Circumcision and HIV: Difference between revisions

  |last=Alcena

  |first=Valiere

  |title=AIDS in Third World Countries

  |journal=N Y State J Med

  |last=Weiss

  |first=Helen A.

  |last2=Quigley

  |first2=Maria A.

  |last3=Hayes

  |first3=Richard J.

  |title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis

  |journal=AIDS

  |last=Fink

  |first=Aaron J.

  |title=A possible Explanation for Heterosexual Male Infection with AIDS

  |journal=New England Journal of Medicine

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

  |author-link=

  |last2=Van de Perre

  |author2-link=

  |last3=LePage

  |author3-link=

  |last4=Allen

  |author4-link=

  |etal=yes

  |title=Human immunodeficiency virus transmission among heterosexual couples in Central Africa

  |journal=AIDS

  |location=

  |last=de Vincenzi

  |first=Isabelle

  |author-link=

  |last2=Mertens

  |first2=Thierry

  |author2-link=

  |etal=no

  |title=Male circumcision: a role in HIV prevention?

  |journal=AIDS

  |location=

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

  |last2=McRaven

  |last3=Kelley

  |last4=Penugonda

  |last5=Hope

  |title=Keratinization of the adult male foreskin and implications for male circumcision

  |journal=AIDS

  |last=de Witte

  |first=Lot

  |first2=Alexey

  |first3=Marjorie

  |first4=Donna

  |first5=Marein A.W.P.

  |first6=Tanja

  |first7=Vincent

  |first8=Yvette

  |first9=Teunis B.H.

  |title=Langerin is a natural barrier to HIV-1 transmission by Langerhans cells

  |journal=Nature Medicine

  |last=Price

  |first=Lance B.

  |first2=Cindy M.

  |last3=Johnson

  |last4=Aziz

  |last5=Lau

  |last6=Bowers

  |last7=Ravel

  |last8=Keim

  |last9=Serwadda

  |last10=Wawer

  |last11=Gray

  |etal=yes

  |title=The Effects of Circumcision on the Penis Microbiome

Strong bias exists in the RCTs.<ref>{{REFjournal

  |last=Green

  |etal=yes

  |title=Male circumcision is not the HIV 'vaccine' we have been waiting for!

  |date=2008

  |volume=2

}}</ref><ref>{{REFjournal

  |last=Montori

  |last2=Devereaux

  |last3=Adhikari

  |etal=yes

  |title=Randomized trials stopped early for benefit: a systematic review

}}</ref><ref>{{REFjournal

  |last=Ioannidis

  |title=Contradicted and initially stronger effects in highly cited clinical research

  |journal=JAMA

}}</ref><ref>{{REFjournal

  |last=Wheatley

  |last2=Clayton

  |title=Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization

  |journal=Control Clin Trials

}}</ref><ref>{{REFjournal

  |last=Slutsky

  |last2=Lavery

  |title=Data safety and monitoring boards

  |journal=N Engl J Med

  |last=Boyle

  |first=Gregory J.

  |last2=Hill

  |first2=George

  |author2-link=George Hill

  |title=Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns

Concerns about the three randomized controlled clinical trials (RCCTs) in Africa (in South Africa, Uganda, and Kenya)<ref>{{REFjournal

  |last=Auvert

  |author-link=Bertran Auvert

  |last3=Lagarde

  |last4=Sobngwi-Tambekou

  |last5=Sitta

  |last6=Puren

  |title=Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial

  |journal=PLoS Med

}}</ref><ref name="bailey2007">{{REFjournal

  |last=Bailey

  |last2=Moses

  |last3=Parker

  |etal=yes

  |title=Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial

}}</ref><ref name="gray2007">{{REFjournal

  |last=Gray

  |last2=Kigozi

  |last3=Serwadda

  |etal=yes

  |title=Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial

* 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>{{REFjournal

  |last=Weiss

  |last2=Quigley

  |last3=Hayes

  |title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis

  |journal=AIDS

}}</ref><ref>{{REFjournal

  |last=Siegfried

  |last2=Muller

  |last3=Deeks

  |etal=yes

  |title=HIV and male circumcision — a systematic review with assessment of the quality of studies

* 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>{{REFjournal

  |last=Slutsky

  |last2=Lavery

  |title=Data safety and monitoring boards

  |journal=N Engl J Med

  |last=Rosenberg

  |first=Molly S.

  |author-link=

  |last2=Gómez-Olivé

  |author2-link=

  |last3=Ronr

  |author3-link=

  |last4=Kahn

  |first4=Kathleen

  |author4-link=

  |last5=Bärnighausen

  |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

In a multivariate analysis, based on the 2013 DHS survey, circumcised men were found to have the same level of infection as uncircumcised men, after controlling for age, sexual behaviour and socioeconomic status. Lastly, circumcised men tended to have somewhat riskier sexual behaviour than uncircumcised men. This study, based on large representative samples of the Zambian population, questions the current strategy of mass circumcision campaigns in southern and eastern Africa.<ref name="garenne-matthews2019">{{REFjournal

  |last=Garenne

  |author-link=

  |last2=Matthews

  |author2-link=

  |etal=no

  |title=Voluntary medical male circumcision and HIV in Zambia: expectations and observations

  |journal=J Biosoc Sci

  |date=2019-10-14

}}</ref><ref>{{REFjournal

  |last=Guimaraes

  |author-link=

  |last2=Vlahov

  |last3=Castilho

  |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.

