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Research Article

Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial

  • Bertran Auvert mail,

    To whom correspondence should be addressed. E-mail: bertran.auvert@apr.aphp.fr

    Affiliations: Hôpital Ambroise-Paré, Assitance Publique—Hôpitaux de Paris, Boulogne, France, INSERM U 687, Saint-Maurice, France, University Versailles Saint-Quentin, Versailles, France, IFR 69, Villejuif, France

    X
  • Dirk Taljaard,

    Affiliation: Progressus, Johannesburg, South Africa

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  • Emmanuel Lagarde,

    Affiliations: INSERM U 687, Saint-Maurice, France, IFR 69, Villejuif, France

    X
  • Joëlle Sobngwi-Tambekou,

    Affiliation: INSERM U 687, Saint-Maurice, France

    X
  • Rémi Sitta,

    Affiliations: INSERM U 687, Saint-Maurice, France, IFR 69, Villejuif, France

    X
  • Adrian Puren

    Affiliation: National Institute for Communicable Disease, Johannesburg, South Africa

    X
  • Published: October 25, 2005
  • DOI: 10.1371/journal.pmed.0020298

Reader Comments (21)

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Rush to judgement

Posted by plosmedicine on 30 Mar 2009 at 23:47 GMT

Author: Richard Winkel
Position: Computer programmer
Institution: University of Missouri
E-mail: rich@math.missouri.edu
Submitted Date: October 30, 2005
Published Date: October 31, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

How have the authors controlled for the non-randomization implicit
in using a pool of men who want to be circumcised? Such self-selection
increases the likelihood of recruiting men who are experiencing
sexual difficulties such as tight foreskins, a common but easily
treatable problem leading to foreskin tearing which would certainly
skew the statistics.

I also find it fascinating that the male prepuce has gone straight from being an inconsequential "flap of skin" to a complex immunological organ just in time to be infected by a virus that targets immune cells. Is this an indication of accelerated evolution, perhaps driven by medicine's century-long obsession with the purported pathologies of male genitals, or perhaps just a demonstration of medicine's capacity for deceiving the public?

It's equally fascinating that the obvious question of male
circumcision's impact on male-to-female HIV transmission seems to be
of no interest to researchers. There are good reasons to expect(1,2) -
and empirical evidence for (3)- the thesis that male genital mutilation
causes a significant increase in the rate of male-to-female HIV
transmission. The net effect of circumcision in a given population
may be evident in the vastly different rates of HIV infection in
the United States and Europe, where routine medical genital surgery on
normal, healthy, non-consenting children is unknown. Although male
circumcision's collateral damage to women might be prevented by
routine FGM, as shown in this impolitic study (4), one would hope
common sense and decency might preempt a new medical crusade against
normal human anatomy.

References
(1) http://jvi.asm.org/cgi/co...
Parameters of Human Immunodeficiency Virus Infection of Human
Cervical Tissue and Inhibition by Vaginal Virucides
(2) http://www.cirp.org/libra...
The effect of male circumcision on the sexual enjoyment of the
female partner
(3) http://www.circumstitions...
Heterosexual HIV transmission, Europe vs the United States
(4) http://www.hiv-knowledge....
Female Circumcision and HIV Infection in Tanzania: for Better or for Worse?

No competing interests declared.