Rebeca Plank

Dr. Rebeca Plank and Dr. Barbara Bassil hold recently circumcised babies.

Dr. Rebeca M. Plank is a Harvard researcher who was involved in three studies, sponsored by the Harvard School of Public Health and Daniel Halperin.

She was interviewed by Harvard's School of Public Health's AIDS Initiative Newsletter in 2010.

“	Article Excerpt: She is the Principal Investigator of a new clinical trial, Infant Male Circumcision in Gaborone, Botswana, and Surrounding Areas: Feasibility, Safety and Acceptability. Plank is an Infectious Disease and HIV specialist who trained at the Brigham and Women’s Hospital in Boston.

Notably, the words "Feasibility" and "Safety" were omitted from the 2010 publication's final title.

Much of her work seems to be oriented to make infant circumcision acceptable in Botswana, even though the WHO's circumcision programs were originally guided to voluntary circumcision (adults) and the World Health Organization manual for infant circumcision recognizes that "A concern about early infant male circumcision is that the child cannot give informed consent for the procedure. Moreover, some of the health benefits, including reducing the risk of HIV infection, will not be realized until many years later when the person becomes sexually active. If circumcision is postponed until an older age the patient can evaluate the risks and benefits and consent to the procedure himself."

Contents

Deaths during the Mogen vs. Plastibell trial

302 healthy male babies where randomly assigned to Mogen and Plastibell. 155 were assigned to the Mogen clamp, but two of them were not circumcised due to fever. 147 were assigned to Plastibell and circumcised. The trial concluded that "NMC can be performed in Botswana with a low rate of adverse events and high parental satisfaction. Although the risk of migration and retention of the Plastibell is small, the Mogen clamp may be safer for NMC in regions where immediate emergent medical attention is not available."

Out of the 153 babies circumcised with Mogen clamp, one died before followup. Two of the babies circumcised with Plastibell died before follow up. These deaths are not mentioned in the abstract of the trial. In a letter to JAIDS Journal of Acquired Immune Deficiency Syndromes, Plank explains that the two babies who were circumcised with Plastibell and later died, died several weeks after the procedure from gastroenteritis. The baby circumcised with Mogen clamp died within 24 hours of the procedure of suspected sepsis, however the researcher does not think this was a consequence of the procedure, even though infection and sepsis are possible consequences of circumcision. No autopsy was performed.

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Author's reply: A randomized trial of Mogen clamp versus Plastibell for neonatal male circumcision in Botswana. "The baby was circumcised using a Mogen clamp on day of life 2 and discharged to home later that day. The following day he was brought to the local health center with respiratory distress and was noted to be febrile and was transferred to the district hospital. The study team was not notified of his admission until the next morning, after he had died. The circumstances of this baby's death were reviewed in great detail with several groups to obtain independent assessment of the cause of death: the hospital staff, the Botswana Ministry of Health, the Botswana Health Research and Development Committee, the Partners Institutional Review Board, and our own Data Safety Monitoring Committee. All parties agreed that based on all the clinical data available, the most likely cause of death was neonatal sepsis or pneumonia and that it was extremely unlikely that the baby's death was related to the circumcision procedure." "Autopsies are very rarely performed in Botswana and were not performed in any of the 3 deaths in the study. Detailed diagnostic work-ups are also often not available in resource-limited settings or are not performed (eg, because a baby dies at home). Finally, prenatal screening for group B streptococcus is not routinely performed, and mothers do not receive prophylactic antibiotics." "Neonates in much of sub-Saharan Africa face the highest mortality rates in the world, and we agree that the exact cause of their death is often not known."

PEPFAR has discontinued support of circumcision of boys under 15-years-old.

Publications

• Plank RM, Makhema J, Kebaabetswe P, et al. Acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts in Gaborone, Botswana, and surrounding areas. AIDS Behav. October 2010; 14(5): 1198-202. PMID. PMC. DOI. Retrieved 11 July 2022.
• Jayeoba O, Dreyden-Peterson S, Okui L, Plank RM, et al. Acceptability of male circumcision among adolescent boys and their parents, Botswana. AIDS Behav. February 2012; 16(2): 340-9. PMID. PMC. DOI. Retrieved 11 July 2022.
• Plank RM, et al. A randomized trial of Mogen clamp versus Plastibell for neonatal male circumcision in Botswana. J Acquir Immune Defic Syndr. 15 April 2013; 62(5): e131-7. PMID. PMC. DOI. Retrieved 11 July 2022.

Population-based studies

September 2021 saw the publication of two huge population studies on the relationship of circumcision and HIV infection:

1. 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 study concluded that circumcision status is not related to risk of HIV infection.
2. Morten Frisch & Jacob Simonsen (2021) carried out a large scale empirical population study in Denmark of 855,654 males regarding the alleged value of male circumcision in preventing 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 men.

No association between lack of circumcision and risk of HIV infection was found by either study. There now is credible evidence that the massive, expensive African circumcision programs have not been effective in preventing HIV infection.

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:

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.

In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe). He reported:

"Results matched earlier observations made in South Africa that circumcised and intact men had similar levels of HIV infection."

External links

• Thornton, Jim (30 March 2013). Boston/Botswana circumcision trial, Ripe Tomatoes. Retrieved 11 July 2022.
• Thornton, Jim (31 March 2013). Boston/Botswana circumcision trial Part 2, Ripe Tomatoes. Retrieved 11 July 2022.
• Thornton, Jim (11 October 2013). Boston/Botswana circ. trial update, Ripe Tomatoes. Retrieved 11 July 2022.
• Gisselquist, David (26 October 2013). Do medical researchers in Africa protect babies? Maybe not always, Bloodborne HIV: Don't Get Stuck. Retrieved 11 July 2022.