Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns. Journal of Law & Medicine. 19(2):316-34, 2011 Dec.
Abstract
“In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventive measure based on three sub-Saharan African randomised clinical trials (RCTs) into female-to-male sexual transmission. A related RCT investigated male-to-female transmission. However, the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered. Why were the trials carried out in countries where more intact men were HIV-positive than in those where more circumcised men were HIV-positive? Why were men sampled from specific ethnic subgroups? Why were so many participants lost to follow-up? Why did men in the male circumcision groups receive additional counselling on safe sex practices? While the absolute reduction in HIV transmission associated with male circumcision across the three female-to-male trials was only about 1.3%, relative reduction was reported as 60%, but, after correction for lead-time bias, averaged 49%. In the Kenyan trial, male circumcision appears to have been associated with four new incident infections. In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain.”
If the WHO/UNAIDS really wants to turn the epidemic tide, distribute free condoms!
James Pate, MD 
Thank you Dr. Pate for your very concise summary of the circumcision to “prevent AIDS” situation.
Yours is an informed and refreshing truth compared with Daniel Halperin’s propaganda book, Tinderbox in which, gosh oh gee on just about every other page, guess what’s going to solve the AIDS epidemic in Africa?
The underlying motivations of those promoting genital cutting as the solution to AIDS have yet to be exposed.
I hope you and your readers will take the time to read that very disturbing book and review and rate it accordingly on Amazon.
Thank you for continuing to bring this issue forward.
LikeLike
Your headline should read: Circumcision research not conclusive concerning HIV transmission.
The article you quote points evidence to HIV reduction as correlating to increased circumcision, but certain parts remain inconclusive. There is uncertainty, and there are valid questions raised to how the research was conducted. Your article states:
“While the absolute reduction in HIV transmission associated with male circumcision across the three female-to-male trials was only about 1.3%, relative reduction was reported as 60%, but, after correction for lead-time bias, averaged 49%. In the Kenyan trial, male circumcision appears to have been associated with four new incident infections. In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men.”
The first part says there has been reduction, and the following phrase is inconclusive. 61% increase of what? Female partners are having consensual unprotected sex with HIV infected men? Or protected? Let’s see, there were four new cases of women contracting AIDS with HIV infected partners. Circumcised or not, HIV infected is HIV infected. The concluding statement says that male circumcision may correlate with reckless behavior, fair enough, that’s a danger, but the article remains uncertain, and yet you rubber stamp it with a headline of your own making. You forcing a conclusion makes you come across as a biased quack and a demagogue incapable of objective research.
LikeLike
Thank you for your thoughts, Caleb, however I disagree with your conclusions. The title of this post is 100% accurate. “Circumcision does not prevent HIV” — it does not take a rocket-scientist or even a double-blind randomized controlled trial to come to this conclusion. The only thing that will stop the pandemic is education and safer-sex practices which above all include barrier method contraception — CONDOMS.
You are correct in stating that the evidence regarding the effect of circumcision on the transmission of HIV is inconclusive. This article concludes that circumcision as a public health measure in Africa may (not “does”) increase the rate of HIV transmission. Likewise, my summation that circumcision “… may [not “does”] increase it” is also accurate.
I do not deny the fact that I am biased against circumcision however I did not “rubber-stamp” anything. Should you be interested in reading this article in detail, then by all means click on the link to purchase it and read it yourself.
Though I post summaries to articles that question the therapeutic benefit of circumcision, this does not make me a “quack”.
A demagogue is “a leader who makes use of popular prejudices and false claims and promises in order to gain power.” Why you think this applies to me is truly beyond me.
And though you assert that I am “incapable of objective research”, you have nothing on which to base this claim other than self-delusion and loads of hot air. Good luck with that.
LikeLike
I think that even if circumcision did snagificnitly reduce the HIV transmission rate in consenting adult men in Africa practicing unsafe sex under unsanitary conditions and dangerous cultural beliefs (and even that is a BIG if ), I don’t think that research is remotely applicable to performing circumcision on non-consenting American infants, growing up with easy access to sanitation of all forms and condoms, in a culture where no one believes sex with a virgin cures AIDS. Of course, circumcision offers no protection for women or gay men, either, or any protection for needle drug users, which means that the most common methods of transmission and the groups with the highest infection rate in the US wouldn’t benefit, anyway. All of this is irrelevant to me, anyway, as I think it’s a basic violation of human rights and human decency to perform elective, cosmetic surgery (often unanesthetized) on an infant. Cutting parts off babies without dire, immediate need is wrong. Why does the argument need to past that?
LikeLike
Honestly, I cannot understand how any fairly educated person can conclude that by removing a piece of skin from their genitalia; they are somehow better protected from AIDS. I’ve read all the supposed research and while I admit that I am not a rocket scientist; I couldn’t see the correlation. In fact the research, to me, seemed rather faulty and biased. If circumcising men reduced AIDS transmission than wouldn’t circumcising women be beneficial as well. By circumcising women; I of course mean cutting away the clitoral hood, not the clitoris or labia. Considering that the two parts are made from the same tissue; the results should be the same. However, no one recommends protection women by doing this. It’s also funny how in Europe the rate of AIDS seems lower and overall penile health seems to be better than ours. For those who do not realize this; Europe is mostly made up of intact men.
I have 3 sons and I kept them all intact. I could not find one iota of research that I felt justified mutilating my children. I decided that these children will once be men and have a God-given right to their body as it was presented at birth. My children are not owned by me; rather on lend to me until they are adults. With this I felt it was my obligation to protect them from unnecessary societal practices ranging from circumcision, routine birth practices and vaccinating. Honestly I am not the one who has to go around my whole life with a maimed organ and I will not suffer any consequences of my choices regarding their body; thus I thought it safer to take the approach of not doing permanent things to my children; especially their genitalia. Also I find RIC barbaric and sick. To alter a childs genitalia to ones liking just screams of pedophilia; in my opinion,
LikeLike
I am originally from England, where it is unmmocon for men to BE circumcised unless for some religious or medical reason. Don’t get it, doesn’t need to happen and if I have a son, I really don’t want it done to them.
LikeLike
Muslims and Jews wash their genitals after urinating, So Imagine how many times they clean their genitals everyday. They wash their whole body after sex. That is the real reason why they are low in HIV infection. Plus they do not mainly have many partners and they do not have mainly homosexuality.
Instead of circumcision not provide condoms but simply teach to wash genitals after urinating and wash genitals + taking a shower after sex and you reduce all STDs.
LikeLike
Thank you for reading and commenting. Personal hygiene is an excellent preventative measure to minimize infection risk, however it is not 100% effective. STDs in particular not only have an affinity for tissue of the genitourinary tract but have evolved to be especially effective at latching on, breeding and causing infection. Think of larger parasites like leeches and tapeworms. No amount of hygiene or water is going to get rid of these entities once they have latched on. All they need is a point of entry and that’s exposure. The only way to reduce your risk of catching STDs is to practice monogamy with a trustworthy partner (remember, 25% of couples have at least one person who cheats) and/or to use barrier contraception such as condoms.
LikeLike