Circumcision and Sexually Transmitted Diseases (STDs): Difference between revisions

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  | date=2010-03-27
  | date=2010-03-27
  | accessdate=2011-06-28
  | accessdate=2011-06-28
}}</ref> Another study found that "no difference can be clearly visualized between the inner and outer foreskin."''<ref>{{REFcontribution
}}</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
  | 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.
  | quote=No difference can be clearly visualized between the inner and outer foreskin.
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  | date=2009-12-06
  | date=2009-12-06
  | accessdate=
  | accessdate=
}}</ref>
}}</ref>-->


==== Langerhans Cell Hypothesis ====
==== Langerhans Cell Hypothesis ====
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== African RCTs ==
== African RCTs ==
Strong bias exists in the RCTs.<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 RCTs.<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>{{REFcontribution
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>{REFdocument
| 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
  | url=http://www.path.org/publications/detail.php?i=1048
| format=
  | title=Program and Policy Implications For HIV Prevention and Reproductive Health
  | title=Program and Policy Implications For HIV Prevention and Reproductive Health
| author=
  | publisher=USAID
  | publisher=USAID
  | place=
  | postscript=
| pages=
  | date=18 + 19 September 2002
  | date=September 18 and 19, 2002
  | accessdate=2019-09-29
  | accessdate=2011-07-07
| contribution=Male Circumcision: Current Epidemiological and Field Evidence
| quote=designed to detect a minimum 50 percent reduction in HIV risk
}}</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.
}}</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.


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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. http://journals.plos.org/plosone/article?id=10.1371/journal.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. http://journals.plos.org/plosone/article?id=10.1371/journal.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>{{REFcontribution
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>{REFdocument
| contribution=Levels and spread of HIV seroprevalence and associated factors: Evidence from national household surveys
| quote=
  | url=http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
  | url=http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
| format=
  | title=DHS Comparative Reports 22
  | title=DHS Comparative Reports 22
| author=
  | publisher=Measre DHS
  | publisher=Measre DHS
  | place=
  | postscript=
| date=
| accessdate=2019-09-29
  | pages=103
  | pages=103
  | date=
  | contribution=Levels and spread of HIV seroprevalence and associated factors: Evidence from national household surveys
| accessdate=
}}</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
}}</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, PhD
  | last=Brewer, PhD