Circumcision and HIV: Difference between revisions
Created page with "{{Construction Site}} Recently, circumcision has been heavily promoted as a method of preventing HIV. The World Health Organization (WHO) has..." |
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}}</ref> Another study found that "no difference can be clearly visualized between the inner and outer foreskin."''<ref> {{ | }}</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 (2009) | |||
| author=Dinh, Minh H.; 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=2011-06-28 | |||
}}</ref> | |||
==== Langerhans Cell Hypothesis ==== | ==== Langerhans Cell Hypothesis ==== | ||
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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> "These | 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> "These | ||
trials, 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> {{ | trials, 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 risk | |||
| url=http://www.path.org/publications/detail.php?i=1048 | |||
| title=Program and Policy Implications For HIV Prevention and Reproductive Health | |||
| author= | |||
| publisher=USAID | |||
| place= | |||
| pages= | |||
| date=September 18 and 19, 2002 | |||
| accessdate=2011-07-07 | |||
}}</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>: | 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>: | ||
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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>Garenne M. Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa. Afr J AIDS Res 2008;7(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>Connolly C, Simbayi LC, Shanmugam R, Nqeketo A. Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002. S Afr Med J 2008;98:789 –94.</ref> When commercial sex worker patterns are controlled, male circumcision is not signifıcantly associated with lower HIV prevalence.<ref>Talbott JR. Size matters: the number of prostitutes and the global HIV/AIDS pandemic. PloS One 2007;2(6):e543. www.plosone. org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000543.</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>Lima V, Anema A, Wood R, et al. The combined impact of male circumcision, condom use and HAART coverage on the HIV-1 epidemic in South Africa: a mathematical model. 5th IAS Conference on HIV Treatment, Pathogenesis and Prevention, Cape Town, abstract WECA105, 2009.</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.<ref>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. 2010 Nov;39(5):479-82. Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. PMID: 20965388 </ref> | 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>Garenne M. Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa. Afr J AIDS Res 2008;7(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>Connolly C, Simbayi LC, Shanmugam R, Nqeketo A. Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002. S Afr Med J 2008;98:789 –94.</ref> When commercial sex worker patterns are controlled, male circumcision is not signifıcantly associated with lower HIV prevalence.<ref>Talbott JR. Size matters: the number of prostitutes and the global HIV/AIDS pandemic. PloS One 2007;2(6):e543. www.plosone. org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000543.</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>Lima V, Anema A, Wood R, et al. The combined impact of male circumcision, condom use and HAART coverage on the HIV-1 epidemic in South Africa: a mathematical model. 5th IAS Conference on HIV Treatment, Pathogenesis and Prevention, Cape Town, abstract WECA105, 2009.</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.<ref>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. 2010 Nov;39(5):479-82. Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. PMID: 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> | 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>{{REFcontribution | ||
{{ | | contribution=Levels and spread of HIV seroprevalence and associated factors: Evidence from national household surveys | ||
| contribution = Levels and spread of HIV seroprevalence and associated factors: Evidence from national household surveys | | quote= | ||
| title = DHS Comparative Reports 22 | | url=http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf | ||
| publisher = Measre DHS | | title=DHS Comparative Reports 22 | ||
| pages = 103 | | author= | ||
| | | publisher=Measre DHS | ||
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| format = PDF | | format = PDF | ||
}} | }}</ref> | ||
</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 | 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, PhD | | last=Brewer, PhD | ||