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'''{{Construction SiteFULLPAGENAME}}''' discusses the relationship of male '''circumcision and HIV''' infection. For a discussion of [[circumcision]] and other sexually transmitted infections, see [[Circumcision and STDs]].

Recently, circumcision has been heavily promoted as a method of preventing [[HIV]]. The [[cl:World Health Organization|World Health Organization]] (WHO) has , now known to be corrupted, hasitly endorsed male circumcision as a form of [[HIV ]] preventionin 2007, based on three recent studies (2005) & (2007) conducted in Africa (Kenya, South Africa, and Uganda) which claim that male circumcision is supposed to "reduce the risk of [[HIV ]] transmission by 60%."<ref>{{REFweb | quote= | url=http://www.who.int/hiv/topics/malecircumcision/en/ | title=Male circumcision for HIV prevention | last= | first= | publisher=World Health Organization | website= | date=20112007 | accessdate=2011-05-06

| last=Mazzotta | first=Meredith | coauthors= | url=http://sciencespeaksblog.org/2011/03/04/swaziland-embarks-on-ambitious-plan-to-circumcise-80-percent-of-men-18-to-49-this-year/ | title=Swaziland embarks on ambitious plan to circumcise 80 percent of men 18 to 49 this year | publisher= | work=Science Speaks: HIV & TB News | quote=The emphasis is on reaching 80 percent coverage with the Soka Uncobe campaign... | date=2011-03-04 | accessdate=2011-05-06}}</ref> and the promotion of male circumcision as a [[HIV]]-prevention method by the [[cl:Centers for Disease controlControl|Centers for Disease Control]] <ref>{{REFweb | quote= | url=http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm | title=Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States | last= | first= | publisher= | website= | date=February 2008-02 | accessdate=2011-06-01

| quote= | url=http://www.cdc.gov/botusa/Success-Stories/0307-MaleCircumcision-Botswana.htm | title=Success Stories: Male Circumcision: A Question and Answer Session | last= | first= | publisher= | website=[[CDC]] | date=March 2007-03 | accessdate=2011-06-01

| quote= | url=http://www.cdcnpin.org/Display/FundDisplay.asp?FundNbr=4285 | title=Funding | last= | first= | publisher= | website= | date=2011-01-09 | accessdate=2011-06-01

== Origin of the Circumcisioncircumcision/HIV Hypothesis hypothesis ==

The idea that [[circumcision ]] prevented [[HIV ]] transmission was invented by [[Valiere Alcena]], long before there was any "research" to substantiate the claim.<ref>{{REFjournal | last=Alcena | first=Valiere | coauthorsinit=V |author-link=Valiere Alcena | title=AIDS in Third World Countries | journal=PLoS MedicineN Y State J Med | volume= | issue=8 | pages=[online] | url=http://medicine.plosjournals.org/perlserv/?request=read-response&doi=10.1371/journal.pmed.0020298#r1326 | quote=446 | pubmedID= | pubmedCID=3463895 | DOI=10.1371/journal.pmed.0020298#r1326 | date=October 2006-10 | accessdate=2020-05-28}}</ref> In 1986, California urologist [[cl: Aaron J. Fink| Aaron J. Fink]], (1926-1994) adopted this idea,<ref>{{REFbook | last=Glick | first=LeonardB. |init=LB |author-link=Leonard B. Glick | year=2005 | title=Marked in Your Flesh | url= | work= | editor= | edition= | volume= | chapter="This Little Operation", Jewish American Physicians and Twentieth-Century Circumcision Advocacy | pagespage=206 | location=New York, New YorkNY | publisher={{UNI|Oxford University |Oxon}} Press | isbn=0-19-517674-X | quote=What if circumcision protected against infection with HIV... | accessdate=2011-02-19 | note=

| last=Weiss | first=Helen A. | coauthorsinit=HA |author-link=Helen Weiss |last2=Quigley, |first2=Maria A.; |init2=MA |last3=Hayes, |first3=Richard J. |init3=RJ | title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis | journal=AIDS | volume=14 | issue=15 | pages=2361–23702361-2370 | url=http://www.aidsonline.com/pt/re/aids/fulltext.00002030-200010200-00018.htm | quote= | pubmedID=11089625 | pubmedCID= | DOI=10.1097/00002030-200010200-00018 | date=October 2000 | accessdate=-10

In 1986, Fink sent a letter to the ''New England Journal of Medicine'' titled "A possible Explanation for Heterosexual Male Infection with [[AIDS]]," where he argued that the hard and toughened glans of the circumcised male resisted infection, while the soft and sensitive foreskin and glans [[mucosa ]] of the intact male were ports of entry.<ref>{{REFjournal |last=Fink, |first=Aaron J. |init=AJ |author-link=Aaron J. "Fink |title=A possible Explanation for Heterosexual Male Infection with AIDS." '' |journal=New England Journal of Medicine'' |volume=315, |issue=18 ( |year=1986) |page=1167 |url=https: 1167//www.nejm.org/doi/full/10.1056/NEJM198610303151818 |pubmedID=3762636 |}}</ref> Fink proposed in his letter: "I suspect that men in the United States, who, as compared with those in Africa and elsewhere, have had less acquisition of [[AIDS]], have benefited from the high rate of newborn [[circumcision ]] in the United States," regardless of the fact that the United States has one of the highest circumcision rates, and one of the highest [[HIV ]] rates, in the western (industrialized) world (compare with European countries, Canda, and Australia).<ref>{{REFweb | quote= | url=http://www.who.int/hiv/facts/hiv2003/en/ | title=A global view of HIV infection | last=WHO/UNAIDS | first= | publisher=[[World Health Organization | website=WHO/UNAIDS]] | date=2004 | accessdate=2011-02-27

| last=Glick | first=LeonardB. |init=LB |author-link=Leonard B. Glick | year=2005 | title=Marked in Your Flesh | url= | work= | editor= | edition= | volume= | chapter="This Little Operation", Jewish American Physicians and Twentieth-Century Circumcisoin Circumcision Advocacy | pagespage=207 | location=New York, New YorkNY | publisher={{UNI|Oxford University |Oxon}} Press | isbn=0-19-517674-X | quote=This is nothing I can prove. | accessdate=2011-02-19 | note=}}</ref> This didn't stop other physicians from conducting "research" leading to a steady stream of widely publicized articles arguing that circumcised men were less likely to contract [[HIV-]] -with the result that prevention of [[HIV ]] infection has now surpassed even cancer prevention as the most popular claim of circumcision advocates. 

| Title=Fink's Own Words | Text=This is nothing I can prove. | Author=[[Aaron J. Fink]] | Source="This Little Operation". ''Marked in Your Flesh.'' p.206-208

Alcena and Fink abandoned lacked a hypothesis to explain why the circumcision/foreskin would be an entry point for HIV controversy in 1991infection, but this was supplied by circumcision promoter [[Gerald N. Weiss]] and he died in 1994two colleagues. Weiss et al. He left behind an indelible legacy nonetheless; (1993) produced the circumcision/plausible but incorrect hypothesis that [[Langerhans cells]] attracted HIV hypothesis continues . A medical journal in [[Israel]] was willing to be supported publish the paper by researchers and scientists that are adopting his assertions and writing studies based upon them, and the campaign to establish a causal Weiss et al.<ref name="weiss1993">{{REFjournal |last=Weiss |first=Gerald N. |init=GN |author-link=Gerald N. Weiss |last2=Sanders |first2= |init2=M |author2-link= |last3=Westbrook |first3= |init3=KC |author3-link between HIV infection = |etal=no |title=The distribution and density of Langerhans cells in the presence human prepuce: site of the foreskin continues to this daya diminished immune response? |journal= Isr J Med Sci |location= |date=1993-01 |volume=20 |issue=1 |article= |page= |pages=42-3 |url= |archived= |quote= |pubmedID=8454447 |pubmedCID= |DOI= |accessdate=2022-10-28}}</ref>.

