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Therefore, further efforts are still required to quantify the relative risk associated with the lack of male circumcision. Some of this can be achieved by using observational designs which better address the limitations discussed above. Laboratory and primate research might also continue to provide useful information.
As the safety, expected benefits, feasibility and acceptability of mass circumcision are all questionable, neither public-health interventions nor intervention studies appear to be defensible options before there is stronger evidence from observational studies in different settings that show lack of male circumcision may be a genuinely independent risk factor for the transmission of HIV.<ref>{{REFjournal
|last=de Vincenzi
|first=Isabelle
Thomas ''et al''. (2004) studied the incidence of HIV in circumcision and intact men in a United States Navy population. A slightly higher incidence of HIV infection was found in circumcised men (84.9%) as compared with intact men (81.8%). The authors concluded:
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Although there may be other medical or cultural reasons for male circumcision, it is not associated with HIV or STI prevention in this U.S. military population.<ref name="thomas2004">Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA. [https://d1wqtxts1xzle7.cloudfront.net/46054655/ADA458066.pdf ?1464571918=&response-content-disposition=inline%3B+filename%3DPrevalence_of_Circumcision_and_its_Assoc.pdf&Expires=1593715109&Signature=ecYcK3EIbcr0P3pgaGC2RSoSXWb0mT3mKrLQo6yXtUiHonZhCiagfa5DJbxOdLxpqwIeTbWwp8QRyqrwCimTRy714YpPPkCAwW6-v2UpRxDqz8FZK~i3pgk3rGNYPPDtxkWqupx65eMlaBvA~wt9rx6gPpoMafrL7WzN1-zre14bHSzXrvZWvsICVWC9lnVKY0qD93gpEnaT42DBNulBMg~nTWSy9ON4jR5tjW9m04ziBsbcrHkrMe9JCaJZWsrmL4AbIrg0OyXHM5DAozRQJv0zyqwHRXqGylD~YrY4aHf~ZlrLpxdsMMkIO7qCTTamGpQz853rGgDYfkfZeD8Mkw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. Navy population]. Abstract no. TuPeC4861. Presented at the XV International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.</ref>
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