Mounting evidence shows that male circumcision dramatically reduces the risk of HIV infection, at least for heterosexual males.
According to researchers writing in a 2009 issue of AIDS Patient Care and STDs, the prophylactic effect of male circumcision is owed to the following physical facts:
There are high densities of HIV target cells in the inner mucosal surface of the human foreskin … These HIV target cells lie beneath a protective layer of keratin, which is absent on the inner surface of the prepuce. By removing all or part of the foreskin, circumcision reduces both the number and susceptibility of target cells to HIV infection.
Since 2007, several randomized clinical trials have established that male circumcision could lower the risk of HIV acquisition in heterosexual men by as much as 62 percent. Sixty-two percent! So far, these studies have been limited to African populations that have been particularly hard-hit by AIDS-related casualties. In South Africa, a third of reproductive-aged women are infected. If you’re a 15-year-old living in that country today, there’s a 59 percent chance that you’ll die before reaching your 60th birthday; just 10 years ago, these odds were only 29 percent.
Here’s how the clinical trials basically worked. Thousands of adult, HIV-negative, sexually active, uncircumcised men in Kenya, Uganda and South Africa agreed to be randomly assigned to a circumcision group or a no-circumcision group. Those randomly assigned to the circumcision group had their foreskins removed by medical professionals, were told to abstain from intercourse until their wounds healed (about three weeks—there may actually be a greater risk of HIV infection during this period, so this is vital), and then were instructed to return to the clinic at six-month intervals to test for the virus. The results were unequivocal: two years later, the circumcised males were significantly less likely than their uncircumcised peers to have contracted HIV. In fact, the researchers decided to end these clinical trials early for ethical reasons: with data so clearly showing the advantages of circumcision in an environment rife with the virus, it’s hard to justify a further wait-and-see approach for those men that had been randomly assigned to the no-circumcision group.
For the Ugandan study, 22 of 2,387 circumcised men acquired HIV over the two-year period compared to 45 of 2,430 uncircumcised men who were infected during this time span. Extensive interview methods confirmed that the two groups did not differ in terms of their actual sexual behaviors, enabling the authors to conclude that the results were owed directly to the circumcision intervention. (For those data heads among you, P < 0.00001.) These numbers may not sound massive, but note that they refer to only a 24-month period; over a lifetime, they would become dramatic.
In fact, using the results from the South African study, one group of computer modellerscrunched these numbers to find out how many lives mass neonatal male circumcision could potentially save in this region over a 10-year period. They concluded that male circumcision could save the lives of 300,000 people in Southern Africa alone. Move forward 20 years, they pointed out, and 2 to 7 million deaths could be averted.
It’s presently unknown whether homosexual males would also benefit from circumcision. The studies simply haven’t been done. But Beijing STD specialist Yuhua Ruan and colleagues suspect that circumcision would protect insertive partners (“tops”) against HIV much more than it would receptive partners (“bottoms”). This is because the anal mucosa is highly susceptible to trauma and so the risk of HIV infection through receptive anal sex is very high. The lesser benefit served by being on the receiving end might also apply to heterosexual couples, however. A study published in The Lancet last year found that circumcision in HIV-infected men from Uganda appeared to offer no protection against the virus to their female partners. Thus, although it’s too soon to tell, the real benefits of circumcision may be reserved primarily for heterosexual men or insertive gay men. But that’s still a lot of people whose foreskins may be compromising their health.
In a 2007 report in The Lancet, UCLA infectious disease specialist Sharif Sawires and his colleagues put it bluntly:
In regions where high HIV prevalence exposes the population to risks that have a devastating effect on entire societies, the risks associated with male circumcision could be outweighed by the potential lives saved …
We encourage multicultural, bilateral, and government agencies, along with non-governmental organizations to make this life-saving strategy affordable and safely available to relevant populations bearing the heaviest burden.
These authors certainly aren’t alone in endorsing male circumcision on HIV-preventative grounds. It is now being recommended as a crucial, relatively simple tool against the threat of AIDS by the World Health Organization and UNAIDS. Importantly, of course, these experts also hastily point out that circumcision is just one effective strategy and must be used in conjunction with other preventative measures such as condoms and education.
Nine members of a Christian militia group, Hutaree, were charged Monday with plotting to kill a police officer and slaughter scores more with homemade bombs. According to the indictment, the actions were done in hopes of igniting an uprising against the U.S. government.
