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==== Countries in Africa ====
}}</ref>
== African RCTs ==
Strong bias exists in the RCTs.<ref>{{REFjournal
|last=Green
|first=L.W.
|etal=yes
|title=Male circumcision is not the HIV 'vaccine' we have been waiting for!
|journal=Future HIV Ther.
|date=2008
|volume=2
|issue=3
|pages=193–199
}}</ref><ref>{{REFjournal
|last=Montori
|first=V.M.
|last2=Devereaux
|first2=P.J.
|last3=Adhikari
|first3=N.K.J.
|etal=yes
|title=Randomized trials stopped early for benefit: a systematic review
|journal=JAMA
|date=2005
|volume=294
|pages=2203-2209
}}</ref><ref>{{REFjournal
|last=Ioannidis
|first=J.P.
|title=Contradicted and initially stronger effects in highly cited clinical research
|journal=JAMA
|date=2005
|volume=294
|pages=218-228
}}</ref><ref>{{REFjournal
|last=Wheatley
|first=K.
|last2=Clayton
|first2=D.
|title=Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization
|journal=Control Clin Trials
|date=2003
|volume=24
|pages=66-70
}}</ref><ref>{{REFjournal
|last=Slutsky
|first=A.S.
|last2=Lavery
|first2=J.V.
|title=Data safety and monitoring boards
|journal=N Engl J Med
|date=2004
|volume=350
|pages=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>{{REFdocument
|contribution=Male Circumcision: Current Epidemiological and Field Evidence
|quote=designed to detect a minimum 50 percent reduction in HIV risk
|url=https://path.azureedge.net/media/documents/HIV-AIDS_male-circ.pdf
|title=Program and Policy Implications For HIV Prevention and Reproductive Health
|publisher=USAID
|format=PDF
|date=2002-01
|accessdate=2019-09-29
}}</ref> By designing a trial to "detect" a minimum 50 percent reduction risk in HIV, these researchers might have artificially created the clinical setting to observe the effect they were looking to discover.
Boyle & Hill (2011) have shown these RCTs to be have significant methodological flaws and statistical errors that render their claims invalid. Although a 60 percent ''relative'' reduction in HIV was claimed, the ''absolute'' reduction was a statistically insignificant 1.3 percent.<ref name="boyle-hill2011">{{REFjournal
|last=Boyle
|first=Gregory J.
|author-link=
|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
|journal=J Law Med
|date=2011-12
|volume=19
|issue=2
|pages=316-334
|url=http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf
|quote=
|pubmedID=22320006
|pubmedCID=
|DOI=
|accessdate=2019-10-13
}}</ref>
Concerns about the three randomized controlled clinical trials (RCCTs) in Africa (in South Africa, Uganda, and Kenya)<ref>{{REFjournal
|last=Auvert
|first=B.
|author-link=Bertran Auvert
|last2=Taljaard
|first2=D.
|last3=Lagarde
|first3=E.
|last4=Sobngwi-Tambekou
|first4=J.
|last5=Sitta
|first5=R.
|last6=Puren
|first6=A.
|title=Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial
|journal=PLoS Med
|date=2005
|volume=2
|issue=11
|page=e298
}}</ref><ref>{{REFjournal
|last=Bailey
|first=R.C.
|last2=Moses
|first2=S.
|last3=Parker
|first3=C.B.
|etal=yes
|title=Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial
|journal=Lancet
|date=2007
|volume=369
|issue=9562
|pages=643–656
}}</ref><ref>{{REFjournal
|last=Gray
|first=R.H.
|last2=Kigozi
|first2=G.
|last3=Serwadda
|first3=D.
|etal=yes
|title=Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial
|journal=Lancet
|date=2007
|volume=369
|issue=9562
|pages=657-666
}}</ref>:
* The three RCCTs were terminated early because results had reached signifıcance 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
|first=D.
|year=2008
|title=Points to consider: responses to HIV/AIDS in Africa, Asia, and the Caribbean
|url=
|publisher=Adonis and Abbey
|location=London
|pages=
|chapter=7
|isbn=
|accessdate=
}}</ref>
* Participants received continuous counseling, free condoms, and monitoring for infection, which was unlikely in real-world campaigns.
* 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
|first=H.A.
|last2=Quigley
|first2=M.A.
|last3=Hayes
|first3=R.J.
|title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis
|journal=AIDS
|date=2000
|volume=14
|pages=2361–2370
}}</ref><ref>{{REFjournal
|last=Siegfried
|first=N.
|last2=Muller
|first2=M.
|last3=Deeks
|first3=J.
|etal=yes
|title=HIV and male circumcision — a systematic review with assessment of the quality of studies
|journal=Lancet Infect Dis
|date=2005
|volume=5
|pages=165–173
}}</ref>
* 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
|first=A.S.
|last2=Lavery
|first2=J..V.
|title=Data safety and monitoring boards
|journal=N Engl J Med
|date=2004
|volume=350
|pages=1143-1147
Relocate section.