=== Debunked Ad-hoc Hypotheses =Early research==

Various hypotheses have been suggested in regards Hrdy (1987) identified numerous African cultural practices other than circumcision or non-circumcision that would contribute to the mechanism whereby circumcision prevents the tarnsmission spread of [[HIV]] infection. Such factors include:* Female circumcision and [[infibulation]].* Promiscuity. They have all been disproven, however, * Homosexuality and all anal intercourse.* Practices resulting in exposure to blood.* Practices involving the use of the shared instruments.* Contact with non-human primates.<ref name="studieshrdy1987" attempting >{{REFjournal |last=Hrdy |first=Danniel B |init=DB |etal=no |title=Cultural practices contributing to establish a causal link between circumcion and the transmission of human immunodeficiency virus in Africa |journal=Rev Infect Dis |date=1987-11 |volume=9 |issue=6 |pages=1109-19 |url=http://www.cirp.org/library/disease/HIV transmission remain unsubstantiated by a working hypothesis/hrdy1/ |pubmedID=3321361 |DOI=10.1093/clinids/9.6.1109 |accessdate=2021-05-12}}</ref>

Carael et al. (1988) studied [[HIV]] transmission among heterosexual couples in Central Africa. No difference was found between couples in which the male was circumcised and in which the male was intact.<ref name="carael1988">{{REFjournal |last=Carael |init=M |author-link= Hardened Skin Hypothesis |last2=Van de Perre |init2=PH |author2-link= |last3=LePage |init3=PH |author3-link= |last4=Allen |init4=S |author4-link= |etal=yes |title=Human immunodeficiency virus transmission among heterosexual couples in Central Africa |journal=AIDS |location= |date=1988-06 |volume=2 |issue=3 |pages=201-5 |url=http://www.cirp.org/library/disease/HIV/carael/ |pubmedID=3134914 |accessdate=2020-05-28}}</ref>

Perhaps de Vincenzi & Mertens (1994) reviewed the oldest hypothesis on literature regarding the mechanism whereby circumcision prevents alleged role of the [[foreskin]] in [[HIV]] transmission . They concluded:<blockquote>The potential public-health benefits of HIV is male circumcision have been greatly discussed in the theory past 50 years, often in a passionate and emotional manner. However, relatively few studies have been carried out and those that suggests that the keratinized surface have, present conflicting results. The major criticism of most of the penis in circumcised male resists infection, while studies preformed to date is the mucosa lack of the glans attention given to potential confounding factors, which could be related to both circumcision status and inner risk of the intact male are ports sexually transmitted infections, such as sexual behaviour or differences in hygienic practices, or differential use of entryspecific health facilities. As Poland [48] noted, which was purported by Aaron J. Fink"We must remember that circumcision is not performed randomly."

Recent studiesTherefore, however, disprove this hypothesisfurther efforts are still required to quantify the relative risk associated with the lack of male circumcision. One study found that there is "no difference between the keratinization Some of this can be achieved by using observational designs which better address the inner limitations discussed above. Laboratory and outer aspects of primate research might also continue to provide useful information. As the adult male foreskinsafety, expected benefits," feasibility and acceptability of mass circumcision are all questionable, neither public-health interventions nor intervention studies appear to be defensible options before there is stronger evidence from observational studies in different settings that "keratin layers alone were unlikely to explain why uncircumcised men are at higher show lack of male circumcision may be a genuinely independent risk factor for the transmission of [[HIV infection]]."<ref>{{REFjournal | last=Dinhde Vincenzi | first=MHIsabelle | coauthorsinit=McRaven MD, Kelley Z, Penugonda S, Hope TJI | titleauthor-link=Keratinization of the adult male foreskin and implications for male circumcision | journallast2=AIDSMertens | volumefirst2=24Thierry | issueinit2=6T | pages=899author2-906 | urllink=http://www.ncbi.nlm.nih.gov/pubmed/20098294 | quoteetal=We found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection. | pubmedIDtitle=20098294Male circumcision: a role in HIV prevention? | pubmedCIDjournal=AIDS | DOIdate=1994 | datevolume=2010-03-278 | accessdateissue=2011-06-28}}</ref> Another study found that "no difference can be clearly visualized between the inner and outer foreskin."''<ref>{{REFcontribution2 | contributionpages=HIV153-1 Interactions and Infection in Adult Male Foreskin Explant Cultures | quote=No difference can be clearly visualized between the inner and outer foreskin.60 | url=http://retroconferencewww.cirp.org/2009library/disease/HIV/PDFsvincenzi/502.pdf | title=16th Conference on Retroviruses and Opportunistic Infections (2009) | author=Dinh, Minh H.; Sheila M Barry, Meegan R Anderson, Scott G McCoombe, Shetha A Shukair, Michael D McRaven, Thomas J Hope | publisher= | placepubmedID=Montreal, Canada | pages= | date=2009-12-068043224 | accessdate=20112020-0605-2829

[[Robert Darby| Darby]] (2002) examined the claims that circumcision is preventive of infection with [[HIV]]. He tabulated the prevalence of circumcision and [[HIV]] infection in various nations. He found no connection between the prevalence of circumcision and [[HIV]] infection. Darby also compared the nineteenth century British attempts to control syphilis (then a dreaded and incurable disease) with male circumcision, which was equally unsuccessful.<ref name="darby2002">{{REFjournal |last=Darby |first=Robert |init= Langerhans Cell Hypothesis R |author-link=Robert Darby |url=https://pool.intactiwiki.org/w/images/2002-09_Darby-BeenThereDoneThat.pdf |title=Been There, Done That: Thoughts on the proposition that yet more circumcision can save the world from AIDS |journal=Australian Quarterly |date=2002-09 |volume=74 |issue=5 |pages=26-35 |accessdate=2021-05-08}}</ref>

Recent circumcision studies Thomas et al. (2004) studied the incidence of [[HIV]] in [[circumcised]] and [[intact]] men in Africa were conducted under the hypothesis that the Langerhans cells were the prime port a United States Navy population. A slightly higher incidence of entry [[HIV]] infection was found in circumcised men (84.9%) as compared with intact men (81.8%). The authors concluded:<blockquote>Although there may be other medical or cultural reasons for the male circumcision, it is not associated with [[HIV virus]] or STI prevention in this U. According to the hypothesisS. military population.<ref name="thomas2004">Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA. [http://www.cirp.org/library/disease/HIV/thomas1/ Prevalence of male circumcision was supposed to prevent and its association with HIV transmission by removing the Langerhans cells found and sexually transmitted infections in a U.S. Navy population]. Abstract no. TuPeC4861. Presented at the inner mucosal lining of the foreskinXV International [[AIDS]] Conference, Bangkok, Thailand, July 11-16, 2004.</ref></blockquote>

== Confounding factors == === Debunked ad-hoc hypotheses === Various hypotheses have been suggested in regards to the mechanism whereby circumcision prevents the tarnsmission of [[HIV]]. They have all been disproven, however, and all of the "studies" attempting to establish a causal link between circumcion and [[HIV]] transmission remain unsubstantiated by a working hypothesis. ==== Keratinization hypothesis ====Perhaps the oldest hypothesis on the mechanism whereby circumcision prevents the transmission of [[HIV]] is the theory that suggests that the [[Keratinization| keratinized]] surface of the penis in circumcised male resists infection, while the [[mucosa]] of the glans and inner of the intact male are ports of entry, which was purported by [[Aaron J. Fink]]. Recent studies, however, disprove this hypothesis. One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why [[uncircumcised]] men are at higher risk for [[HIV]] infection."<ref>{{REFjournal |last=Dinh |init=MH |last2=McRaven |init2=MD |last3=Kelley |init3=Z |last4=Penugonda |init4=S |last5=Hope |init5=TJ |title=Keratinization of the adult male foreskin and implications for male circumcision |journal=AIDS |volume=24 |issue=6 |pages=899-906 |url=http://www.ncbi.nlm.nih.gov/pubmed/20098294 |quote=We found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why [[uncircumcised]] men are at higher risk for HIV infection. |pubmedID=20098294 |pubmedCID= |DOI= |date=2010-03-27 |accessdate=2011-06-28}}</ref> Another study found that "no difference can be clearly visualized between the inner and outer foreskin."''<!-- <ref>{{REFcontribution |contribution=HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures |quote=No difference can be clearly visualized between the inner and outer foreskin. |url=http://retroconference.org/2009/PDFs/502.pdf |title=16th Conference on Retroviruses and Opportunistic Infections |author=Minh H Dinh; Sheila M Barry, Meegan R Anderson, Scott G McCoombe, Shetha A Shukair, Michael D McRaven, Thomas J Hope |publisher= |place=Montreal, Canada |pages= |date=2009-12-06 |accessdate=}}</ref>--> ==== Langerhans cell hypothesis ====Recent circumcision studies in Africa were conducted under the hypothesis that the [[Langerhans cells]] were the prime port of entry for the [[HIV]] virus. According to the hypothesis, circumcision was supposed to prevent [[HIV]] transmission by removing the Langerhans cells found in the inner [[mucosa]]l lining of the foreskin. deWitte found that not only are Langerhans cells found all over the body and that their complete removal is virtually impossible. Furthermore, but furthermore, deWitte found that Langerhans cells that are present in the [[foreskin ]] produce ''Langerin'', a substance that has been proven to kill the [[HIV ]] virus on contact, acting as a natural barrier to HIV-1 transmission by Langerhans cells.<ref>{{DeWitte etal 2007}}</ref> ==== Bacterial environment hypothesis ====This hypothesis attempts to identify the change in [[microbiome| bacterial environment]] that results in the [[penis]] as a result of [[adult circumcision]], as the mechanism whereby circumcision reduces the spread of [[HIV]] transmission. A desperate ad-hoc hypothesis, the explanation is rather farfetched. The argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflammation, a condition that facilitates the transmission of viruses. The chances for penile inflammation are reduced, thereby reducing the chances of sexually transmitted viruses, such as [[HIV]].<ref>{{REFjournal | last=de WittePrice | first=LotLance B. |init=LB | coauthorslast2=Alexey Nabatov, Marjorie Pion, Donna Fluitsma, Marein AW P de Jong, Tanja de Gruijl, Vincent Piguet, Yvette van Kooyk, Teunis B Liu |first2=Cindy M. |init2=CM |last3=Johnson |first3=Kristine E. |init3=KE |last4=Aziz |first4=Maliha |init4=M |last5=Lau |first5=Matthew K. |init5=MK |last6=Bowers |first6=Jolene |init6=J |last7=Ravel |first7=Jacques |init7=J |last8=Keim |first8=Paul S. |init8=PS |last9=Serwadda |first9=David |init9=D |last10=Wawer |first10=Maria J. |init10=MJ |last11=Gray |first11=Ronald H Geijtenbeek. |init11=RH |etal=yes | title=Langerin is a natural barrier to HIV-1 transmission by Langerhans cellsThe Effects of Circumcision on the Penis Microbiome | journal=Nature MedicinePLoS ONE | volume=5 | issue= | pages=1 | url=httphttps://wwwjournals.circumcisionandhivplos.comorg/filesplosone/de_Witte_2007article?id=10.pdf1371/journal.pone.0008422 | quote= | pubmedID= | pubmedCID=The anoxic microenvironment of the subpreputial space may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. Thus, the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases. | DOI=10.10381371/nm1541journal.pone.0008422 | date=2007-03-042010 | accessdate=2011-06-2829

