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The idea that circumcision prevented HIV transmission was invented by Valiere Alcena, long before there was any "research" to substantiate the claim.<ref>{{REFjournal
| last=Alcena | first=Valiere | coauthors= | title=AIDS in Third World Countries | journal=PLoS Medicine | volume= | issue= | pages=[online] | url=http://medicine.plosjournals.org/perlserv/?request=read-response&doi=10.1371/journal.pmed.0020298#r1326 | quote= | pubmedID= | pubmedCID= | DOI=10.1371/journal.pmed.0020298#r1326 | date=October 2006 | accessdate=
}}</ref> In 1986, California urologist [[Aaron J. Fink| Aaron J. Fink]], (1926-1994) adopted this idea,<ref>{{REFbook
|last=Glick
|note=
}}</ref> and vehemently promoted it,<ref>{{REFjournal
| last=Weiss | first=Helen A. | coauthorslast2=Quigley, |first2=Maria A.; |last3=Hayes, |first3=Richard J. | title=Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis | journal=AIDS | volume=14 | issue=15 | pages=2361–2370 | url=http://www.aidsonline.com/pt/re/aids/fulltext.00002030-200010200-00018.htm | quote= | pubmedID=11089625 | pubmedCID= | DOI=10.1097/00002030-200010200-00018 | date=October 2000 | accessdate=
}}</ref> without any kind of proof whatsoever.
Recent studies, however, disprove this hypothesis. One study found that there is "no difference between the keratinization of the inner and outer aspects of the adult male foreskin," and that "keratin layers alone were unlikely to explain why uncircumcised men are at higher risk for HIV infection."<ref>{{REFjournal
| last=Dinh | first=MH | coauthorslast2=McRaven MD, |first2=M.D. |last3=Kelley |first3=Z, . |last4=Penugonda |first4=S, . |last5=Hope TJ |first5=T.J. | title=Keratinization of the adult male foreskin and implications for male circumcision | journal=AIDS | volume=24 | issue=6 | pages=899-906 | url=http://www.ncbi.nlm.nih.gov/pubmed/20098294 | quote=We found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection. | pubmedID=20098294 | pubmedCID= | DOI= | 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>{{REFcontribution
| contribution=HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures
deWitte found that not only are Langerhans cells found all over the body and that their complete removal is virtually impossible. Furthermore, deWitte found that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact, acting as a natural barrier to HIV-1 transmission by Langerhans cells.<ref>{{REFjournal
| last=de Witte | first=Lot | coauthorsfirst2=Alexey |last2=Nabatov, |first3=Marjorie |last3=Pion, |first4=Donna |last4=Fluitsma, |first5=Marein AW A.W.P . |last5=de Jong, |first6=Tanja |last6=de Gruijl, |first7=Vincent |last7=Piguet, |first8=Yvette |last8=van Kooyk, |first9=Teunis B .H . |last9=Geijtenbeek | title=Langerin is a natural barrier to HIV-1 transmission by Langerhans cells | journal=Nature Medicine | volume= | issue= | pages= | url=http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf | quote= | pubmedID= | pubmedCID= | DOI=10.1038/nm1541 | date=2007-03-04 | accessdate=2011-06-28
}}</ref>
==== Bacterial Environment Hypothesis ====
This hypothesis attempts to identify the change in bacterial environment that results in the penis as a result of circumcision, as the mechanism whereby circumcision reduces the spread of HIV transmission. A desparate ad-hoc hypothesis, the explanation is rather farfetched. The argument is that the change in bacterial environment after circumcision makes it difficult for bacteria that cause diseases to live; there are less chances for penile inflamation, a condition that facilitates the transmission of viruses. The chances for penile inflamation are reduced, thereby reducing the chances of sexually transmitted viruses, such as HIV.<ref>{{REFjournal
| last=Price | first=Lance B. | coauthorsfirst2=Cindy M. |last2=Liu, |first3=Kristine E. |last3=Johnson, |first4=Maliha |last4=Aziz, |first5=Matthew K. |last5=Lau, |first6=Jolene |last6=Bowers, |first7=Jacques |last7=Ravel, |first8=Paul S. |last8=Keim, |first9=David |last9=Serwadda, |first10=Maria J. |last10=Wawer, |first11=Ronald H. |last11=Gray |etal=yes | title=The Effects of Circumcision on the Penis Microbiome | journal=PLoS ONE | volume=5 | issue=1 | pages= | url=http://www.plosone.org/article/info:doi%2F10.1371%2Fjournal.pone.0008422 | quote=The anoxic microenvironment of the subpreputial space may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. Thus, the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted diseases. | pubmedID= | pubmedCID= | DOI=10.1371/journal.pone.0008422 | date=2010 | accessdate=2011-06-29
}}</ref>
