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Thread: Circumcision For HIV Prevention - Debunked

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    Default Circumcision For HIV Prevention - Debunked

    From NewZimbabwe.com:

    Impact of male circumcision on HIV doubted
    22/02/2012 00:00:00
    by Gilbert Nyambabvu

    MALE circumcision is a dangerous distraction in the fight against HIV/AIDS, researchers have warned insisting that contrary to widespread claims the procedure only reduces transmission rates by no more than 1.3 percent.

    Zimbabwe is among several countries in sub-Saharan Africa that have launched mass male circumcision campaigns after the World Health Organisation (WHO) and UNAIDS recommended the procedure in 2007 as an effective HIVAIDS preventive measure.

    The WHO/UNAIDS recommendation was based on clinical trials carried out in Kenya, South Africa and Uganda which suggested that circumcision could reduce female-to-male HIV transmission by up to 60 percent.

    Thousands of men have undergone the surgical nip and tuck since Zimbabwe launched the campaign in 2009 with promoters enthusiastically claiming that if at least 80 percent of the adult male population was circumcised about 750 000 cases of HIV infections could be prevented.

    But new research has cast doubt on the supposed efficacy of the procedure with an article in the December Australian Journal of Law and Medicine citing numerous flaws in the Kenya, South Africa and Uganda studies.

    Researchers Gregory J. Boyle and Gregory Hill claimed the 60 percent reduction in transmission was only relative with the absolute reduction rate actually no more than 1.3 percent.

    Boyle and Hill said: “What does the frequently claimed ‘60 percent relative reduction’ in HIV infections actually mean?

    “Across all the three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18 percent) became HIV positive while among the 5,497 controls 137 (2.49 percent) became HIV positive.

    “So the absolute decrease in HIV infection was only 1.31 percent, which is statistically not significant.”

    The authors of the article insisted that the WHO/UNAIDS recommendation “uncritically accepted” the findings of the Kenya, South Africa and Uganda trials, in the process ignoring a vast body of contradictory evidence.

    “Examination of epidemiological data shows that male circumcision does not provide protection against HIV transmission in several sub-Saharan African countries including Cameroon, Ghana, Lesotho, Malawi, Rwanda and Tanzania all of which have higher prevalence of HIV infection among circumcised men,” they said.
    “In Malawi, the HIV prevalence rate is 13.2 percent among circumcised men and 9.5 percent among those who are intact. (Again) in Cameroon prevalence among those circumcised is 5.1 percent compare to 1.5 percent for those who are intact.

    “If male circumcision reduces HIV transmission as the trials claim then why is HIV prevalence much higher in the United States (where most men are circumcised) than in developed countries where most men are intact (such as Europe, the United Kingdom and Scandinavia)?”

    The article warns that relying on male circumcision in the fight against HIV/AIDS is especially dangerous for sub-Saharan Africa women because circumcised men could still acquire and transmit the virus to their sexual partners.

    “Evidence suggests that mass circumcision programs may exacerbate the HIV epidemic among women (and) under these circumstances it would be irresponsible and unethical to advocate mass circumcision programmes in southern Africa,” the article concludes.

    “Male circumcision is a dangerous distraction and a waste of scarce resources that should be used for known preventive measures (such as condoms which are 80 percent effective.”

    ************************************************** ****

    My Comments:

    The evidence that circumcision stops HIV infection in men is extremely thin. The policy is based on three studies, all carried out around the same time, in South Africa, Kenya and Uganda.


    JAMA. 2005 Nov 2;294(17):2203-9.
    Randomized trials stopped early for benefit: a systematic review.


    In all cases the number of seroconverting men was very small compared to the study size, and in two cases studies were stopped early, increasing the risk of documenting bias. In their review of randomized clinical trials that have been stopped early, VM Montori et al concluded:

    "RCTs stopped early for benefit are becoming more common, often fail to adequately report relevant information about the decision to stop early, and show implausibly large treatment effects, particularly when the number of events is small. These findings suggest clinicians should view the results of such trials with skepticism."

    Randomized trials stopped early for benefit: a systematic review.
    It is alarming that such a drastic policy as mass circumcision would be based on such thin evidence.

    (South Africa, 2006) Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial
    http://www.ncbi.nlm.nih.gov/pubmed/16231970

    (Kenya, 2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.
    http://www.ncbi.nlm.nih.gov/pubmed/17321310

    (Uganda, 2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.
    http://www.ncbi.nlm.nih.gov/pubmed/17321311

    CONCLUSIONS: RCTs stopped early for benefit are becoming more common, often fail to adequately report relevant information about the decision to stop early, and show implausibly large treatment effects, particularly when the number of events is small. These findings suggest clinicians should view the results of such trials with skepticism.

  2. #2
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    Default Re: Circumcision For HIV Prevention - Debunked

    Ed,

    Please do not double-post. It scatters the responses across multiple threads.

    You posted this same information here.

    Another identical thread was deleted for the same reason and this one will also be deleted shortly.

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