Presenting this hypothesis presents a two-fold problem. First, it presents an irrelevant conclusion; the discredited randomized control trials were measuring frequency in [[HIV]] transmission, not for frequency in penile bacterial inflammation, and whether said inflammation facilitated sexually transmitted [[HIV]]. And secondly, circumcision advocates give themselves the new burden of proving the newly introduced hypothesis, that change in bacterial infection does indeed result in a significant reduction of [[HIV]] transmission. A new study is needed to measure [[HIV]] transmission in men who have been [[circumcised]], [[intact]] men with constant penile inflammations, and [[intact]] men who don't suffer constant penile inflammation. Unless the randomized controlled studies were limited to only [[intact]] men who suffered constant penile inflammation. ==The immunological function of the foreskin == Bacterial Environment Hypothesis  The [[foreskin]]'s inner fold and the [[glans]] of the penis are comprised of [[Preputial mucosa|mucous membrane]] tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These are the first line of immunological defense for the body's orifices. These mucous membranes perform many immunological and hygienic functions.  Certain components such as [[Langerhans cells]],<ref>{{REFjournal |last=Weiss |init=GN |last2=Sanders |init2=M |last3=Westbrook |init3=KC |url=http://www.circumstitions.com/Langerhans.html |title=The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response? |journal=Isr J Med Sci |date=1993-01 |volume=29 |issue=1 |pages=42-43 |accessdate=2019-10-20}}</ref> plasma cells,<ref name="flower1983">{{REFjournal |last=Flower |init=PJ |last2=Ladds |init2=PW |last3=Thomas |init3=AD |last4=Watson |init4=DL |url=https://journals.sagepub.com/doi/abs/10.1177/030098588302000206 |title=An immunopathologic study on the bovine prepuce |journal=Vet Pathol |date=1983-03 |volume=20 |issue=2 |pages=189-201 |accessdate=2019-10-20}}</ref> apocrine glands,<ref>{{REFjournal |last=Ahmed |init=A |last2=Jones |init2=AW |url=https://www.academia.edu/5687437/APOCRINE_CYSTADENOMA_A_REPORT_OF_TWO_CASES_OCCURRING_ON_THE_PREPUCE |title=Apocrine Cystadenoma: a report of two cases occurring on the prepuce |journal=Br J Dermatol |date=1969-12 |volume=81 |issue=12 |pages=899-901 |accessdate=2019-10-20}}</ref> and sebaceous glands,<ref>{{REFjournal |last=Hyman |init=AB |last2=Brownstein |init2=MH |title=Tyson's "glands": ectopic sebaceous glands and papillomatosis penis |journal=Arch Dermatol |date=1969-01 |volume=99 |issue=1 |pages=31-36 |accessdate=2019-10-20}}</ref><ref>{{REFjournal |last=Delbanco |init=E |title=Über das gehäufte Auftreten von freien Talgdrüsen an der Innenfläche des Präputiums |trans-title=About the increased occurrence of free sebaceous glands on the inner surface of the prepuce |language=German |journal=Monatshefte für praktische Dermatologie |date=1904 |volume=38 |pages=536-538 |accessdate=2019-10-20}}</ref><ref>{{REFjournal |last=Piccinno |init=R |last2=Carrel |first2=Ch.-F. |init2=CF |last3=Menni |init3=S |etal=yes |title=sebacous glands mimicking molluscum contagiosum |journal=Acta Derm Venerol |date=1990 |volume=70 |pages=344-345}}</ref><ref>{{REFjournal |last=Krompecher |first=St. |init=S |title=Die Histologie der Absonderung des Smegma praeputii |trans-title=Histology of allocation of a smegma praeputii |language=German |journal=Anatomischer Anzeiger |date=1932 |volume=75 |pages=170-176}}</ref>, collectively secrete emollient lubricants.<ref name="parkash-jeykumar1973">{{REFjournal |last=Parkash |init=S |last2=Jeykumar |init2=S |last3=Subramanyan |init3=K |last4=Chaudhuri |init4=S |url=http://www.cirp.org/library/anatomy/parkash/ |title=Human subpreputial collection: its nature and formation |journal=J Urol |date=1973-08 |volume=110 |issue=2 |pages=211-212 |accessdate=2019-10-20}}</ref> Apocrine glands perform a crucial function by secreting enzymes such as lysosomal enzymes, cathepsin B, chymotrypsin, and neutrophil elastase.<ref>{{REFjournal |last=Frohlich |init=E |last2=Shamburg-Lever |init2=G |last3=Klesses |init3=C |title=Immunelectron microscopic localization of cathepsin B in human apocrine glands |journal=J Cutan Pathol |date=1993-02 |volume=20 |issue=1 |pages=54-60}}</ref>  There is also some research to suggest that lysozyme may protect against HIV infection.<ref>{{REFweb |first=George |last=Hill |author-link=George Hill |url=http://www.cirp.org/library/disease/HIV/hill1/ |title=Summary of evidence that the foreskin and lysozyme may protect against HIV infection |date=2003-09-07 |accessdate=2019-10-20}}</ref> <ref name="fleiss-hodges-vanhowe1998" />

This hypothesis attempts to identify the change in bacterial environment that results in the penis as a result of circumcision, as the mechanism whereby circumcision reduces the spread of HIV transmission. A desparate ad-hoc hypothesis, the explanation is rather farfetched. The argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflamation, a condition that facilitates the transmission of viruses. The chances for penile inflamation are reduced, thereby reducing the chances of sexually transmitted virusesApocrine glands also produce cytokine, such as HIV.<ref>{{REFjournal | last=PriceAhmed | firstinit=Lance B.AA | coauthorslast2=Cindy M. Liu, Kristine E. Johnson, Maliha Aziz, Matthew K. Lau, Jolene Bowers, Jacques Ravel, Paul S. Keim, David Serwadda, Maria J. Wawer, Ronald H. GrayNordlind | titleinit2=The Effects of Circumcision on the Penis MicrobiomeK | journallast3=PLoS ONESchultzberd | volumeinit3=5M | issuelast4=1Liden | pagesinit4=S | url=httphttps://wwwlink.plosonespringer.orgcom/article/info:doi%2F1010.13711007%2Fjournal.pone.00084222FBF01105803 | quotetitle=The anoxic microenvironment Immunohistochemical localization of the subpreputial space may support proIL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands |journal=Arch Dermatol Res |date=1995 |volume=287 |issue=8 |pages=764-766 |accessdate=2019-10-20}}</ref> which is a very important non-inflammatory anaerobes antibody protein that can activate Langerhans generates immune response when in contact with specific agents. Plasma cells which increase in number in response to present HIV pathogens levels, secrete immunoglobulin.<ref name="flower1983"/>It is also very important to CD4 note that [[Langerhans cells ]] that are present in draining lymph nodes. Thusthe foreskin produce ''Langerin'', the reduction in putative anaerobic bacteria after circumcision may play a role in protection from substance that has been proven to kill human immunodeficency virus ([[HIV and other sexually transmitted diseases]]) on contact.<ref>{{REFjournal |last=de Witte | pubmedIDinit=L | pubmedCIDlast2=Nabatov | DOIinit2=10A |last3=Pion |init3=M |etal=yes |url=http://www.cirp.1371org/news/healthday2007-03-05/ |title=Langerin is a natural barrier to HIV-1 transmission by Langerhans cells |journal.pone.0008422=Nat Med | date=20102007-03 |volume=13 |issue=3 |pages=367-371 | accessdate=20112019-0610-2920

Presenting this hypothesis presents a two-fold problemAll of these function to sequester and “digest” foreign pathogens. First, it presents All these substances play an irrelevant conclusion; important role in protecting the randomized control trials were measuring frequency in HIV transmission, not for frequency in penile [[penis]] from viral and bacterial inflamation, and whether said inflamation facilitated sexually transmitted HIVpathogens. And secondly, circumcision advocates give themselves the new burden The immunological functions of proving the newly introduced hypothesis, that change in bacterial infection does indeed result in a significant reduction of HIV transmission. A new study is needed to measure HIV transmission in men who human [[prepuce]] have been circumcised, uncircumcised men with constant penile inflamations, and uncircumcised men who don't suffer constant penile inflamation. Unless the randomized controlled studies were limited to only uncircumcised men who suffered constant penile inflamationextensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998">{{FleissP HodgesF VanHoweRS 1998}}</ref>

