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

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

|}}</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

* Homesexuality Homosexuality and anal intercourse.

Thomas et al. (2004) studied the incidence of [[HIV]] in circumcision [[circumcised]] and [[intact ]] men in a United States Navy population. A slightly higher incidence of [[HIV]] infection was found in circumcised men (84.9%) as compared with intact men (81.8%). The authors concluded:

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 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 mucosal [[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, 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>{{REFjournal |last=de Witte |first=Lot |init=L |last2=Nabatov |first2=Alexey |init2=A |last3=Pion |first3=Marjorie |init3=M |last4=Fluitsma |first4=Donna |init4=D |last5=de Jong |first5=Marein A.W.P. |init5=MAWP |last6=de Gruijl |first6=Tanja |init6=T |last7=Piguet |first7=Vincent |init7=V |last8=van Kooyk |first8=Yvette |init8=Y |last9=Geijtenbeek |first9=Teunis B.H. |init9=TBH |title=Langerin is a natural barrier to HIV-1 transmission by Langerhans cells |journal=Nature Medicine |volume=13 |issue=3 |pages=367-71 |url=http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf |format=PDF |pubmedID=17334373 |pubmedCID=10.1038/nm1541 |DOI=10.1038/nm1541 |date=DeWitte etal 2007-03-04 |accessdate=2020-07-02}}</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=Price

|url=httphttps://wwwjournals.plosoneplos.org/plosone/article/info%3Adoi%2F10?id=10.1371%2Fjournal/journal.pone.00155520008422

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 inflamationinflammation, and whether said inflamation 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 inflamationsinflammations, 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 [[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.

All of these function to sequester and “digest” foreign pathogens. All these substances play an important role in protecting the [[penis ]] from viral and bacterial pathogens. The immunological functions of the human [[prepuce ]] have been extensively documented by respected researchers for quite some time.<ref name="fleiss-hodges-vanhowe1998">{{REFjournal |last=Fleiss |init=PM |author-link=Paul M. Fleiss |last2=Hodges |init2=FM |author2-link=Frederick M. Hodges |last3=Van Howe |init3=RS |author3-link=Robert S. Van Howe |title=Immunological functions of the human prepuce |journal=Sex Trans Infect |date=FleissP HodgesF VanHoweRS 1998-10 |volume=74 |issue=5 |pages=364-67 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758142/pdf/v074p00364.pdf |quote= |pubmedID=10195034 |pubmedCID= |DOI= |accessdate=2021-10-27}}</ref>

Circumcision destroys the natural [[Immunological and protective function of the foreskin| immunological protections of the foreskin ]] and [[preputial sac]], so it results in increased risk of contracting [[infection]].

Concerns about the [[HIV trials in Africa|three randomized controlled clinical trials (RCCTs) in Africa ]] (in South Africa, Uganda, and Kenya)<ref>{{REFjournal |last=RCT Auvert |init=B |author-link=Bertran Auvert |last2=Taljaard |init2=D |last3=Lagarde |init3=E |last4=Sobngwi-Tambekou |init4=J |last5=Sitta |init5=R |last6=Puren |init6=A |title=Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial |journal=PLoS Med |date=et al 2005 |volume=2 |issue=11 |page=e298}}</ref><ref name="bailey2007">{{REFjournal |last=RCT Bailey |init=RC |last2=Moses |init2=S |last3=Parker |init3=CB |etal=yes |title=Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial |journal=Lancet |date=et al 2007 |volume=369 |issue=9562 |pages=643–656}}</ref><ref name="gray2007">{{REFjournal |last=RCT Gray |init=RH |last2=Kigozi |init2=G |last3=Serwadda |init3=D |etal=yes |title=Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial |journal=Lancet |date=et al 2007 |volume=369 |issue=9562 |pages=657-666}}</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, 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>{{REFbook |last=Gisselquist

According to demographic health studies performed in other countries in Africa, [[HIV]] transmission was prevalent in [[circumcised ]] men in at least 6 different countries:

===== Cameroon =====In Cameroon, where 91% of the male population is circumcised, the ratio of [[circumcised [[ men vs. [[intact ]] men who contracted [[HIV]] was 4.1 vs. 1.1. <ref>{{REFbook

===== Ghana =====

===== Lesotho =====

''"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

::''An interesting defense of male circumcision, given the fact that the latest "studies," if they can even be called that, observed [[HIV]] 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 =====