Presenting this hypothesis presents a two-fold problem. First, it presents an irrelevant conclusion; the randomized control trials were measuring frequency in HIV transmission, not for frequency in penile bacterial inflamation, and whether said inflamation 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, uncircumcised men with constant penile inflamations, and uncircumcised men who don't suffer constant penile inflamation. Unless the randomized controlled studies were limited to only uncircumcised men who suffered constant penile inflamation.
== African RCTs ==Strong bias exists in the RCTs.<ref>{{REFjournal |last=Green |first=L.W. |etal=yes |title=Male circumcision is not the HIV 'vaccine' we have been waiting for! |journal=Future HIV Ther. |date=2008 |volume=2 |issue=3 |pages=193–199}}</ref><ref>{{REFjournal |last=Montori |first=V.M. |last2=Devereaux |first2=P.J. |last3=Adhikari |first3=N.K.J. |etal=yes |title=Randomized trials stopped early for benefit: a systematic review |journal=JAMA |date=2005 |volume=294 |pages=2203-2209}}</ref><ref>{{REFjournal |last=Ioannidis |first=J.P. |title=Contradicted and initially stronger effects in highly cited clinical research |journal=JAMA |date=2005 |volume=294 |pages=218-228}}</ref><ref>{{REFjournal |last=Wheatley |first=K. |last2=Clayton |first2=D. |title=Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization |journal=Control Clin Trials |date=2003 |volume=24 |pages=66-70}}</ref><ref>{{REFjournal |last=Slutsky |first=A.S. |last2=Lavery |first2=J.V. |title=Data safety and monitoring boards |journal=N Engl J Med |date=2004 |volume=350 |pages=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>{{REFdocument |contribution=Male Circumcision: Current Epidemiological and Field Evidence |quote=designed to detect a minimum 50 percent reduction in HIV risk |url=https://path.azureedge.net/media/documents/HIV-AIDS_male-circ.pdf |title=Program and Policy Implications For HIV Prevention and Reproductive Health |publisher=USAID |format=PDF |date=2002-01 |accessdate=2019-09-29}}</ref> By designing a trial to "detect" a minimum 50 percent reduction risk in HIV, these researchers might have artificially created the clinical setting to observe the effect they were looking to discover. Boyle & Hill (2011) have shown these RCTs to be have significant methodological flaws and statistical errors that render their claims invalid. Although a 60 percent ''relative'' reduction in HIV was claimed, the ''absolute'' reduction was a statistically insignificant 1.3 percent.<ref name="boyle-hill2011">{{REFjournal |last=Boyle |first=Gregory J. |author-link= |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 |journal=J Law Med |date=2011-12 |volume=19 |issue=2 |pages=316-334 |url=http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf |quote= |pubmedID=22320006 |pubmedCID= |DOI= |accessdate=2019-10-13}}</ref> Concerns about the three randomized controlled clinical trials (RCCTs) in Africa (in South Africa, Uganda, and Kenya)<ref>{{REFjournal |last=Auvert |first=B. |author-link=Bertran Auvert|last2=Taljaard |first2=D. |last3=Lagarde |first3=E. |last4=Sobngwi-Tambekou |first4=J. |last5=Sitta |first5=R. |last6=Puren |first6=A. |title=Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial |journal=PLoS Med |date=2005 |volume=2 |issue=11 |page=e298}}</ref><ref>{{REFjournal |last=Bailey |first=R.C. |last2=Moses |first2=S. |last3=Parker |first3=C.B. |etal=yes |title=Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial |journal=Lancet |date=2007 |volume=369 |issue=9562 |pages=643–656}}</ref><ref>{{REFjournal |last=Gray |first=R.H. |last2=Kigozi |first2=G. |last3=Serwadda |first3=D. |etal=yes |title=Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial |journal=Lancet |date=2007 |volume=369 |issue=9562 |pages=657-666}}</ref>:* The three RCCTs were terminated early because results had reached signifıcance 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 |first=D. |year=2008 |title=Points to consider: responses to HIV/AIDS in Africa, Asia, and the Caribbean |url= |publisher=Adonis and Abbey |location=London |pages= |chapter=7 |isbn= |accessdate=}}</ref>* Participants received continuous counseling, free condoms, and monitoring for infection, which was unlikely in real-world campaigns.* 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 |first=H.A. |last2=Quigley |first2=M.A. |last3=Hayes |first3=R.J. |title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis |journal=AIDS |date=2000 |volume=14 |pages=2361–2370}}</ref><ref>{{REFjournal |last=Siegfried |first=N. |last2=Muller |first2=M. |last3=Deeks |first3=J. |etal=yes |title=HIV and male circumcision — a systematic review with assessment of the quality of studies |journal=Lancet Infect Dis |date=2005 |volume=5 |pages=165–173}}</ref>* 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 |first=A.S. |last2=Lavery |first2=J..V. |title=Data safety and monitoring boards |journal=N Engl J Med |date=2004 |volume=350 |pages=1143-1147}}</ref>== Real world data ===
According to demographic health studies performed in other countries in Africa, HIV transmission was prevalent in circumcised men in at least 6 different countries:
|publisher=International Herald Tribune
|date=2007-03-06
}}</ref>