==African RCTs == Countries Strong bias exists in the RCTs.<ref>{{REFjournal |last=Green |init=LW |etal=yes |title=Male circumcision is not the HIV 'vaccine' we have been waiting for! |url=https://www.arclaw.org/wp-content/uploads/Green-Circumcision-not-HIV-Vaccine-2008.pdf |format=PDF |journal=Future HIV Ther |date=2008 |volume=2 |issue=3 |pages=193–199}}</ref><ref>{{REFjournal |last=Montori |init=VM |last2=Devereaux |init2=PJ |last3=Adhikari |init3=NKJ |etal=yes |title=Randomized trials stopped early for benefit: a systematic review |url=https://d1wqtxts1xzle7.cloudfront.net/57167251/Randomized_Trials_Stopped_Early_for_Bene20180810-22454-13zq2zz.pdf?1533940688=&response-content-disposition=inline%3B+filename%3DRandomized_Trials_Stopped_Early_for_Bene.pdf&Expires=1615121597&Signature=JYjNyliXY07z-v1JvMYVTVJG9IXinNjHYEsmuOy5GWAvqugfhsIwpf~gDfqgLbvyVwGpOQ-6~k05ckod-TeM~zo7Ja-fy1p-mg027mlh~MxWCjgQXWVFenwNqHV6liaq~8fVHQ5aZNRkQnu170vW4faves-pNadzVaRo0CgAtr2dvzQ4hA8dXYHKEuMXMyAsOTjErY-1Zgurz2mGdn99oya4~yAnUkj6QiYgVeDKiLJCTxRB6arwHJrIYDwcCh6vzkqZx7e23Faiiv6pXrB-plS1neoUQp5gE1UVt40YUiqpAlkAYmcxmsTJ~pPmZoIgRPLGcqN0rqpjPjlHwhycFw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA |journal=JAMA |date=2005 |volume=294 |pages=2203-2209}}</ref><ref>{{REFjournal |last=Ioannidis |init=JP |title=Contradicted and initially stronger effects in Africa highly cited clinical research |url=https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.321.8200&rep=rep1&type=pdf |format=PDF |journal=JAMA |date=2005According |volume=294 |pages=218-228}}</ref><ref>{{REFjournal |last=Wheatley |init=K |last2=Clayton |init2=D |title=Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization |url=https://www.sciencedirect.com/science/article/abs/pii/S0197245602002738 |journal=Control Clin Trials |date=2003 |volume=24 |pages=66-70}}</ref><ref>{{REFjournal |last=Slutsky |init=AS |last2=Lavery |init2=JV |title=Data safety and monitoring boards |journal=N Engl J Med |date=2004 |volume=350 |pages=1143-1147}}</ref> "These trials, designed to demographic health studies performed detect a minimum 50 percent reduction in other countries [[HIV]] risk, should provide definitive evidence regarding the efficacy and safety of MC within three to five years."<ref>{{REFdocument |contribution=Male Circumcision: Current Epidemiological and Field Evidence |quote=designed to detect a minimum 50 percent reduction in Africa, HIV transmission was prevalent risk |url=https://path.azureedge.net/media/documents/HIV-AIDS_male-circ.pdf |title=Program and Policy Implications For HIV Prevention and Reproductive Health |publisher=USAID |format=PDF |date=2002-01 |accessdate=2019-09-29}}</ref> By designing a trial to "detect" a minimum 50 percent reduction risk in circumcised men in at least 6 different countries:[[HIV]], these researchers might have artificially created the clinical setting to observe the effect they were looking to discover.

Boyle & Hill (2011) have shown these RCTs to be have significant methodological flaws and statistical errors that render their claims invalid. Although a 60 percent ''relative'' reduction in [[HIV]] was claimed, the ''absolute'' reduction was a statistically insignificant 1.3 percent.<ref name===== Cameroon ====="boyle-hill2011">{{BoyleGJ HillG 2011}}</ref>

In CameroonConcerns about the [[HIV trials in Africa|three randomized controlled clinical trials (RCCTs) in Africa]] (in South Africa, where 91% of the male population is circumcisedUganda, and Kenya)<ref>{{RCT Auvert et al 2005}}</ref><ref name="bailey2007">{{RCT Bailey et al 2007}}</ref><ref name="gray2007">{{RCT Gray et al 2007}}</ref>:* The three RCTs were terminated early because results had reached a signifıcent level showing reduced [[HIV]] infections in experimental compared with control groups; however, the ratio of circumcised men vsit was too soon to gauge long-term effectiveness. intact * The results have no relevance for women or for men who have sex with men.* Far more participants were lost to follow-up than were reported to have contracted [[HIV was 4]].1 vs. 1.1* A substantial number of participants appeared to have contracted [[HIV]] from nonsexual sources: 23 of the 69 infections reported in the South African trial and 16 of the 67 in the Ugandan study.<ref>{{REFbook | last=Mosoko, Jembia J.; Affana, Gislaine A.N.Gisselquist | first=D. | yearinit=2005D | titleyear=Prévalence du VIH et facteurs associés2008 | urltitle=httpPoints to consider:responses to HIV//www.measuredhs.com/pubs/pdf/FR163/16chapitre16.pdf | work=Enquête Démographique et de Santé du Cameroun | editor=CalvertonAIDS in Africa, MDAsia, USAand the Caribbean | editionurl= | volumepublisher=Adonis and Abbey | chapterlocation=16London | pages=309 | location=Cameroon | publisherchapter=DHS7 | isbn= | quote=Contrairement aux résultats trouvés dans d’autres pays, notamment le Kenya... | accessdate=2011-06-02 | note=

==== Cameroon ====In GhanaCameroon, where 91% of the ratio male population is 1.6 vs 1.4 (95.3% circumcised). ''"..., the vast majority ratio of Ghanaian [[circumcised[[ men (95 percent) are circumcisedvs.[[intact]] men who contracted [[HIV]] was 4.1 vs. There is little difference in the HIV prevalence by circumcision status1.1.."''<ref>{{REFbook | last=Marum, LMosoko |first=Jembia J.; Muttunga, J |init=JJ |last2=Affana |first2=Gislaine A.; Munene, FN. | firstinit2=GAN | year=20032005 | title=HIV Prevalence and Associated FactorsPrévalence du VIH et facteurs associés | url=http://www.measuredhs.com/pubs/pdf/FR152FR163/13Chapter1316chapitre16.pdf | work=Kenya: Demographic and Health Survey 2003 | editor=Calverton, MD, USA | edition=Enquête Démographique et de Santé du Cameroun | volume= | chapter=1316 | pagespage=250-251309 | location=Nairobi, KenyaCameroon | publisher=Central Bureau of StatisticsDHS | isbn= | quote=...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the HIV prevalence by circumcision statusContrairement aux résultats trouvés dans d’autres pays, notamment le Kenya... | accessdate=2011-06-02 | note=

====Ghana = Lesotho ===In Ghana, the ratio is 1.6 vs 1.4 (95.3% circumcised). ''"...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the [[HIV]] prevalence by circumcision status..."''<ref>{{REFbook |last=Marum |first=L. |init=L |last2=Muttunga |first2=J. |init2=J |last3=Munene |first3=F. |init3=F |year=Central Bureau of Statistics |title=HIV Prevalence and Associated Factors |url=http://www.measuredhs.com/pubs/pdf/FR152/13Chapter13.pdf |work=Kenya: Demographic and Health Survey 2003 |editor= |edition= |volume= |chapter=13 |pages=250-251 |location=Nairobi, Kenya |publisher=Central Bureau of Statistics |isbn= |quote=...the vast majority of Ghanaian men (95 percent) are circumcised... There is little difference in the HIV prevalence by circumcision status... |accessdate= |note=}}</ref>

''"The relationship between male circumcision and [[HIV ]] levels in Lesotho does not conform to the expected pattern of higher rates among [[uncircumcised ]] men than circumcised men. The [[HIV ]] rate is in fact substantially higher among circumcised men (23 percent) than among men who are not circumcised (15 percent). Moreover, the pattern of higher infection rates among circumcised men compared with [[uncircumcised ]] men is virtually uniform across the various subgroups for which results are shown in thetablethe table. This finding could be explained by the Lesotho custom to conduct male circumcision later in life, when the individuals have already been exposed to the risk of [[HIV ]] infection. (Additional analysis is necessary to better understand the unexpected pattern in Table 12.9.)"''<ref>{{REFbook | last=Ministry of Health and Social Welfare; Bureau of Statistics | first= | year=2005 | title=HIV Prevalence and Associated Factors | url=http://www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf | work=Lesotho Demographic and Health Survey 2004 | editor= | edition= | volume= | chapter= | pagespage=13 | location=Calverton, Maryland | publisher=Ministry of Health and Social Welfare | isbn= | quote= | accessdate=2011-06-02 | note=