===== Rwanda =====

=====South Africa===== 

===== Swaziland =====

:"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>

=====Zambia=====

[[Michel Garenne |Garenne]] & Matthews (2019) report:

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

|author-link=Michel Garenne

==== Malaysia ====According to Malaysian [[AIDS]] Council vice-president Datuk Zaman Khan, more than 70% of the 87,710 [[HIV]]/[[AIDS]] sufferers in the country are Muslims. In Malaysia, most, if not all Muslim men are circumcised, whereas circumcision is uncommon in the non-Muslim community. 60% of the Malaysian population is Muslim, which means that [[HIV]] is spreading in the community where most men are circumcised at an even faster rate, than in the community 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>

==== The Philippines ====[[Tuli]] or male circumcision, a nearly compulsory cultural practice in the Philippine Islands, causes 93 percent of Filipino males to be [[circumcised]].

The statistics suggest that removal of the protective [[foreskin]] by [[circumcision ]] increases the risk of contracting [[HIV]] infection.

==== [[Israel =]] ===Despite circumcision being near-universal, [[HIV]] is an increasing problem in [[Israel]].<ref>{{REFweb

==== The United States ====In America, the majority of the male population is [[circumcised]], approximately 7562%, <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 ===

Circumcision advocates use the latest discredited RCT African studies and WHO's endorsement based on them as proof "beyond reasonable doubt" that circumcision "reduces the risk of [[HIV]]." However, there are problems with the WHO's endorsement, as the studies on which it is based on suffer various flaws and confounding factors that bring their credibility in to question, many of which will be discussed in this article.

[[Robert S. Van Howe |Van Howe]] & Boyle (2018) pointed out numerous reasons that one should doubt the published results of the randomised clinical trials (RCTs)<ref name= "vanhowe2018">{{REFjournal

[[George C. Denniston]], {{MD}}, {{MPH}}, the president of [[Doctors Opposing Circumcision (D.O.C.)| Doctors Opposing Circumcision]], in a letter to Ambassador Deborah L. Birx, {{MD}}, {{MPH}}, (2020), the head of the President’s Emergency Plan for AIDS Relief (PEPFAR) has called on [[PEPFAR]] to suspend the provision of male [[circumcision]] because it is ineffective and may increase the reception of [[HIV]] infection due to the loss of [[Immunological and protective function of the foreskin| immunological protections]] of the [[foreskin]], and to focus on the provision of anti-retroviral therapy and condoms.<ref name="denniston2020">{{REFdocument

|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

===September 2021===September 2021 saw Threre now is credible evidence that the publication of two huge population studies on the relationship of massive, expensive African circumcision and programs have ''not'' been effective in preventing [[HIV]] infection.

