The troubled history of the foreskin: Common in the US, rare in Europe and now championed in Africa, male circumcision is hotly debated. Jessica Wapner explores whether the gains are worth the loss.

Respectfully, I am an HIV/AIDS researcher and my knowledge of circumcision is not based on some web article that does not include citations and makes claims that are not grounded in fact.

The stakes around HIV/AIDS in Southern Africa are too high for this authors' obvious agenda.

Here are some links to published randomized scientific studies that demonstrate the protective benefits of circumcision in African settings:

  1. "Male Circumcision Decreases Acquisition and Increases Clearance of High-Risk Human Papillomavirus in HIV-Negative Men: A Randomized Trial in Rakai, Uganda" Journal of Infectuous Diseases

  2. "Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda" The Lancet

  3. "Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial" The Lancet

  4. "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial" PLOS Medicine

  5. "Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial"

The author's own critique of these randomized trials is not based on pointing out flaws in the study designs but rather a misunderstanding of epidemiological research methodology. The author says:

There is also a problem with the information given to those who volunteer for surgery. I met many newly circumcised men who repeated what Gabriel had heard: circumcision reduces the risk of contracting HIV by 60 per cent. Yet this figure is what epidemiologists call the relative risk reduction. It tells us that in the clinical trials there were 60 per cent fewer new HIV infections among the circumcised men than the uncircumcised group. It says nothing about the actual risk of contracting HIV. That risk depends very much on sexual behavior. Critically, if men have frequent sex with infected women they will likely get HIV, regardless of whether they are circumcised.

What a randomized trial will tell you is what the average difference in some outcome is between two groups. The reason randomization is viewed as the gold standard is that it allows differences in sexual behavior not to interfere with the estimated effect of circumcision, as individuals with high sexual behavior are as likely to be assigned the treatment as not.

You can't just say theres no scientific consensus because thats what it says in the article! The only way you can demonstrate that their isn't meaningful scientific consensus is showing me published peer-reviewed randomized trials of circumcision that did not find significant protective effects. As far as I know, you will not be able to do this.

The only other public health intervention that has been demonstrated to be more efficacious in preventing HIV than MC is early antiretroviral therapy. Unfortunately, until this is more affordable it is not a feasible means of reducing the spread of HIV.

To stop promoting circumcision is going to lead to more deaths, more ill-health and continued poverty in already otherwise troubled region.

/r/Foodforthought Thread Link - mosaicscience.com