::''An interesting defense of male circumcision, given the fact that the latest "studies," if they can even be called that, observed [[HIV trasmission ]] transmission in men [[circumcised ]] as adults. Then again, this demographic health survey was conducted in 2004, BEFORE the newer "studies" in 2006. None the less, the unproven assertion that "circumcision is only effective in reducing the risk of [[HIV ]] when done in infancy" persists in some circles.'' ===== Malawi =====

: "The relationship between [[HIV ]] prevalence and circumcision status is not in the expecteddirection. In Malawi, circumcised men have a slightly higher [[HIV ]] infection rate than men who were

| last=Chipeta, |first=John; |init=J |last2=Schouten, |first2=Erik; |init2=E |last3=Aberle-Grasse, |first3=John | firstinit3=J | year=2005 | title=HIV Prevalence and Associated Factors | url=http://www.measuredhs.com/pubs/pdf/FR175/12Chapter12.pdf | work=Malawi Demographic and Health Survey 2004 | editor= | edition= | volume= | chapter=12 | pagespage=234 | location=Calverton, Maryland | publisher=National Statistical Office | isbn= | quote= | accessdate=2011-06-02 | note=

:: ''...where one would expect [[HIV ]] to be the most rampant.'' ===== Rwanda =====

====South Africa= Swaziland ===Rosenberg et al. (2018) report that circumcised men in South Africa are more likely to be [[HIV]] infected than intact men.<ref name="Rosenberg2018">{{REFjournal |last=Rosenberg |first=Molly S. |init=MS |author-link= |last2=Gómez-Olivé |init2=FX |author2-link= |last3=Ronr |first3=Julia K. |init3=JK |author3-link= |last4=Kahn |first4=Kathleen |init4=K |author4-link= |last5=Bärnighausen |first5=Till W. |init5=TW |author5-link= |etal=no |title=Are circumcised men safer sex partners? Findings from the HAALSI cohort in rural South Africa |journal=PLOS ONE |date=2018-08-01 |volume=13 |issue=8 |page=e0201445 |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201445 |quote= |pubmedID=30067842 |pubmedCID=6070310 |DOI=10.1371/journal.pone.0201445 |accessdate=2019-10-20}}</ref>

: "As Table 14.10 shows, the relationship between [[HIV ]] prevalence and circumcision status is not in the expected direction. [[Circumcised ]] men have a slightly higher [[HIV ]] infection rate than men who are [[Intact| not circumcised ]] (22 percent compared with 20 percent).<ref>{{REFweb |url=http://www.measuredhs.com/pubs/pdf/FR202/FR202.pdf P. 256 |title=Swaziland Demographic and Health Survey |last= |first= |date=2006 |accessdate=2022-06-15}}</ref>

==== Malaysia Zambia ====The prevalence of [[HIV]] infection among men aged 15-29 has ''not'' decreased despite several campaigns to perform male circumcision.

According to Malaysian AIDS Council vice-president Datuk Zaman Khan[[Michel Garenne|Garenne]] & Matthews (2019) report:<blockquote>In a multivariate analysis, more than 70% of based on the 872013 DHS survey,710 HIV/AIDS sufferers in [[circumcised]] men were found to have the country are Muslimssame level of infection as [[uncircumcised]] men, after controlling for age, sexual behaviour and socioeconomic status. In MalaysiaLastly, most, if not all Muslim circumcised men tended to have somewhat riskier sexual behaviour than [[uncircumcised]] men are circumcised. This study, whereas circumcision is uncommon in the non-Muslim community. 60% based on large representative samples of the Malaysian Zambian population is Muslim, which means that HIV is spreading in questions the community where most men are circumcised at an even faster rate, than current strategy of mass circumcision campaigns in the community where most men are intactsouthern and eastern Africa.<refname="garenne-matthews2019">http://www.mmail.com.my/content/39272{{REFjournal |last=Garenne |init=M |author-72link=Michel Garenne |last2=Matthews |init2=A |author2-percentlink= |etal=no |title=Voluntary medical male circumcision and HIV in Zambia: expectations and observations |journal=J Biosoc Sci |date=2019-aidshiv10-sufferers14 |volume=Epub ahead of print |pages=1-malaysia-are13 |pubmedID=31608845 |DOI=10.1017/S0021932019000634 |accessdate=2019-muslims10-says-council19}}</ref></blockquote>

Interestingly enough, === Malaysia is home ===According to Malaysian [[AIDS]] Council vice-president Datuk Zaman Khan, more than 70% of the 87,710 [[HIV]]/[TaraKlamp[AIDS]]sufferers in the country are Muslims. In Malaysia, most, if not all Muslim men are circumcised, a controversial whereas circumcision device being marketed is uncommon in the non-Muslim community. 60% of the Malaysian population is Muslim, which means that [[HIV]] is spreading in KwaZulu Natalthe community where most men are circumcised at an even faster rate, Africa than in the name of HIV preventioncommunity where most men are intact.<ref{{REFweb |url=http://www.mmail.com.my/content/39272-72-percent-aidshiv-sufferers-malaysia-are-muslims-says-council |title= |last= |first= |date= |accessdate=2022-06-15}}></ref>

=== Philippines ===[[Tuli]] or male circumcision, a nearly compulsory cultural practice in the Philippine Islands, causes 93 percent of Filipino males to be [[circumcised]].In the 2010 Global [[AIDS ]] report released by UNAIDS in late November, the Philippines was one of seven nations in the world which reported over 25 percent in new [[HIV ]] infections between 2001 and 2009, whereas other countries have either stabilized or shown significant declines in the rate of new infections. Among all countries in Asia, only the Philippines and Bangladesh are reporting increases in [[HIV ]] cases, with others either stable or decreasing. <ref>http://globalnation.inquirer.net/news/breakingnews/view/20110102-312124/Philippines-HIVAIDS-problem-worries-UN</ref>

=== [[Israel]] ===Despite circumcision being near-universal, [[HIV ]] is an increasing problem in [[Israel]].<ref>http{{REFweb |url=https://www.haaretz.com/print1.4998790 |title=Failing the AIDS Test |date=2008-edition/opinion/failing07-the04 |accessdate=2020-aids01-test-1.24908805}}</ref><ref>http{{REFweb |url=https://www.haaretz.com/print1.5000364 |title=Israeli Gays Shun Condoms Despite Worrying Rise in AIDS |date=2008-edition/features/israeli07-gays09 |accessdate=2020-shun01-condoms-despite-worrying-rise-in-aids-1.24937205}}</ref><ref>http{{REFweb |url=https://www.haaretz.com/news/has-1.5067072 |title=Has theAIDS Cocktail Worked Too Well in Israel? |date=2008-aids11-cocktail30 |accessdate=2020-worked01-too-well-in-israel-1.25852005}}</ref><ref>http{{REFweb |url=https://www.haaretz.com/print-edition/news/hiv-diagnoses-1.4996895 |title=HIV Diagnoses inIsrael Climb; New Cases Among Gays Up Sharply |date=2008-israel06-climb27 |accessdate=2020-new01-cases-among-gays-up-sharply-1.24865105}}</ref> ==== The United States ====

=== The United States ===In America, the majority of the male population is [[circumcised]], approximately 8062%, <ref name="moore2015">{{REFweb |url=https://today.yougov.com/topics/lifestyle/articles-reports/2015/02/03/younger-americans-circumcision |title=Young Americans less supportive of circumcision at birth |last=Moore |first=Peter |date=2015-02-03 |accessdate=2022-06-15}}</ref> while in most countries in Europe, [[circumcision ]] is uncommon. One would expect for there to be a lower transmission rates in the [[United States]], and for [[HIV ]] to be rampant in Europe; [[HIV ]] transmission rates are in fact higher in the [[United States]], where most men are [[circumcised]], than in various countries in Europe, where most men are [[intact]].<ref>http://data.unaids.org/pub/Report/1998/19981125_global_epidemic_report_en.pdf</ref>

However, it is precisely these reasons given, that sex education and condoms aren't catching on in Africa, why circumcision advocates say "mass circumcision campaigns" should be promoted in Africa. What failed in the [[United States ]] is somehow supposed to work miracles in Africa.

