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This article also evaluates the evidence that circumcision decreases bacterial vaginosis, T vaginalis infection, and genital ulcer disease in heterosexual men’s female partners. Additionally, it discusses the plausibility of a biological basis for why male circumcision would reduce viral sexually transmitted diseases.
As to the ethics of the Zambian study, we do not believe that it violates the basic [[human rights ]] of its participants. Parents must make choices for their children when they are unable to consent for themselves. Although there may be controversy over the question of whether parents can give proxy consent to non-therapeutic interventions, especially if they carry risks, there is no controversy over whether parents can give proxy consent to therapeutic interventions such as vaccines or appendectomies. The randomized clinical trial data provides assurance that male circumcision is therapeutic, unlike female circumcision. You may be interested in the position of the WHO which states that female circumcision can be very harmful and that there are not any health benefits derived from the procedure (http://www.who.int/mediacentre/factsheets/fs241/en/).
We can assure you that safeguards are in place for all NIH-supported research involving people. For instance, local committees--called Institutional Review Boards (IRBs) and Research Ethics Committees (RECs)--are required to review research to assure that the rights and welfare of study participants are protected. This review includes the equitable selection of participants, maintenance of privacy and confidentiality, minimizing coercion or undue influence, and ensuring appropriate safeguards in vulnerable participants. Committee members have knowledge of the local research context and cultural considerations. In addition, research is often conducted in adult populations to obtain safety data prior to acquiring data in vulnerable population such as children. In the case of Zambia, the Zambian Ministry of Health (MOH) oversees research. It is the MOH’‘s role to consider the ethical and public health implications of research studies within their purview. As such, the Zambian MOH is responsible for approving and implementing the WHO recommendations regarding male circumcision for [[HIV]] prevention in that country and have made the decision to do so. Since the Zambian Ministry of Health and the local IRB/REC have reviewed and approved the research study in question, the local ethical and public health issues, in their opinion, have been addressed.