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

  |last2=Bailey

  |last3=Bukusi

  |last4=Montandon

  |last5=Kwena

  |etal=yes

  |title=Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs

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

  |title=Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa

  |journal=Afr J AIDS Res

}}</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

  |last2=Simbayi

  |last3=Shanmugam

  |last4=Nqeketo

  |title=Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002

  |journal=S Afr Med J

}}</ref> When commercial sex worker patterns are controlled, male circumcision is not signifıcantly associated with lower HIV prevalence.<ref>{{REFjournal

  |last=Talbott

  |title=Size matters: the number of prostitutes and the global HIV/AIDS pandemic

  |journal=PloS One

}}</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>{{REFjournal

  |last=Green

  |last2=Travis

  |last3=McAllister

  |author3-link=Ryan McAllister

  |last4=Peterson

  |last5=Vardanyan

  |last6=Craig

  |title=Male circumcision and HIV prevention insufficient evidence and neglected external validity

  |journal=Am J Prev Med

  |last=Brewer

  |first=Devon D.

  |first2=John J.

  |first3=John M.

  |first4=Stuart

  |title=Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania

  |journal=Annals of Epidemiology

Circumcision in real-world African settings will likely be a vector for transmitting the virus and is as such likely to worsen the pandemic.<ref>{{REFjournal

  |last=Brewer

  |last2=Brody

  |last3=Drucker

  |last4=Gisselquist

  |last5=Minkin

  |last6=Potterat

  |last7=Rothenberg

  |last8=Vachon

  |title=Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm

  |journal=Int J STD AIDS

}}</ref><ref>{{REFjournal

  |last=Gisselquist

  |last2=Potterat

  |last3=Brody  

  |last4=Vachon

  |title=Let it be sexual: how health care transmission of AIDS in Africa was ignored

  |journal=Int J STD AIDS

}}</ref><ref>{{REFjournal

  |last=Gisselquist

  |last2=Potterat

  |last3=Brody

  |title=Running on empty: sexual co-factors are insufficient to fuel Africa's turbocharged HIV epidemic

  |journal=Int J STD AIDS

}}</ref><ref>{{REFjournal

  |last=Gisselquist

  |last2=Potterat

  |title=Heterosexual transmission of HIV in Africa: an empiric estimate

  |journal=Int J STD AIDS

}}</ref><ref>{{REFjournal

  |last=Gisselquist

  |last2=Rothenberg

  |last3=Potterat

  |last4=Drucker

  |title=Non-sexual transmission of HIV has been overlooked in developing countries

  |journal=Br Med J

}}</ref><ref>{{REFjournal

  |last=Nyindo

  |title=Complementary factors contributing to the rapid spread of HIV-I in sub-Saharan Africa: a review

  |journal=East Afr Med J

  |last=Van Howe

  |first=Robert S.

  |author-link=Robert S. Van Howe

  |last2=Boyle

  |first2=Gregory J.

  |author2-link=Gregory J. Boyle

  |etal=no

  |title=Meta-analysis of HIV-acquisition studies incomplete and unstable  

  |journal=BJU Int

  |location=

A recent prospective study<ref>{{REFjournal

  |last=Turner

  |last2=Morrison

  |last3=Padian

  |etal=yes

  |title=Men’s circumcision status and women’s risk of HIV acquisition in Zimbabwe and Uganda

}}</ref> showed that male circumcision offered no protection to women, and an RCCT<ref>{{REFjournal

  |last=Wawer

  |last2=Makumbi

  |last3=Kigozi

  |etal=yes

  |title=Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial

* 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>{{REFjournal

  |last=Green

  |last2=Travis

  |last3=McAllister

  |last4=Peterson

  |last5=Vardanyan

  |last6=Craig

  |title=Male circumcision and HIV prevention insufficient evidence and neglected external validity

  |journal=Am J Prev Med (Department of Epidemiology and Biostatistics, University of California at San Francisco, USA)

|+ Estimated per act risk for acquisition<br/>of HIV by exposure route (US only) <ref name=MMWR3>{{REFjournal

  |last=Smith

  |last2=Grohskopf

  |last3=Black

  |etal=yes

  |title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States

| 9,000<ref name=Donegan>{{REFjournal

  |last=Donegan

  |last2=Stuart

  |last3=Niland

  |etal=yes

  |title=Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations

| 2,500<ref name=Coovadia>{{REFjournal

  |last=Coovadia

  |title=Antiretroviral agents&mdash;how best to protect infants from HIV and save their mothers from AIDS

  |journal=N. Engl. J. Med.

| 67<ref name=Kaplan>{{REFjournal

  |last=Kaplan

  |last2=Heimer

  |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.

| 30<ref name=Bell>{{REFjournal

  |last=Bell

  |title=Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview

  |volume=102

  |issue=5B

}}</ref><ref name=Varghese>{{REFjournal

  |last=Varghese

  |last2=Maher

  |last3=Peterman

  |last4=Branson

  |last5=Steketee

  |title=Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use

  |volume=29

  |issue=1

| 10<ref name=ESG /><ref name=Varghese /><ref name=Leynaert>{{REFjournal

  |last=Leynaert

  |last2=Downs

  |last3=de Vincenzi

  |title=Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV

  |volume=148

  |issue=1