Mayan et al. (2021) carried out a massive empirical study of the male population of the province of Ontario, [[Canada]] (569,950 males), of whom 203,588 (35.7%) were circumcised between 1991 and 2017. The == Increased risk to women ==A recent prospective study concluded that circumcision status is not related to risk of [[HIV]] infection.<ref name="mayan2021">{{REFjournal |last=Mayan |first=MadhurTurner |init= |author-link=AN |last2=Hamilton |first2=Robert J.Morrison |init2= |author2-link=CS |last3=Juurlink |first3=David N.Padian |init3= |author3-link= |last4=Austin |first4=Peter C. |init4= |author4-link= |last5=Jarvi |first5=Keith A. |init5= |author5-link=NS |etal=noyes |title=Circumcision Men’s circumcision status and Risk women’s risk of HIV Among Males From Ontario, Canadaacquisition in Zimbabwe and Uganda |trans-titlejournal=AIDS |languagedate=2007 |journalvolume=J Urol21 |locationpages=1779–1789 |date=2021-09-23}}</ref> showed that male circumcision offered no protection to women, and an RCCT<ref>{{REFjournal |volumelast=Wawer |issueinit=MJ |articlelast2=Makumbi |pageinit2=F |pageslast3=Kigozi |urlinit3=https://www.auajournals.org/doi/pdf/10.1097/JU.0000000000002234G |archivedetal=yes |quotetitle=We found that circumcision was not independently associated with the risk of acquiring Circumcision in HIV among -infected men from Ontarioand its effect on HIV transmission to female partners in Rakai, Canada.Uganda: a randomised controlled trial |pubmedIDjournal=34551593Lancet |pubmedCIDdate=2009 |DOI=10.1097/JU.0000000000002234volume374 |accessdatepages=2021229-10-02237}}</ref> [[Morten Frisch]] and Jacob Simonsen (2021) carried out a large scale empirical population study in [[Denmark]] of 855found that male circumcision actually increased the risk to women. Women also are placed at greater risk from unsafe sex practices when they,654 males regarding the alleged value of or their circumcised male partners, wrongly believe that with circumcision in preventing they are immune to [[HIV]] and other sexually transmitted infections in men. They found that circumcised men have a higher rate of STI and [[HIV]] infection overall than [[intact]] mentherefore they choose not to use condoms.<ref name="frisch2021">{{REFjournalREFweb |last=FrischNyakairu |first=Morten |init= |author-link=Morten Frisch |last2=Simonsen |first2=Jacob |init2= |author2-link= |etal=noF. |title=Non-therapeutic male Uganda turns to mass circumcision in infancy or childhood and risk of human immunodeficiency virus and other sexually transmitted infections: national cohort study in Denmark |trans-title=AIDS fıght |language= |journal=Eur J Epidemiol |locationpublisher=Reuters Africa |date=20212008-0908-2613 |volumeurl=Published online ahead of printhttps://www.reuters.com/article/idUSLD23235720080813 |issue=}}</ref><ref>{{REFweb |articletitle=Circumcision gives men an excuse not to use condoms |pagepublisher=UN Offıce for the Coordination of Humanitarian Affairs |pageswebsite=The New Humanitarian (formerly IRIN News) |url=httpshttp://linkwww.springerthenewhumanitarian.comorg/news/2008/article07/10.100731/s10654circumcision-021gives-00809men-6excuse-not-use-condoms |archiveddate= |quote= |pubmedID=34564796 |pubmedCID= |DOI=10.1007/s10654-021-008092008-607 |accessdate=20212020-1001-2005

There now is credible evidence that the massiveare legitimate additional concerns about:* How male circumcision programs, or being circumcised, expensive African will influence human behavior.* The sidelining of women when considering male circumcision programs have ''not'' been effective as a prevention method.* 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 preventing [[HIV]] infectionthe use of condoms and other safe sex practices.<ref name="Green etal 2010"/> == Effective prevention ==

{| class="wikitable" border= Increased risk to women "1" style="float:right; font-size:85%; margin-left:15px;"|- style="background:#efefef;"A recent prospective study|+ Estimated per act risk for acquisition<br/>of [[HIV]] by exposure route (US only) <refname=MMWR3>{{REFjournal |last=TurnerSmith |init=ANDK |last2=MorrisonGrohskopf |init2=CSLA |last3=PadianBlack |init3=NSRJ

|title=Men’s circumcision status and women’s risk of Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV acquisition in Zimbabwe and Ugandathe United States |journal=AIDSMMWR |datevolume=200754 |volumeissue=21RR02 |pages=1779–17891-20 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1 |quote= |pubmedID= |pubmedCID= |DOI= |date=2005 |accessdate=2009-03-31}}</ref> showed that male circumcision offered no protection |- style="background:#efefef;"! style="width: 100px" abbr="Route" | Exposure Route! style="width: 130px" abbr="Infections" | Estimated infections<br/>per 10,000 exposures<br/>to womenan infected source|-! style="text-align:left"| Blood Transfusion| 9, and an RCCT000<refname=Donegan>{{REFjournal |last=WawerDonegan |init=MJE |last2=MakumbiStuart |init2=FM |last3=KigoziNiland |init3=GJC