=== Studies with contrary conclusions ===

According to USAID, there appears no clear pattern of association between male circumcision and [[HIV ]] prevalence—in 8 of 18 countries with data, [[HIV ]] prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.<ref>http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf</ref>

"Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative [[HIV ]] seroprevalence data. The results are important in considering the development of circumcision-focused interventions within [[AIDS ]] prevention programs."<ref>http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431</ref>

Results: ...No consistent relationship between male circumcision and [[HIV ]] risk was observed in most countries."<ref>"http://apha.confex.com/apha/134am/techprogram/paper_136814.htm</ref>

 Male circumcision has been found not to decrease the risk of [[HIV ]] and may in fact increase the risk of male to female transmission<ref>{{REFconference |last=Castilho EA, |first=E.A. |author-link= |coauthors=Boshi-Pinto C., Guimaraes MDGM.D.G. |coauthors-link= |title=Male circumcision and HIV heterosexual transmission. |url= |place= |source=XIV World AIDS Conference. |date=2002. |datefrom= |dateto= |accessdate=}}</ref><ref>{{REFjournal |last=Guimaraes |init=MD, |author-link= |last2=Vlahov |init2=D, |last3=Castilho |init3=EA. |title=Postcoital vaginal bleeding as a risk factor for transmission of the human immunodeficiency virus in a heterosexual partner study in Brazil. (Rio de Janeiro Heterosexual Study Group. ) |journal=Arch Intern Med. |date=1997; |volume=157( |issue=12): |pages=1362-8.1368 |accessdate=}}</ref><ref>{{REFconference |last=Guimaraes |first=M, . |author-link= |coauthors=Castilho E., Ramos-Filho C., et al. |coauthors-link= |title=Heterosexual transmission of HIV-1: a multicenter study in Rio de Janeiro, Brazil. |url= |place= |source=VII Intl Conf on AIDS. |date=1991. |datefrom= |dateto= |accessdate=}}</ref><ref>{{REFconference |last=Changedia SM, |first=S.M. |coauthors=Gilada ISI.S. |title=Role of male circumcision in HIV transmission insignificant in Conjugal relationship. |source=XIV World AIDS Conference. 2002.</ref><ref>Circumcision protects men from AIDS but might increase risk to women, early results suggest.International Herald Tribune, Tuesday, 6 March 2007.</ref>  |date== African RCT's ==2002 Strong bias exists in the RCT's.<ref>Green LW et al. Male circumcision is not the HIV 'vaccine' we have been waiting for! Future HIV Ther. (2008) 2(3), 193–199.</ref><ref>Montori VM, Devereaux PJ, Adhikari NKJ, et al. Randomized trials stopped early for benefit: a systematic review. JAMA. 2005;294:2203-2209.</ref><ref>Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294:218-228.}}</ref><ref>Wheatley K, Clayton D. Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization. Control Clin Trials. 2003;24:66-70.</ref><ref>Slutsky AS, Lavery JV. Data safety and monitoring boards. N Engl J Med. 2004;350:1143-1147.</ref> "Thesetrials, designed to detect a minimum 50 percent reduction in HIV risk, should provide definitive evidence regarding the efficacy and safety of MC within three to five years."<ref>{{REFcontribution | contribution=Male Circumcision: Current Epidemiological and Field Evidence | quote=designed to detect a minimum 50 percent reduction in HIV riskREFweb | url=http://www.pathcirp.org/publicationsnews/iht2007-03-06/detail.php?i=1048 | title=Program and Policy Implications For HIV Prevention and Reproductive Health | author=Circumcision protects men from AIDS but might increase risk to women, early results suggest | publisher=USAID | place= | pages=International Herald Tribune | date=September 18 and 19, 2002 | accessdate=20112007-0703-0706}}</ref> By designing a trial to "detect" a minimum 50 percent reduction risk in HIV, these researchers might have artifically created the clinical setting to observe the effect they were looking to discover. Concerns about the three randomized controlled clinical trials (RCCTs) in Africa (in South Africa, Uganda, and Kenya)<ref>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.</ref><ref>Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet 2007;369(9562):643–56.</ref><ref>Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet 2007;369(9562):657– 66.</ref>:* The three RCCTs were terminated early because results had reached signifıcance showing reduced HIV infections in experimental compared with control groups; however, it was too soon to gauge long-term effectiveness.* The results have no relevance for women or for men who have sex with men.* Far more participants were lost to follow-up than were reported to have contracted HIV.* A substantial number of participants appeared to have contracted HIV from nonsexual sources: 23 of the 69 infections reported in the South African trial and 16 of the 67 in the Ugandan study.<ref>Gisselquist D. Points to consider: responses to HIV/AIDS in Africa, Asia, and the Caribbean. London: Adonis and Abbey, 2008, chapter 7.</ref>* Participants received continuous counseling, free condoms, and monitoring for infection, which was unlikely in real-world campaigns.* The sanitary conditions of the surgeries would be diffıcult to replicate on a mass scale in many parts of Africa where HIV infection rates and prevalence are highest.<ref>Weiss HA, Quigley MA, Hayes RJ. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000;14:2361–70.</ref><ref>Siegfried N, Muller M, Deeks J, et al. HIV and male circumcision—a systematic review with assessment of the quality of studies. Lancet Infect Dis 2005;5:165–73.</ref>* Follow-up of any of these RCCTs is impossible. Study participants agreed to be circumcised when joining the study and were randomized into “circumcise now” and “circumcise later” groups.<ref>Slutsky AS, Lavery JV. Data safety and monitoring boards. N Engl J Med. 2004;350:1143-1147.</ref>

Using a population-based survey, Westercamp et al. (2010) examined the behaviors, beliefs, and [[HIV]]/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with [[HIV]]/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with the belief that circumcised men are less likely to become infected with [[HIV]].<ref>{{REFjournal | last=Westercamp | firstinit=M. | coauthorslast2=Bailey |init2=RC, |last3=Bukusi |init3=EA, |last4=Montandon |init4=M, |last5=Kwena |init5=Z, et al. |etal=yes | title=Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs | journal=PLoS ONE | volume=5 | issue=12 | pages= | url=http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552 | quote= | pubmedID= | pubmedCID= | DOI=10.1371/journal.pone.0015552 | date=2010 | accessdate=

An analysis of [[HIV ]] prevalence compared to circumcision status in sub-Saharan Africa concluded that male circumcision is not associated with reduced [[HIV ]] prevalence.<ref>{{REFjournal |last=Garenne |init=M. |author-link=Michel Garenne |title=Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa |url=http://www.circumstitions.com/Docs/garenne-2. pdf |format=PDF |journal=Afr J AIDS Res |date=2008; |volume=7( |issue=1 |pages=1):1– -8.}}</ref> Another study on circumcision prevalence compared to [[HIV ]] in the general South African population concluded: “Circumcision had no protective effect on [[HIV ]] transmission.”<ref>{{REFjournal |last=Connolly |init=C, |last2=Simbayi |init2=LC, |last3=Shanmugam |init3=R, |last4=Nqeketo |init4=A. |title=Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002 |url=http://artemide.bioeng.washington.edu/connolly_nqeketo_male_samj_2008_98_10. pdf |format=PDF |journal=S Afr Med J |date=2008; |volume=98: |pages=789 –94.-794}}</ref> When commercial sex worker patterns are controlled, male circumcision is not signifıcantly associated with lower [[HIV ]] prevalence.<ref>{{REFjournal |last=Talbott |init=JR. |title=Size matters: the number of prostitutes and the global HIV/AIDS pandemic. PloS One 2007;2(6) |url=http:e543//journals. wwwplos.org/plosone. org/article/info%3Adoi%2F10?id=10.1371%2Fjournal/journal.pone.0000543. |journal=PloS One |date=2007 |volume=2 |issue=6 |page=e543}}</ref> Mathematical impact modeling of circumcision, antiretroviral therapy (ART), and condom use for South Africa concluded: “Male circumcision was found to have considerably lower impact than condom use or anti-retroviral therapy on [[HIV ]] infection rates and death rates.”<ref>{{REFconference |last=Lima |first=V, . |author-link= |coauthors=Anema A., Wood R., et al. |coauthors-link= |title=The combined impact of male circumcision, condom use and HAART coverage on the HIV-1 epidemic in South Africa: a mathematical model. |url= |place=Cape Town |source=5th IAS Conference on HIV Treatment, Pathogenesis and Prevention, Cape Town, (abstract WECA105, ) |date=2009. |datefrom= |dateto= |accessdate=}}</ref> Both the U.S. and sub-Saharan Africa have relatively high incidence rates of [[HIV ]] infection, considering that about 75% of U.S. men and about 70% of sub-Saharan African men are circumcised—higher percentages than in most other regions or countries with lower prevalence of [[HIV]].<refname="Green etal 2010">{{REFjournal |last=Green |init=LW, |last2=Travis |init2=JW, |last3=McAllister |init3=RG, |author3-link=Ryan McAllister |last4=Peterson |init4=KW, |last5=Vardanyan |init5=AN, |last6=Craig |init6=A. |title=Male circumcision and HIV prevention insufficient evidence and neglected external validity |url=https://www.arclaw.org/wp-content/uploads/Green-Circ-HIV-Prev-Insufficient-AmJPrevMed-2010. pdf |format=PDF |journal=Am J Prev Med. 2010 Nov;39(5):479-82. |publisher=Department of Epidemiology and Biostatistics, {{UNI|University of California |UCSF}} at San Francisco, USA. PMID: |date=2010-11 |volume=39 |issue=5 |pages=479-482 |pubmedID=20965388 }}</ref>