News of this terror plot is likely to spark a great deal of discussion around the idea of domestic terrorism. But there are some things that are not likely to be part of that discourse. For example, we’re not likely to hear experts discussing whether or not Christian doctrine teaches its followers to overthrow governments and kill people. And, although the Hutaree website quotes scripture passages that allude to battle and sacrificing lives for the greater cause, the Bible is not likely to become condemned for inspiring acts of terror.
Hutaree means “Christian Warrior,” yet the American public is not likely to blame Christianity. And Homeland Security probably isn’t going to single out all people with Christian names in the airport security line. The FBI most likely isn’t going to start wire-tapping Churches and Christian homes, and it’s unlikely that the whole world will be expecting every peace-loving Christian to apologize for actions they had nothing to do with — just because it was done in their name.
Unfortunately, these rules do not apply to Muslims. When a Muslim commits a crime, the Quran goes on trial. For example, after the failed “Christmas bombing,” a January Wall Street Journal piece highlighted the fact that Umar Farouk Abdulmutallab had studied at the San’a Institute for Arabic Language. “He knew how to read and write in Arabic because he had learned to read the Quran being a Muslim, but his speaking abilities were very limited,” recalls Mohammed Al-Anisi, the institute’s director. Abdulmutallab may have also studied French poetry as a student, but that probably wouldn’t have been considered relevant to his crime. The study of the Quran and Arabic, on the other hand, seems to be.
If there’s news of a Muslim terrorist, Islam becomes complicit in the crime. Yet few people are going to accuse Christianity of motivating the terrorism of the Hutaree militia. These Christian terrorists are considered violent criminals who’ve perverted a peaceful religion.
Muslim terrorists, on the other hand, are just following a violent, perverted religion. A Christian terrorist is considered violent in spite of his or her faith, whereas a Muslim is violent because of it. Some might claim that this assumption is because the Quran is full of violent passages while the Bible teaches only peace and love. But in a recent NPR piece, religion historian Philip Jenkins explained that in fact there is more violence in the Bible than in the Quran. “Much to my surprise, the Islamic scriptures in the Quran were actually far less bloody and less violent than those in the Bible,” Jenkins said. He explained that violence in the Quran is largely defensive.
“By the standards of the time, which is the seventh century A.D., the laws of war that are laid down by the Quran are actually reasonably humane,” says Jenkins. “Then we turn to the Bible, and we actually find something that is for many people a real surprise. There is a specific kind of warfare laid down in the Bible which we can only call genocide.”
Are we now going to create a new brand of crime called “Christian terrorism”? Is the entire Christian community going to be put on the defensive, while media pundits begin the mantra: “Why aren’t Christians condemning acts of terrorism?” Probably not. The question is: why should someone named Christopher need to condemn the acts of the Hutaree militia any more than someone named Mohammad does? And why should Mohammed be expected to condemn the acts of the “Christmas bomber” any more than Christopher?
As FBI agent Andrew Arena said, Hutaree is just “an example of radical and extremist fringe groups which can be found throughout our society.” Their crimes are committed in spite of their religious affiliations — not because of them.
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Green city planned for the desert
Abu Dhabi has started to build what it says is the world’s first zero-carbon, zero-waste car-free city.
Masdar City will cost $22bn (£11.3bn), take eight years to build and be home to 50,000 people and 1,500 businesses.
The city will be mostly powered by solar energy and residents will move in travel pods running on magnetic tracks.
Abu Dhabi has one of the world’s biggest per capita carbon footprints and sceptics fear Masdar may be just a fig leaf for the oil-rich Gulf emirate.
Others fear Masdar City – on the outskirts of Abu Dhabi City – may become a luxury development for the rich.
The project is supported by global conservation charity, the WWF.
Less power, less water
The city will make use of traditional Gulf architecture to create low-energy buildings, with natural air conditioning from wind towers.
Water will be provided through a solar-powered desalination plant, Masdar says. The city will need a quarter of the power required for a similar sized community, while its water needs will be 60% lower.
An artist’s impression of a Masdar City transport pod
The city forms part of an ambitious plan to develop clean energy technologies.
In January, the government of Abu Dhabi announced a $15bn five-year initiative to develop clean energy technologies, calling it “the most ambitious sustainability project ever launched by a government”.
As part of the plan, Abu Dhabi will become home to the world’s largest hydrogen power plant.
The money is being channelled through the Masdar Initiative, a company established to develop and commercialise clean energy technologies, and Abu Dhabi hopes it will lead to international joint ventures involving much more money.
Abu Dhabi will invest $4bn of equity in the project and borrow some of the rest, Masdar said.