|title=Circumcision in Infection with human immunodeficiency virus type 1 (HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial1) among recipients of antibody-positive blood donations |journal=LancetAnn. Intern. Med. |datevolume=2009113 |volume374issue=10 |pages=229733-237739 |url= |quote= |pubmedID=2240875 |pubmedCID= |DOI= |date=1990 |accessdate=}}</ref> found that male circumcision actually increased the risk |-! style="text-align:left"| Childbirth <small>(to women. Women also are placed at greater risk from unsafe sex practices when they, or their circumcised male partnerschild)</small>| 2, wrongly believe that with circumcision they are immune to [[HIV]] and therefore they choose not to use condoms.500<refname=Coovadia>{{REFwebREFjournal |last=NyakairuCoovadia |firstinit=F.H |title=Uganda turns Antiretroviral agents&mdash;how best to mass circumcision in protect infants from HIV and save their mothers from AIDS fıght |publisherjournal=Reuters AfricaN. Engl. J. Med. |datevolume=351 |issue=3 |pages=2008289-08-13292 |url=https://www.reuters.com/article/idUSLD23235720080813}}</ref><ref>{{REFweb |titlequote=Circumcision gives men an excuse not to use condoms |publisherpubmedID=UN Offıce for the Coordination of Humanitarian Affairs15247337 |websitepubmedCID=The New Humanitarian (formerly IRIN News) |urlDOI=http://www10.thenewhumanitarian.org1056/news/2008/07/31/circumcision-gives-men-excuse-not-use-condomsNEJMe048128 |date=2008-072004 |accessdate=2020-01-05

|-There are legitimate additional concerns about:* How male circumcision programs, or being circumcised, will influence human behavior.* The sidelining of women when considering male circumcision as a prevention method.* 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 etal 2010"/> == Effective prevention == {| class="wikitable" border="1" ! style="float:right; fonttext-sizealign:85%; margin-left:15px;"|Needle- style="background:#efefef;"sharing injection drug use|+ Estimated per act risk for acquisition<br/>of [[HIV]] by exposure route (US only) 67<ref name=MMWR3Kaplan>{{REFjournal |last=SmithKaplan |init=DKEH |last2=GrohskopfHeimer |init2=LA |last3=Black |init3=RJ |etal=yesR |title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United Statesincidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data |journal=MMWRJ. Acquir. Immune Defic. Syndr. Hum. Retrovirol. |volume=5410 |issue=RR022 |pages=1175-20176 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1 |quote= |pubmedID=7552482 |pubmedCID= |DOI= |date=20051995 |accessdate=2009-03-31

! style="text-align:left"| Blood TransfusionPercutaneous needle stick| 9,00030<ref name=DoneganBell>{{REFjournal |last=DoneganBell |init=E |last2=Stuart |init2=M |last3=Niland |init3=JC |etal=yesDM |title=Infection with Occupational risk of human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donationsinfection in healthcare workers: an overview |journal=Ann. Intern. Am J Med. |volume=113102 |issue=105B |pages=7339-73915

|pubmedID=22408759845490

|DOI=10.1016/S0002-9343(97)89441-7 |date=19901997

! style="text-align:left"| Childbirth Receptive anal intercourse<smallsup>(to child)*</smallsup>| 2,50050<ref name=CoovadiaESG>{{REFjournal |last=CoovadiaEuropean Study Group on Heterosexual Transmission of HIV |initfirst=H |title=Antiretroviral agents&mdash;how best Comparison of female to protect infants from male and male to female transmission of HIV and save their mothers from AIDSin 563 stable couples |journal=N. Engl. J. Med.BMJ |volume=351304 |issue=36830 |pages=289809-292813

|pubmedID=152473371392708 |pubmedCID=1881672 |DOI=10.10561136/NEJMe048128bmj.304.6830.809 |date=2004

}}</ref>|-! style="text-align:left"| Needle-sharing injection drug use| 67<ref name=KaplanVarghese>{{REFjournal |last=KaplanVarghese |init=EHB |last2=HeimerMaher |init2=RJE |last3=Peterman |init3=TA |last4=Branson |init4=BM |last5=Steketee |init5=RW |title=Reducing the risk of sexual HIV incidence among New Haven needle exchange participantstransmission: updated estimates from syringe tracking quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and testing datacondom use |journal=J. Acquir. Immune Defic. Syndr. Hum. Retrovirol.Sex Transm Dis |volume=1029 |issue=21 |pages=17538-17643

|pubmedID=755248211773877

|date=19952002

! style="text-align:left"| Percutaneous needle stickInsertive anal intercourse^*| 6.5<ref name=ESG /><ref name=Varghese />|-! style="text-align:left"| 30Receptive penile-vaginal intercourse^*| 10<ref name=ESG /><ref name=BellVarghese /><ref name=Leynaert>{{REFjournal |last=BellLeynaert |init=DMB |last2=Downs |init2=AM |last3=de Vincenzi |init3=I |title=Occupational risk Heterosexual transmission of human immunodeficiency virus : variability of infectivity throughout the course of infection in healthcare workers: an overview. European Study Group on Heterosexual Transmission of HIV |journal=Am J MedEpidemiol |volume=102148 |issue=5B1 |pages=988-1596