There is no clear pattern of association between male circumcision and [[HIV ]] prevalence. In 10 out of 18 countries, [[HIV ]] prevalence is higher amongst circumcised men.<ref>{{REFcontributionREFdocument | contribution=Levels and spread of HIV seroprevalence and associated factors: Evidence from national household surveys | quotetitle=DHS Comparative Reports 22 | url=http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf | titlepage=103 |publisher=Measre DHS Comparative Reports 22 | authorformat= |date= |accessdate=2019-09-29}}</ref> Furthermore, [[HIV]] prevalence was found to be higher amongst circumcised males and females for virgins and adolescents in Kenya, Lesotho, and Tanzania.<ref>{{REFjournal |last=Brewer |first=Devon D. |init=DD |last2=Potterat |first2=John J. |init2=JJ |last3=Roberts Jr | publisherfirst3=Measre DHSJohn M. | placeinit3=JM | pageslast4=103Brody | datefirst4=Stuart | accessdateinit4=S |title=Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania |url=https://www.orchidproject.org/wp-content/uploads/2019/03/Male_Female_Circumcision_Prevalent_HIV_Infection_Virgins_Adolescents_Kenya_Lesotho_Tanzania.pdf | format = PDF |journal=Annals of Epidemiology |volume=17 |issue=3 |pages=217.e1-217.e12 |note=Annals of Epidemiology |accessdate=2011-06-02

Furthermore[[David Gisselquist]], {{PhD}}, who has studied health care practices in sub-Saharan Africa, finds that much of health care, especially injection practices, in Africa is non-sterile, and is likely the cause of the high incidence of [[HIV prevalence ]] infection. He notes that the consensus to make sex the primary cause of infection was found determined in the 1980s and is likely to be higher amongst circumcised males and females for virgins and adolescents in Kenyainaccurate, Lesotho, and Tanzaniabecause it does not give sufficient weight to medical transmission of [[HIV]] infection.<refname=”gisselquist2002”>{{REFjournal | last=Brewer, PhDGisselquist | firstinit=Devon D. | coauthorslast2=Rothenberg |init2=R |last3=Potterat |init3=John J. Potterat, BA, John M. Roberts Jr., PhD, Stuart Brody, PhD |last4=Drucker |init4=E | title=Male and Female Circumcision Associated With Prevalent Non-sexual transmission of HIV Infection has been overlooked in Virgins and Adolescents in Kenya, Lesotho, and Tanzaniadeveloping countries |url=https://europepmc.org/article/med/11809652#free-full-text | journal=Annals of EpidemiologyBr Med J |date=2002 | volume=17324 | issue=37331 | pagespage=217235}}</ref> Gisselquist et al.e1argue strongly that statistical evidence indicates that 5/6s of the [[HIV]] infection in Africa is non-217sexual.e12<ref name=”gisselquist2003”>{{REFjournal |last=Gisselquist |init=D |last2=Potterat |init2=JJ |title=Heterosexual transmission of HIV in Africa: an empiric estimate | url=http://www.annalsofepidemiologycirp.org/articlelibrary/disease/HIV/gisselquist2/gisselquist2.pdf |format=PDF |journal=Int J STD AIDS |date=2003 |volume=14 |pages=162-73}}</ref><ref>{{REFjournal |last=Gisselquist |init=D |last2=Potterat |init2=JJ |last3=Brody |init3=S |title=Running on empty: sexual co-factors are insufficient to fuel Africa's turbocharged HIV epidemic |url=https://www.researchgate.net/profile/John-Potterat/publication/S10478479267_Running_on_empty_Sexual_co-2797factors_are_insufficient_to_fuel_Africa%2806%290026527s_turbocharged_HIV_epidemic/links/00b7d529d10fbac5c9000000/Running-on-empty-Sexual-co-factors-are-insufficient-to-fuel-Africas-turbocharged-HIV-epidemic.pdf |format=PDF |journal=Int J STD AIDS |date=2004 |volume=15 |issue=7 |pages=442-152}}</abstractref> Male circumcision has been proposed to reduce the incidence of sexual transmission of [[HIV]]. In reality, it actually increases the sexual transmission of [[HIV]]. Even if it did work, it would be ineffective against non-sexual transmission by unsafe health care. Furthermore, non-sterile health care could mean that the circumcision operation could transmit the [[HIV]] infection to the patient.<ref>{{REFjournal | quotelast=Nyindo | pubmedIDinit=M | pubmedCIDtitle=Complementary factors contributing to the rapid spread of HIV-I in sub-Saharan Africa: a review |url=https://www.ajol.info//index.php/eamj/article/view/9293 | DOIjournal=East African Medical Journal | date=March 20072005 | accessdatevolume=2011-0682 |issue=1 |pages=40-0246

== Problems with promoting circumcision as HIV prevention policy == The fact that the [[World Health Organization]] is corrupt is now well-established: Circumcision in real-world advocates use the discredited RCT African settings will likely be a vector for transmitting the virus studies and is WHO's endorsement based on them as such likely to worsen the pandemic.<ref>Brewer DD, Brody S, Drucker E, Gisselquist D, Minkin SF, Potterat JJ, Rothenberg RB, Vachon F. Mounting anomalies in proof "beyond reasonable doubt" that circumcision "reduces the epidemiology risk of [[HIV in Africa: cry the beloved paradigm. Int J STD AIDS. 2003; 14(3):144-7]].</ref><ref>Gisselquist D" However, Potterat JJthere are problems with the WHO's endorsement, Brody S, Vachon F. Let as the studies on which it be sexual: how health care transmission of AIDS in Africa was ignored. Int J STD AIDS. 2003; 14:148-61.</ref><ref>Gisselquist D, Potterat JJ, Brody S. Running is based on empty: sexual co-suffer various flaws and confounding factors are insufficient that bring their credibility in to fuel Africa's turbocharged HIV epidemic. Int J STD AIDS. 2004; 15(7):442-52.</ref><ref>Gisselquist Dquestion, Potterat JJ. Heterosexual transmission many of HIV which will be discussed in Africa: an empiric estimate. Int J STD AIDS. 2003; 14:162-73.</ref><ref>Gisselquist D, Rothenberg R, Potterat J, Drucker E. Non-sexual transmission of HIV has been overlooked in developing countries. Br Med J. 2002; 324(7331):235.</ref><ref>Nyindo M. Complementary factors contributing to the rapid spread of HIV-I in sub-Saharan Africa: a review. East Afr Med J. 2005; 82(1):40-6this article.</ref>

== Problems with promoting On their [http://www.who.int/hiv/topics/malecircumcision/en/ website], the WHO acknowledges that, ''"[m]ale circumcision as provides only partial protection,"'' and that it should be part of a ''"comprehensive [[HIV ]] prevention policy ==package"'' that includes [[HIV]] testing and counseling services, treatment for STD infections, the promotion of safer sex practices and the provision of condoms and the promotion of their correct and consistent use.

Circumcision advocates use [[Robert S. Van Howe|Van Howe]] & Boyle (2018) pointed out numerous reasons that one should doubt the published results of the latest African randomised clinical trials (RCTs)<ref name= "vanhowe2018">{{REFjournal |last=Van Howe |first=Robert S. |init=RS |author-link=Robert S. Van Howe |last2=Boyle |first2=Gregory J. |init2=GJ |author2-link=Gregory J. Boyle |etal=no |title=Meta-analysis of HIV-acquisition studies incomplete and WHO's endorsement based on them as proof "beyond reasonable doubt" that unstable |journal=BJU Int |location= |date=2018-10-31 |volume= |issue= |pages= |url=https://www.bjuinternational.com/letters/meta-analysis-circumcision "reduces -incomplete-unstable/ |archived= |quote=Given the effectiveness of condoms, the risk lack of HIV." Howeverconsistent findings on national levels, the methodologically flawed RCTs, there are problems with the WHO's indorsmentlack of translational research, as and the studies on which it is based on suffer various flaws impressive potential uptake and confounding factors that bring their credibility in effectiveness of pre-exposure prophylaxis, circumcision as an intervention to question, many of which will prevent HIV infection should be discussed in this articletreated with greater scepticism. |pubmedID= |pubmedCID= |DOI= |accessdate=2020-09-05}}</ref>

On their [http://www[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.whoC.int/hiv/topics/malecircumcision/en/ website)]], in a letter to Ambassador Deborah L. Birx, {{MD}}, {{MPH}}, (2020), the head of the WHO acknowledges that, ''"President’s Emergency Plan for AIDS Relief (PEPFAR) has called on [[mPEPFAR]]ale to suspend the provision of male [[circumcision provides only partial protection,"'' ]] because it is ineffective and that it should be part may increase the reception of a ''"comprehensive [[HIV prevention package"'' that includes HIV testing ]] infection due to the loss of [[Immunological and counseling services, treatment for STD infections, protective function of the promotion foreskin| immunological protections]] of safer sex practices the [[foreskin]], and to focus on the provision of anti-retroviral therapy and condoms .<ref name="denniston2020">{{REFdocument |title=World Health Organization, HIV, and the promotion of their correct and consistent usemale circumcision |url=https://pool.intactiwiki.org/images/2020-06-15b_LettertoPEPFAR.pdf |contribution= |last=Denniston |first=George C. |publisher=[[Doctors Opposing Circumcision (D.O.C.)]] |format= |date=2020-06-29 |accessdate=2020-09-02}}</ref>