“We are creating an array of financial vehicles to finance the $22bn development,” Masdar chief executive officer Sultan al-Jaber told Reuters news agency.
“We will monetise all carbon emission reductions… Such innovative financing has never been applied to the scale of an entire city.”
Masdar: Abu Dhabi’s carbon-neutral city
By Tom Heap
Presenter, Radio 4′s Costing The Earth
The world’s first zero-carbon city is being built in Abu Dhabi and is designed to be not only free of cars and skyscrapers but also powered by the sun.
The oil-rich United Arab Emirates is the last place you would expect to learn lessons on low-carbon living, but the emerging eco-city of Masdar could teach the world.
FIND OUT MORE
At first glance, the parched landscape of Abu Dhabi looks like the craziest place to build any city, let alone a sustainable one.
The inhospitable terrain suggests that the only way to survive here is with the maximum of technological support, a bit like living on the moon.
The genius of Masdar – if it works – will be combining 21st Century engineering with traditional desert architecture to deliver zero-carbon comfort. And it is being built now.
Masdar will be home to about 50,000 people, at least 1,000 businesses and a university.
It is being designed by British architects Foster and Partners, but it is the ruler of Abu Dhabi, Sheikh Khalifa bin Zayed Al Nahyan, who is paying for it. And it will cost between £10bn ($15bn) and £20bn ($30bn).
The architects are turning the desert’s greatest threat – the sun – into their greatest asset.
The quality of air will be better than any other street in the Gulf and in the world, and that alone will bring you safety, health and happiness
Kaled Awad, director of the Masdar project
They have built the biggest solar farm in the Middle East to power the city and to offset the inevitable burning of diesel and baking of cement in construction.
They are also experimenting. One project involves a circular field of mirrors on the ground, all reflecting towards a tower in the middle.
That, in turn, bounces the light down in a concentrated beam about a metre (3ft) wide to produce heat and drive generators.
But I was told firmly not to wander over and feel the warmth, as it could fry me in seconds.
The international team of engineers have real pride in their work.
This is more than building to them, it is a lab bench with the freedom to get it wrong, and Masdar’s chief architect Gerard Evenden loves the concentration of expertise: “What Abu Dhabi is beginning to generate is the Silicon Valley of renewable energy.”
The Emirates have seen one of the world’s most spectacular building booms paid for by oil and made tolerable by air conditioners, which also depend on oil to feed their vast appetite for energy.
Lunar technology has begun to influence our thinking
Gerard Evenden, architect
But Masdar will have to be low temperature and low carbon.
Part of the solution is apparent the moment you walk in. And you do “walk in” because this is a city surrounded by a wall, a defined boundary.
Unlike the upward and outward sprawl of Dubai or Abu Dhabi, Masdar is compact like ancient Arab cities.
Streets are narrow so buildings shade each other, and the walls and roofs of buildings will do their bit to shed heat too.
The vertical faces are dressed with screens which look like a terracotta mesh. They keep the sun out but let the breeze in.
And as architect Gerard Evenden says: “Lunar technology has begun to influence our thinking.”
One idea being tested is using a thin foil surface covering, a gas or vacuum blanket, to keep the heat out. It is an idea dreamt up for a moon base.
To encourage a breeze, wind towers are being built, drawing draughts through the streets without using energy.
Masdar will still use electricity for gadgets, some air conditioning and, most crucially, to desalinate sea water but, when it comes to power, the city has a simple mantra: “Only use energy when you have exhausted design.”
Conventional cars must be checked in at the city gates and then you can choose between the oldest and newest modes of transport.
At street level, it is all pedestrianised and the planners have done their best to keep the city compact and foot-friendly.
But if fatigue overtakes you, then slip down a level and meet the Personal Rapid Transit or podcars.
These driverless vehicles are guided by magnetic sensors, powered by solar electricity, and they stop automatically if an obstacle appears. They are programmed to go where you ask.
Kaled Awad, director of the Masdar project claims: “The quality of air will be better than any other street in the Gulf and in the world, and that alone will bring you safety, health and happiness.”
The future success of the project will be clear to see.
On top of the wind tower, there will be a beacon betraying the city’s actual energy use: red for too much, blue for just right.
It will be 45m (147ft) up and visible for miles around so, when Masdar is finished in five to 10 years’ time, we will all know if it is in the red.
Costing The Earth: Eco-City Limits will be broadcast on Monday 29 March at 2100 BST on BBC Radio 4 and will be available on the BBC iPlayer.