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|accessdate=2011-06-02
}}</ref>
[[David Gisselquist]], Ph. D., who has studied health care practices in sub-Saharan Africa, finds that much of health care, especially injection practices, in Africa is non-sterile, and is likely the cause of the high incidence of HIV infection. He notes that the consensus to make sex the primary cause of infection was determined in the 1980s and is likely to be inaccurate, because it does not give sufficient weight to medical transmission of HIV infection.<ref name=”gisselquist2002”>{{REFjournal
|last=Gisselquist
|init=D
|last2=Rothenberg
|init2=R
|last3=Potterat
|init3=J
|last4=Drucker
|init4=E
|title=[https://europepmc.org/article/med/11809652#free-full-text Non-sexual transmission of HIV has been overlooked in developing countries]
|journal=Br Med J
|date=2002
|volume=324
|issue=7331
|page=235
}}</ref> Gisselquist ‘’et al’’. argue strongly that statistical evidence indicates that 5/6s of the HIV infection in Africa is non-sexual.<ref name=”gisselquist2003”>{{REFjournal
|last=Gisselquist
|init=D
|last2=Potterat
|init2=JJ
|title=[http://www.cirp.org/library/disease/HIV/gisselquist2/gisselquist2.pdf Heterosexual transmission of HIV in Africa: an empiric estimate]
|journal=Int J STD AIDS
|date=2003
|volume=14
|pages=162-73
}}</ref> <ref>{REFjournal
|last=Gisselquist
|init=D
|last2=Potterat
|init2=JJ
|last3=Brody
|init3=S
|title=[https://www.researchgate.net/profile/John-Potterat/publication/8479267_Running_on_empty_Sexual_co-factors_are_insufficient_to_fuel_Africa%27s_turbocharged_HIV_epidemic/links/00b7d529d10fbac5c9000000/Running-on-empty-Sexual-co-factors-are-insufficient-to-fuel-Africas-turbocharged-HIV-epidemic.pdf Running on empty: sexual co-factors are insufficient to fuel Africa's turbocharged HIV epidemic]
|journal=Int J STD AIDS
|date=2004
|volume=15
|issue=7
|pages=442-52
}</ref> Male circumcision has been proposed to reduce the incidence of sexual transmission of HIV. In reality, it actually increases the sexual transmission of HIV. Even if it did work, it would be ineffective against non-sexual transmission by unsafe health care. Furthermore, non-sterile health care could mean that the circumcision operation could transmit the HIV infection to the patient.
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