Even if Fish et al. (2020), speaking for the [[VMMC Experience Project]], published an article that described the recent trials were accuratePEPFAR program to circumcise African men, as racist and neo-colonialist.<ref name="fish2020">{{REFjournal |last=Fish |first=Max |init= |author-link= |last2=Shavisi |first2=Arianne |init2= |author2-link= |last3=Gwaambuka |first3=Tatenda |init3= |author3-link= |last4=Tangwa |first4=Godfrey B. |init4= |author4-link= |last5=Ncayiyana |first5=Daniel |init5= |author5-link= |last6=Earp |first6=Brian D |init6= |author6-link=Brian D. Earp |etal=no |title=A new Tuskegee? Unethical human experimentation and Western neocolonialism in the mass circumcision would only reduce the relative risk of acquiring HIV between circumcised and uncircumcised African men by 60 |trans-title= |language=English |journal=Developing World Bioeth |location= |date=2020-09-09 |volume=00 |issue= |article= |page= |pages=1-16 |url=http://www.circumcisionharm.org/images-circharm.org/Fish%20Earp%20New%20Tuskegee%20Dev%20World%20Bioeth% over a period of about one year202020. Circumcision pdf |archived= |quote= |pubmedID=32909369 |pubmedCID= |DOI= |accessdate=2021-04-07}}</ref> Threre now is outperformed by condomscredible evidence that the massive, which expensive African circumcision programs have an absolute reduction risk of acquiring ''not'' been effective in preventing [[HIV that's over 95% (closer to 100% when used properly). Even if a man is circumcised, he would still need to use condoms, and even the authors of the latest studies cannot stress this enough]] infection.

 A recent prospective study<ref>{{REFjournal |last=Turner |init=AN, |last2=Morrison |init2=CS, |last3=Padian |init3=NS, et al. |etal=yes |title=Men’s circumcision status and women’s risk of HIV acquisition in Zimbabwe and Uganda. |journal=AIDS |date=2007; |volume=21:1779–89. |pages=1779–1789}}</ref> showed that male circumcision offered no protection to women, and an RCCT<ref>{{REFjournal |last=Wawer |init=MJ, |last2=Makumbi |init2=F, |last3=Kigozi |init3=G, et al. |etal=yes |title=Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. |journal=Lancet |date=2009;374: |volume374 |pages=229 –37.-237}}</ref> found thatmale circumcision actually increased the risk to women. Women also are placed at greater risk from unsafe sex practices when they, or their circumcised male partners, wrongly believe that with circumcision they are immune to [[HIV ]] and therefore they choose not to use condoms.<ref>{{REFweb |last=Nyakairu |first=F. |title=Uganda turns to mass circumcision in AIDS fıght. |publisher=Reuters Africa |date=2008, Aug -08-13. |url=https://www.reuters.com/article/idUSLD 23235720080813idUSLD23235720080813}}</ref><ref>Irin, Swaziland: {{REFweb |title=Circumcision gives men an excuse not to use condoms. |publisher=UN Offıce for the Coordination of Humanitarian Affairs, 2008 Jul. |website=The New Humanitarian (formerly IRIN News) |url=http://www.irinnewsthenewhumanitarian.org/Report.aspx?ReportId�79557news/2008/07/31/circumcision-gives-men-excuse-not-use-condoms |date=2008-07 |accessdate=2020-01-05}}</ref>

* The tendency of both men and women to ascribe undue power to a technical fıx for what must remain a matter of human control, as in the use of condoms and other safe sex practices.<ref>name="Green LW, Travis JW, McAllister RG, Peterson KW, Vardanyan AN, Craig A. Male circumcision and HIV prevention insufficient evidence and neglected external validity. Am J Prev Med. etal 2010 Nov;39(5):479-82. Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. PMID: 20965388<"/ref>

|+ Estimated per act risk for acquisition<br/>of [[HIV ]] by exposure route (US only) <ref name=MMWR3>{{REFjournal | last=Smith |init=DK, |last2=Grohskopf |init2=LA, |last3=Black RJ, et al. | firstinit3=RJ | coauthorsetal=yes | title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States | journal=MMWR | volume=54 | issue=RR02 | pages=1-20 | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1 | quote= | pubmedID= | pubmedCID= | DOI= | date=2005 | accessdate=2009-03-31

| last=Donegan |init=E, |last2=Stuart |init2=M, |last3=Niland JC, et al. | firstinit3=JC | coauthorsetal=yes | title=Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations | journal=Ann. Intern. Med. | volume=113 | issue=10 | pages=733-739 | url= | quote= | pubmedID=2240875 | pubmedCID= | DOI= | date=1990 | accessdate=

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| last=Kaplan |init=EH, Heimer R | firstlast2=Heimer | coauthorsinit2=R | title=HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data | journal=J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. | volume=10 | issue=2 | pages=175-176 | url= | quote= | pubmedID=7552482 | pubmedCID= | DOI= | date=1995 | accessdate=

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The three main transmission routes of [[HIV ]] are [[sexual contact]], exposure to infected body fluids or tissues, and from mother to [[fetus]] or child during [[perinatal]] period. It is possible to find [[HIV ]] in the [[saliva]], [[tears]], and [[urine]] of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.<ref>{{REFweb | quote= | url=http://www.avert.org/aids.htm | title=Facts about AIDS & HIV | last= | first= | publisher=avert.org | work= | date= | accessdate=2007-11-30}}</ref> Anti-retroviral treatment (ART) of infected patients also significantly reduces their ability to transmit [[HIV ]] to others, by reducing the amount of virus in their bodily fluids to undetectable levels.<ref>[http://www.npr.org/templates/story/story.php?storyId=128495103 NPR.org]</ref><ref name="denniston2020" /> == Population-based studies =={{Population-based studies}} ==Two African surveys==The previously reported studies were from developed Western nations. Now we have information from Sub_Saharan Africa. French scientist [[Michel Garenne]], Ph.D. has published two reports in 2022 comparing the incidence of HIV infection in [[circumcised]] and [[intact]] men. In his first report, Garenne presented the findings from a study in Lesotho, the enclave in South Africa. He reported:<blockquote>In couple studies, the effect of circumcision and VMMC on HIV was not significant, with similar transmission from female to male and male to female. The study questions the amount of effort and money spent on VMMC in Lesotho.<ref name="garenne2022A">{{REFjournal |last=Garenne |first=Michel |init=M |author-link=Michel Garenne |title=Changing relationships between HIV prevalence and circumcision in Lesotho |url=https://pubmed.ncbi.nlm.nih.gov/35373731/ |date=2022-04-04 |journal=J Biosoc Sci |volume=online ahead of print |pages=1-16 |DOI=10.1017/S0021932022000153 |pubmedID=35373731 |accessdate=2022-10-28}}</ref> </blockquote>  In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe). He reported:<blockquote> "Results matched earlier observations made in South Africa that [[circumcised]] and [[intact]] men had similar levels of HIV infection."<ref name="garenne2022B">{{REFjournal |last=Garenne |first=Michael |init=M |author-link= |etal=no |title=Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa |trans-title= |language= |journal=J Biosoc Sci |location= |date=2022-10-26 |season= |volume= |issue= |article= |page= |pages=1-13 |url=https://www.cambridge.org/core/journals/journal-of-biosocial-science/article/abs/ageincidence-and-prevalence-of-hiv-among-intact-and-circumcised-men-an-analysis-of-phia-surveys-in-southern-africa/CAA7E7BD5A9844F41C6B7CC3573B9E50 |archived= |quote= |pubmedID=36286328 |pubmedCID= |DOI=10.1017/S0021932022000414 |accessdate=2022-10-27}}</ref></blockquote>  {{SEEALSO}}* [[Foreskin]]* [[Immunological and protective function of the foreskin]]* [[PEPFAR]]* [[Preputial sac]]* [[World Health Organization]]* [[Bill & Melinda Gates Foundation]] {{LINKS}}* {{REFweb |url=http://www.nocirc.org/publish/11-HIV.pdf |title=Answers To Your Questions About Circumcision and HIV/AIDS |trans-title= |language= |last=Milos |first=Marilyn |author-link= |publisher=NOCIRC |website= |date=2007-09 |accessdate=2019-12-07 |format=PDF |quote=}}* {{REFweb |url=https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/hivaids/ |archived= |title=HIV/AIDS |trans-title= |language=English |last= |first= |author-link= |publisher=[[Doctors Opposing Circumcision (D.O.C.)]] |website= |date=2016 |accessdate=2020-06-11 |format= |quote=}}* {{REFweb |url=https://www.vmmcproject.org/ |title=The VMMC Experience Project |last= |first= |accessdate=2021-03-07}}* {{REFweb |url=https://foregen.webflow.io/commentarium-articles/international-contractors-are-profiteering-from-new-circumcision-devices |archived= |title=International Contractors are Profiteering from New Circumcision Devices |trans-title= |language=English |last=[[Foregen]] Staff |first= |author-link= |publisher=[[Foregen]] |website= |date=2021-03-08 |accessdate=2021-03-08 |format= |quote=}}

[[Category:Sexually Transmitted Diseasetransmitted disease]][[Category:Circumcision in Africa]]