22,335
edits
Changes
Jump to navigation
Jump to search
m
no edit summary
| first=
| publisher=World Health Organization
| workwebsite=
| date=2011
| accessdate=2011-05-06
| first=
| publisher=
| workwebsite=
| date=February 2008
| accessdate=2011-06-01
| first=
| publisher=
| workwebsite=
| date=March 2007
| accessdate=2011-06-01
| first=
| publisher=
| workwebsite=
| date=2011-01-09
| accessdate=2011-06-01
| first=
| publisher=World Health Organization
| workwebsite=WHO/UNAIDS
| date=2004
| accessdate=2011-02-27
| date=2010-03-27
| accessdate=2011-06-28
}}</ref> Another study found that "no difference can be clearly visualized between the inner and outer foreskin."''<ref> {{citation REFcontribution | first contribution= Minh H HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures | quote=No difference can be clearly visualized between the inner and outer foreskin. | url=http://retroconference.org/2009/PDFs/502.pdf | last title= Dinh 16th Conference on Retroviruses and Opportunistic Infections (2009) | coauthors author= Dinh, Minh H.; Sheila M Barry, Meegan R Anderson, Scott G McCoombe, Shetha A Shukair, Michael D McRaven, Thomas J Hope | contribution = HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures | title publisher= 16th Conference on Retroviruses and Opportunistic Infections | place = Montreal, Canada | pages= | date = 2009-12-06 | year = 2009| id = | contribution-url = http://retroconference.org/2009/PDFs/502.pdf | format = PDF | accessdate = 2011-06-28 | quote = No difference can be clearly visualized between the inner and outer foreskin.}}</ref>
==== Langerhans Cell Hypothesis ====
Strong bias exists in the RCT's.<ref>Green LW et al. Male circumcision is not the HIV 'vaccine' we have been waiting for! Future HIV Ther. (2008) 2(3), 193–199.</ref><ref>Montori VM, Devereaux PJ, Adhikari NKJ, et al. Randomized trials stopped early for benefit: a systematic review. JAMA. 2005;294:2203-2209.</ref><ref>Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294:218-228.</ref><ref>Wheatley K, Clayton D. Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization. Control Clin Trials. 2003;24:66-70.</ref><ref>Slutsky AS, Lavery JV. Data safety and monitoring boards. N Engl J Med. 2004;350:1143-1147.</ref> "These
trials, designed to detect a minimum 50 percent reduction in HIV risk, should provide definitive evidence regarding the efficacy and safety of MC within three to five years."<ref> {{citation REFcontribution | contribution = Male Circumcision: Current Epidemiological and Field Evidence | quote=designed to detect a minimum 50 percent reduction in HIV risk | url=http://www.path.org/publications/detail.php?i=1048 | title = Program and Policy Implications For HIV Prevention and Reproductive Health | author= | publisher = USAID | place= | pages= | date = September 18 and 19, 2002| id = | contribution-url = http://www.path.org/publications/detail.php?i=1048 | accessdate = 2011-07-07 | quote = designed to detect a minimum 50 percent reduction in HIV risk}}</ref> By designing a trial to "detect" a minimum 50 percent reduction risk in HIV, these researchers might have artifically created the clinical setting to observe the effect they were looking to discover.
Concerns about the three randomized controlled clinical trials (RCCTs) in Africa (in South Africa, Uganda, and Kenya)<ref>Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med 2005;2(11):e298.</ref><ref>Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet 2007;369(9562):643–56.</ref><ref>Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet 2007;369(9562):657– 66.</ref>:
An analysis of HIV prevalence compared to circumcision status in sub-Saharan Africa concluded that male circumcision is not associated with reduced HIV prevalence.<ref>Garenne M. Long-term population effects of male circumcision in generalized HIV epidemics in sub-Saharan Africa. Afr J AIDS Res 2008;7(1):1– 8.</ref> Another study on circumcision prevalence compared to HIV in the general South African population concluded: “Circumcision had no protective effect on HIV transmission.”<ref>Connolly C, Simbayi LC, Shanmugam R, Nqeketo A. Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002. S Afr Med J 2008;98:789 –94.</ref> When commercial sex worker patterns are controlled, male circumcision is not signifıcantly associated with lower HIV prevalence.<ref>Talbott JR. Size matters: the number of prostitutes and the global HIV/AIDS pandemic. PloS One 2007;2(6):e543. www.plosone. org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0000543.</ref> Mathematical impact modeling of circumcision, antiretroviral therapy (ART), and condom use for South Africa concluded: “Male circumcision was found to have considerably lower impact than condom use or anti-retroviral therapy on HIV infection rates and death rates.”<ref>Lima V, Anema A, Wood R, et al. The combined impact of male circumcision, condom use and HAART coverage on the HIV-1 epidemic in South Africa: a mathematical model. 5th IAS Conference on HIV Treatment, Pathogenesis and Prevention, Cape Town, abstract WECA105, 2009.</ref> Both the U.S. and sub-Saharan Africa have relatively high incidence rates of HIV infection, considering that about 75% of U.S. men and about 70% of sub-Saharan African men are circumcised—higher percentages than in most other regions or countries with lower prevalence of HIV.<ref>Green LW, Travis JW, McAllister RG, Peterson KW, Vardanyan AN, Craig A. Male circumcision and HIV prevention insufficient evidence and neglected external validity. Am J Prev Med. 2010 Nov;39(5):479-82. Department of Epidemiology and Biostatistics, University of California at San Francisco, USA. PMID: 20965388 </ref>
There is no clear pattern of association between male circumcision and HIV prevalence. In 10 out of 18 countries, HIV prevalence is higher amongst circumcised men.<ref>{{citationREFcontribution | contribution = Levels and spread of HIV seroprevalence and associated factors: Evidence from national household surveys | quote= | url=http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf | title = DHS Comparative Reports 22 | author= | publisher = Measre DHS | place= | pages = 103 | id date= | contribution-url accessdate= http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
| format = PDF
}}</ref>
Furthermore, HIV prevalence was found to be higher amongst circumcised males and females for virgins and adolescents in Kenya, Lesotho, and Tanzania.<ref>{{REFjournal
| last=Brewer, PhD