|pubmedID=98454909663408

|DOI=10.1016/S0002-9343(97)89441-7 |date=19971998

! style="text-align:left"| Insertive penile-vaginal intercourse^*| 5<ref name=ESG /><ref name=Varghese />|-! style="text-align:left"| Receptive anal oral intercourse^*§| 501<ref name=ESGVarghese />|-! style="text-align:left"| Insertive oral intercourse^*§| 0.5<ref name=Varghese />|- style="background:#efefef;"! colspan=5 style="border-right:0;"| ^* assuming no condom use <br /> ^§ source refers to oral intercourse<br/>performed on a man|}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>{{REFjournalREFweb |url=http://www.avert.org/aids.htm |title=Facts about AIDS & HIV |last=European Study Group on Heterosexual Transmission of HIV

|titlepublisher=Comparison of female to male and male to female transmission of HIV in 563 stable couplesavert.org |journaldate=BMJ |volumeaccessdate=3042007-11-30 |issue}}</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=6830"denniston2020" />  |pages=809= Population-813based studies =={{Population-based studies}}  |url= |quote= |pubmedIDTwo African surveys=1392708 |pubmedCID=1881672 |DOI=10The previously reported studies were from developed Western nations. Now we have information from Sub_Saharan Africa.1136/bmj French scientist [[Michel Garenne]], Ph.304D.6830has published two reports in 2022 comparing the incidence of HIV infection in [[circumcised]] and [[intact]] men.809 |date= |accessdate=In his first report, Garenne presented the findings from a study in Lesotho, the enclave in South Africa. He reported:}}</refblockquote>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=Varghese"garenne2022A">{{REFjournal |last=VargheseGarenne |initfirst=BMichel |last2init=MaherM |init2author-link=JEMichel Garenne |last3title=PetermanChanging relationships between HIV prevalence and circumcision in Lesotho |init3url=TAhttps://pubmed.ncbi.nlm.nih.gov/35373731/ |last4date=Branson |init4=BM |last5=Steketee |init5=RW |title=Reducing the risk of sexual HIV transmission: quantifying the per2022-04-act risk for HIV on the basis of choice of partner, sex act, and condom use04 |journal=Sex Transm DisJ Biosoc Sci |volume=29online ahead of print |issuepages=1 |pages=38-4316 |url= |quoteDOI=10.1017/S0021932022000153 |pubmedID=11773877 |pubmedCID= |DOI= |date=200235373731 |accessdate=2022-10-28}}</ref>|-! style="text-align:left"| Insertive anal intercourse<sup>*</supblockquote>| 6In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe).5<ref name=ESG />He reported:<ref name=Varghese /blockquote>|-! style= "text-align:leftResults matched earlier observations made in South Africa that [[circumcised]] and [[intact]] men had similar levels of HIV infection."| Receptive penile-vaginal intercourse^*| 10<ref name=ESG /><ref name=Varghese /><ref name=Leynaert"garenne2022B">{{REFjournal |last=LeynaertGarenne |first=Michael |init=BM |last2author-link=Downs |init2etal=AMno |last3title=de VincenziAge-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa |init3trans-title=I |titlelanguage=Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV |journal=Am J EpidemiolBiosoc Sci |location= |date=2022-10-26 |season= |volume=148 |issue=1 |article= |page= |pages=881-9613 |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=

|pubmedID=966340836286328

|DOI= |date=1998 |accessdate=}}</ref>|-! style="text-align:left"| Insertive penile-vaginal intercourse^*| 5<ref name=ESG /><ref name=Varghese />|-! style="text-align:left"| Receptive oral intercourse^*§| 1<ref name=Varghese />|-! style="text-align:left"| Insertive oral intercourse^*§| 0.5<ref name=Varghese />|- style="background:#efefef;"! colspan=5 style="border-right:0;"| ^* assuming no condom use <br /> ^§ source refers to oral intercourse<br/>performed on a man|}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 |url=http://www10.avert.org1017/aids.htm |title=Facts about AIDS & HIV |last= |first= |publisher=avert.org |date=S0021932022000414 |accessdate=20072022-1110-3027}}</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" /blockquote>

|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

|last=[[Foregen ]] Staff

|publisher=[[Foregen]]