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[[Category:Circumcision in Africa]]
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}}</ref> Focus countries have been invited to request program funding to increase access to the procedure.
PEPFAR ignominiously ended the provision of non-therapeutic [[circumcision]] of boys under age 15 in November 2019 due to significant, complications, injuries, and other abuses. ==Reimagining PEPFAR's Strategic Direction==This document, ''Reimagining PEPFAR's Strategic Direction'', published in September 2022, provides new directions for PEPFAR's fight against the ''HIV'' pandemic. The document is entirely silent on male and injuriesfemale circumcision, although male circumcision was the cornerstone of the previous effort to prevent HIV infection and PEPFAR formerly proudly trumpeted the 27,700,000+ circumcisions (AKA genital mutilations) in Africa that it had sponsored. It is unclear if PEPFAR will continue to promote circumcision, which has been demonstrated to be ineffective.<ref name="reimagining2022">{{REFdocument |title=Reimagining PEPFAR's Strategic Directio |url=https://www.state.gov/wp-content/uploads/2022/09/PEPFAR-Strategic-Direction_FINAL.pdf |contribution= |last= |first= |publisher=U.S.Department of State |format=PDF |date=2022-09 |accessdate=2022-11-28}}</ref>
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== World AIDS Day (2010) Announcements ==
|last=Van Howe
|first=Robert S.
|init=RS
|author-link=Robert S. Van Howe
|last2=Storms
|first2=Michelle
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|etal=no
|title=How the circumcision solution in Africa will increase HIV infections
|journal=Journal of Public Health in Africa
|location=
|DOI=10.4081/jphia.2011.e4
|accessdate=2021-02-16
}}</ref> [[Robert S. Van Howe |Van Howe]] & Boyle (2018) added further critical comment and suggested the possibility of fraud.<ref name="vanhowe2018">{{REFjournal
|last=Van Howe
|first=
==Recent developments==
[[Michel Garenne |Garenne]] & Matthews (2019) reported that there is little difference in the incidence of [[HIV]] infection between circumcised men and intact men in Zambia. The authors stated that the "effectiveness of VMMC could therefore be seriously questioned."<ref name="garrenne2019">{{REFjournal
|last=Garenne
|first=Michel
|init=M |author-link=Michel Garenne
|last2=Matthews
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</center>
<br>
[[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}}, dated 29 June 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
|title=Letter to Deborah L. Birx, M.D.
|url=https://pool.intactiwiki.org/images/2020-06-15b_LettertoPEPFAR.pdf
|last=Denniston
|first=George C.
|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]
|format=
|date=2020-06-29
}}</ref></blockquote>
[[George Hill]], CFI, ATR, acting for [[Doctors Opposing Circumcision(D.O.C.)]], wrote to Deborah L. Birx on 28 January 2021 regarding her lack of action and to transmit a copy of the article by Fish et al. (2020).<ref name="hill2021">{{REFdocument
|title=Letter to Deborah L. Birx
|url=https://pool.intactiwiki.org/w/images/2021-01-28A_LetterBirx_516.pdf
|last=Hill
|first=George
|publisher=[[Doctors Opposing Circumcision(D.O.C.)]]
|format=PDF
|date=2021-01-28
|accessdate=2021-02-13
}}</ref>
== Population-based studies ==
{{Population-based studies}}
==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:
<blockquote>
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="garenne2022A">{{REFjournal
|last=Garenne
|first=Michel
|init=M
|author-link=Michel Garenne
|title=Changing relationships between HIV prevalence and circumcision in Lesotho
|url=https://pubmed.ncbi.nlm.nih.gov/35373731/
|date=2022-04-04
|journal=J Biosoc Sci
|volume=online ahead of print
|pages=1-16
|DOI=10.1017/S0021932022000153
|pubmedID=35373731
|accessdate=2022-11-04
}}</ref>
</blockquote>
In his second report, Garenne (2022) presented information from six Sub-Saharan African nations (Eswatini, Lesotho, Malawi, Namibia, Zambia, Zimbabwe). He reported:
<blockquote>
"Results matched earlier observations made in South Africa that [[circumcised]] and [[intact]] men had similar levels of HIV infection."<ref name="garenne2022B">{{REFjournal
|last=Garenne
|first=Michael
|init=M
|author-link=
|etal=no
|title=Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa
|trans-title=
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|journal=J Biosoc Sci
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|date=2022-10-26
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|volume=
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|article=
|page=
|pages=1-13
|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=
|quote=
|pubmedID=36286328
|pubmedCID=
|DOI=10.1017/S0021932022000414
|accessdate=2022-11-04
}}</ref></blockquote>
{{SEEALSO}}
* [[Centers for Disease Control|CDC]]
|url=https://foregen.webflow.io/commentarium-articles/international-contractors-are-profiteering-from-new-circumcision-devices
|title=International Contractors are Profiteering from New Circumcision Devices
|last=[[Foregen ]] Staff
|first=
|author-link=
|publisher=[[Foregen]]
|date=2021-03-08
|accessdate=2021-03-08
{{REF}}
[[Category:Circumcision in Africa]]
[[Category:Fund]]
[[Category:Program]]
[[Category:From CircLeaks]]