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}}</ref> Van Howe & Boyle (2018) added further critical comment and suggested the possibility of fraud.<ref name="vanhowe2018">{{REFjournal |last=Van Howe |first= |init=RS |author-link=Robert S. Van Howe |last2=Boyle |first2= |init2=GJ |author2-link=Gregory J. Boyle |etal=no |title=Meta-analysis of HIV-acquisition studies incomplete and unstable |journal=BJU Int |date=2018-10-31 |url=https://www.bjuinternational.com/letters/meta-analysis-circumcision-incomplete-unstable/ |quote=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. |pubmedID= |pubmedCID= |DOI= |accessdate=2022-01-01}}</ref> PEPFAR, however, paid no attention to these warnings and continued to promote the harmful VMMC program.