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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

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  • 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

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  • Eleanor Gouws,

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

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  • Catherine Hankins,

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

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  • Wayne M Getz,

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

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  • John Hargrove,

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

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  • Isabelle de Zoysa,

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

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  • Christopher Dye,

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

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  • 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

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

Reader Comments (5)

Post a new comment on this article

Flawed Premises Produce Flawed Conclusions

Posted by plosmedicine on 30 Mar 2009 at 23:57 GMT

Author: George Hill
Position: Vice-President
Institution: Doctors Opposing Circumcision
E-mail: ghill@doctorsopposingcircumcision.org
Submitted Date: July 26, 2006
Published Date: July 28, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We have previously established that the HIV epidemic is being used as a lever by which to promote universal circumcision.[1] Men who promote male circumcision are driven by emotional factors related to circumcision. According to Goldman:
"One reason that flawed studies are published is that science is affected by cultural values. A principal method of preserving cultural values is to disguise them as truths that are based on scientific research. This 'research' can then be used to support questionable and harmful cultural values such as circumcision. This explains the claimed medical 'benefits' of circumcision."

"Defending circumcision requires minimizing or dismissing the harm and producing overstated medical claims about protection from future harm. The ongoing denial requires the acceptance of false beliefs and misunderstandings of facts. These psychological factors affect professionals, members of religious groups and parents involved in the practice. Cultural conformity is a major force perpetuating non-religious circumcision, and to a greater degree, religious circumcision. The avoidance of guilt and the reluctance to acknowledge the mistake and all that that implies help to explain the tenacity with which the practice is defended."[2]

There is a long history of circumcision advocates producing evidence to support their goal. For example, Abraham Wolbarst, who had written defending ritual circumcision,[3] later published "research" which "proved" that circumcision prevented penile cancer.[4] Unfortunately for Dr. Wolbarst, cases of cancer in circumcised men kept appearing[5,6] and the falseness of his claims were revealed to the world.

When we review the medical literature regarding the use of circumcision to prevent HIV infection, we frequently find that the author(s) previously have made statements or written articles in favor of circumcision to prevent various diseases, including AIDS. Consequently, we regard such "research" with deep suspicion, since we feel that such studies are undertaken to "prove" previously held beliefs. Researcher bias may be overwhelming and, under such circumstances, the studies can have only one outcome - that male circumcision has a strong protective effect against HIV infection. Such studies simply cannot be believed.

HIV infection is common among children in Africa.[7] These infections are not sexually transmitted, so any paradigm, which exclusively relies on the sexual transmission of HIV infection, is flawed.

The excellent and detailed statistical analysis by Williams et al.[8], therefore, is based on flawed science, so cannot be taken seriously.

George Hill
Vice-President for Bioethics and Medical Science
Doctors Opposing Circumcision
Suite 42
2442 NW Market Street
Seattle, Washington 98107-4137
USA
Web: http://www.doctorsopposin...

References:

1. Hill G. Misuse of the AIDS epidemic to promote male circumcision. BMJ Rapid Response 2001; May 20. Available at: http://bmj.bmjjournals.co...
2. Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93-103.
3. Wolbarst AL. Universal circumcision as a sanitary measure. JAMA 1914;62(2):92-7.
4. Wolbarst A. Circumcision and penile cancer. Lancet 1932;1(5655):150-3.
5. Boczko S, Freed S. Penile carcinoma in circumcised males. N Y State J Med 1979; 79(12):1903-4.
6. Cold CR, Storms MR, Van Howe RS. Carcinoma in situ of the penis in a 76-year-old circumcised man. J Fam Pract 1997; 44:407-10.
7. Brody S, Gisselquist D, Potterat JJ, Drucker E. Evidence of iatrogenic HIV transmission in children in South Africa. Br J Obstet Gynaecol 2003;110:450;2.
8. Williams BG, Lloyd-Smith JO, Gouws E, Hankins C, Getz WM, et al. The potential impact of male circumcision on HIV in sub-saharan Africa. PLoS Med 2006 3(7)

Competing interests declared: None