Using a population-based survey, Westercamp et al. examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with the belief that circumcised men are less likely to become infected with HIV.<ref>{{REFjournal
| last=Westercamp | first=M. | coauthorslast2=Bailey RC, |first2=R.C. |last3=Bukusi EA, |first3=E.A. |last4=Montandon |first4=M, . |last5=Kwena |first5=Z, et al. |etal=yes | title=Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs | journal=PLoS ONE | volume=5 | issue=12 | pages= | url=http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552 | quote= | pubmedID= | pubmedCID= | DOI=10.1371/journal.pone.0015552 | date=2010 | accessdate=
}}</ref>
|accessdate=2019-09-29
}}</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 | first=Devon D. | coauthorsfirst2=John J. |last2=Potterat, BA, |first3=John M. |last3=Roberts Jr., PhD, |first4=Stuart |last4=Brody, PhD | title=Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania | journal=Annals of Epidemiology | volume=17 | issue=3 | pages=217.e1-217.e12 | url=http://www.annalsofepidemiology.org/article/S1047-2797%2806%2900265-1/abstract | quote= | pubmedID= | pubmedCID= | DOI= | date=Annals of Epidemiology | accessdate=2011-06-02
}}</ref>
|- style="background:#efefef;"
|+ Estimated per act risk for acquisition<br/>of HIV by exposure route (US only) <ref name=MMWR3>{{REFjournal
| last=Smith DK, |first=D.K. |last2=Grohskopf LA, |first2=L.A. |last3=Black RJ, et al. | firstfirst3=R.J. | coauthorsetal=yes | title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States | journal=MMWR | volume=54 | issue=RR02 | pages=1-20 | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1 | quote= | pubmedID= | pubmedCID= | DOI= | date=2005 | accessdate=2009-03-31
}}</ref>
|- style="background:#efefef;"
! style="text-align:left"| Blood Transfusion
| 9,000<ref name=Donegan>{{REFjournal
| last=Donegan |first=E, . |last2=Stuart |first2=M, . |last3=Niland JC, et al. | firstfirst3=J.C. | coauthorsetal=yes | title=Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations | journal=Ann. Intern. Med. | volume=113 | issue=10 | pages=733-739 | url= | quote= | pubmedID=2240875 | pubmedCID= | DOI= | date=1990 | accessdate=
}}</ref>
|-
! style="text-align:left"| Childbirth <small>(to child)</small>
| 2,500<ref name=Coovadia>{{REFjournal
| last=Coovadia | first=H. | coauthors= | title=Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS | journal=N. Engl. J. Med. | volume=351 | issue=3 | pages=289-292 | url= | quote= | pubmedID=15247337 | pubmedCID= | DOI=10.1056/NEJMe048128 | date=2004 | accessdate=
}}</ref>
|-
! style="text-align:left"| Needle-sharing injection drug use
| 67<ref name=Kaplan>{{REFjournal
| last=Kaplan EH, Heimer R | first=E.H. |last2=Heimer | coauthorsfirst2=R. | title=HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data | journal=J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. | volume=10 | issue=2 | pages=175-176 | url= | quote= | pubmedID=7552482 | pubmedCID= | DOI= | date=1995 | accessdate=
}}</ref>
|-
! style="text-align:left"| Percutaneous needle stick
| 30<ref name=Bell>{{REFjournal
| last=Bell | first=DM | coauthors=D.M. | title=Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview | journal=Am. J. Med. | volume=102 | issue=5B | pages=9-15 | url= | quote= | pubmedID=9845490 | pubmedCID= | DOI=10.1016/S0002-9343(97)89441-7 | date=1997 | accessdate=
}}</ref>
|-
! style="text-align:left"| Receptive anal intercourse<sup>*</sup>
| 50<ref name=ESG>{{REFjournal
| last=European Study Group on Heterosexual Transmission of HIV | first= | coauthors= | title=Comparison of female to male and male to female transmission of HIV in 563 stable couples | journal=BMJ | volume=304 | issue=6830 | pages=809-813 | url= | quote= | pubmedID=1392708 | pubmedCID=1881672 | DOI=10.1136/bmj.304.6830.809 | date= | accessdate=
}}</ref><ref name=Varghese>{{REFjournal
| last=Varghese |first=B, . |last2=Maher JE, |first2=J.E. |last3=Peterman TA, |first3=T.A. |last4=Branson BM,Steketee RW | firstfirst4=B.M. |last5=Steketee | coauthorsfirst5=R.W. | title=Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use | journal=Sex. Transm. Dis. | volume=29 | issue=1 | pages=38-43 | url= | quote= | pubmedID=11773877 | pubmedCID= | DOI= | date=2002 | accessdate=
}}</ref>
|-
! style="text-align:left"| Receptive penile-vaginal intercourse<sup>*</sup>
| 10<ref name=ESG /><ref name=Varghese /><ref name=Leynaert>{{REFjournal
| last=Leynaert |first=B, . |last2=Downs AM, de Vincenzi I | firstfirst2=A.M. |last3=de Vincenzi | coauthorsfirst3=I. | title=Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV | journal=Am. J. Epidemiol. | volume=148 | issue=1 | pages=88-96 | url= | quote= | pubmedID=9663408 | pubmedCID= | DOI= | date=1998 | accessdate=
}}</ref>
|-