergone FGC orgasmed at some point. Can I ask where you got the 65% can't figure?

Offline Oniya

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Re: This.. This is just wrong.
« Reply #22 on: May 08, 2010, 07:41:37 PM »
http://www.sexualhealth.com/article/read/women-sexual-health/orgasm/486/  Second paragraph.

Also, research by Shere Hite (summarized in this Wiki entry.)

Offline Sure

Re: This.. This is just wrong.
« Reply #23 on: May 08, 2010, 07:49:50 PM »
Interesting... it's a general statement, though, and wholly uncited and doesn't detail a specific study of any sort.

Anyway, here's my source:
http://www.fgmnetwork.org/authors/Lightfoot-klein/sexualexperience.htm

Offline DarklingAlice

Re: This.. This is just wrong.
« Reply #24 on: May 09, 2010, 01:12:40 AM »
@Jude:
Did you even bother reading the three studies?

Also as for the wikipedia article you reference:
Quote
A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and that 72 circumcisions would need to be performed to prevent one HIV infection.
There are ~32,000,000 people in Uganda. ~1,000,000 of them have HIV and the sexes are at an almost 1:1 ratio. So, according to your source, and assuming these numbers stay constant, if we were to circumcise the men of Uganda we would reduce the # of HIV cases by almost 22%. For those keeping score that puts its efficacy at over half of the 30% reduction of the most promising vaccine we currently have. And all without the vaccine production and distribution costs or waiting period for drug trials.

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Sounds like a study based on pure correlation which alternative explanations could be offered for.
Really? What specific critiques can you offer of study methodology? What part of the articles to you take exception to? Where do you see the authors not full exploring the alternatives? I would love to know specifically what flaws these studies have, with citation from the text of the study itself.

You should cite your Lancet article. I have referenced three, separate, published, randomized control trials (and a 5 second pubmed search reveals a number of additional randomized control trials on this matter). So it seems suspect.

EDIT3:  These seem to imply that if there is a benefit, it's not much.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960998-3/fulltext
http://jama.ama-assn.org/cgi/content/short/300/14/1674
I'm going to assume you just missed this point. Circumcision is not going to effect the partner of the circumcised man. It is going to effect the person who underwent the procedure. The point is in keeping the men free of infection in the first place. Therefore studies about transmission from already HIV+ men to partners are irrelevant. That is not hard to understand.

Please look more closely at both my cited references and your own before spinning a slipshod argument.

@Zakharra: Circumcision makes it less likely for the circumcised man to contract HIV, not an already HIV+ man from passing it on. Please at least try to understand an argument and explore its references before responding.

This is my final word in this thread. I never intended to hijack it with a discussion of HIV and male circumcision (indeed I could have and should have used another, less hot-button STD for my example). If at all possible it should keep to its original topic of the AAP. If you have a problem with my claims, take it up with the Lancet and the Public Library of Science who published the results they are based on. If you are still not satisfied, PM me, but please make sure you have done your research first.