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Research Article

The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa

  • Brian G Williams mail,

    To whom correspondence should be addressed. E-mail: williamsbg@who.int

    Affiliation: World Health Organization, Stop TB Department, Geneva, Switzerland

    X
  • James O Lloyd-Smith,

    Affiliations: Department of Environmental Science, Policy, and Management, University of California Berkeley, Berkeley, California, United States of America, Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, Pennsylvania, United States of America

    X
  • Eleanor Gouws,

    Affiliation: Joint United Nations Programme on HIV/AIDS (UNAIDS), Policy, Evidence, and Partnerships Department, Geneva, Switzerland

    X
  • Catherine Hankins,

    Affiliation: Joint United Nations Programme on HIV/AIDS (UNAIDS), Policy, Evidence, and Partnerships Department, Geneva, Switzerland

    X
  • Wayne M Getz,

    Affiliation: Department of Environmental Science, Policy, and Management, University of California Berkeley, Berkeley, California, United States of America

    X
  • John Hargrove,

    Affiliation: South African Centre for Epidemiological Modelling and Analysis, Stellenbosch, South Africa

    X
  • Isabelle de Zoysa,

    Affiliation: World Health Organization, Family and Community Health, Geneva, Switzerland

    X
  • Christopher Dye,

    Affiliation: World Health Organization, Stop TB Department, Geneva, Switzerland

    X
  • Bertran Auvert

    Affiliations: INSERM, Saint Maurice, France, University of Versailles-Saint Quentin, Faculté de Médecine Paris-Ile-de-France-Ouest, Saint Maurice, France, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Pare, Boulogne, France

    X
  • Published: July 11, 2006
  • DOI: 10.1371/journal.pmed.0030262

Reader Comments (5)

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Unanswered questions

Posted by plosmedicine on 31 Mar 2009 at 00:06 GMT

Author: Thomas Hogner
Position: Consultant
Institution: ILC
E-mail: thomas.hogner@gmail.com
Submitted Date: February 23, 2007
Published Date: February 26, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

There are several problems with this paper. The first is that they have not provided the results of HIV testing. We know that both the circumcised group and non-circumcised group were roughly the same size, yet they fail to state the number in each group that became infected. Stating that it reduces the risk by 50% means nothing unless the risk prior to the reduction is known.

It is likely they tested each participant for HIV prior to the testing. Considering that would result in a group of participants that simply by not-being infected were likely to practice safer sexual practices than the population in general, the test appears flawed in determining application to the general population. Had they simply used random samples of boys prior to their becoming sexually active the test might have had some validity.

They failed to log the number of sexual experience each subject had both before and after the test began. It is quite reasonable to assume that the non-circumcised group members would not have deviated from their normal sexual behavior. It is however quite possible that the newly circumcised group members modified their sexual behavior. If the sexual activity of the circumcised group was curtailed by 50%, one would have to question whether the circumcision provided any protection beyond inhibiting the participants from engaging in sexual intercourse.

Although the hypothesis is interesting, the described study does nothing to validate it.

No competing interests declared.