HIV is an initialism that stands for human immunodeficiency virus.
HIV is a sexually transmitted infection (STI). Persons who are infected with HIV frequently exhibit autoimmune deficiency syndrome, better known by its own acronym AIDS.
HIV was identified in 1981. It is thought to have originated in Africa.
Despite the known immunological functions of the foreskin, certain promoters of male circumcision attempted to link HIV infection to lack of circumcision. Three randomized controlled trials (RCTs) were carried out in Africa in an attempt to prove their hypothesis.
Green et al. (2008), in a preliminary report, published a long list of methodological issues with the RCTs.
September 2021 saw the publication of two huge population studies on the relationship of circumcision and 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 study concluded that circumcision status is not related to risk of HIV infection.
- 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.
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:
- Green LW, McAllister RS, Peterson KW, Travis JW. Male circumcision is not the HIV ‘vaccine’ we have been waiting for!. Future HIV Therapy. 2008; 2(3): 193-9. DOI. Retrieved 29 November 2021.
- Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns . Thompson Reuter. December 2011; 19(2): 316-34. PMID. Retrieved 30 December 2020.
- Van Howe RS, Boyle GJ. Meta-analysis of HIV-acquisition studies incomplete and unstable. BJU Int. 31 October 2018; Retrieved 24 November 2021.
Given the effectiveness of condoms, the lack of consistent findings on national levels, the methodologically flawed RCTs, the lack of translational research, and the impressive potential uptake and effectiveness of pre-exposure prophylaxis, circumcision as an intervention to prevent HIV infection should be treated with greater scepticism.
- Mayan M, Hamilton RJ, Juurlink DN, Austin PC, Jarvi KA. Circumcision and Risk of HIV Among Males From Ontario, Canada. J Urol. 23 September 2021; PMID. DOI. Retrieved 21 August 2022.
We found that circumcision was not independently associated with the risk of acquiring HIV among men from Ontario, Canada.
- Frisch M, Simonsen J. Non-therapeutic male circumcision in infancy or childhood and risk of human immunodeficiency virus and other sexually transmitted infections: national cohort study in Denmark. Eur J Epidemiol. 26 September 2021; 37: 251–9. PMID. DOI. Retrieved 16 January 2022.
- Garenne M. Changing relationships between HIV prevalence and circumcision in Lesotho. J Biosoc Sci. 4 April 2022; online ahead of print: 1-16. PMID. DOI. Retrieved 28 October 2022.
- Garenne M. Age-incidence and prevalence of HIV among intact and circumcised men: an analysis of PHIA surveys in Southern Africa. J Biosoc Sci. 26 October 2022; : 1-13. PMID. DOI. Retrieved 27 October 2022.