Flawed African Studies into Male Circumcision and HIV Sexual Transmission

The Journal of Law and Medicine has published a new critique of the three randomised clinical trials from Africa that purported to find that male circumcision reduces female-to-male sexual transmission of HIV by 60 percent.
This critique provides a detailed documentation of numerous flaws in the execution of these studies and shows that the actual (absolute) reduction in HIV transmission was only 1.3 percent (without adjusting for the several sources of error bias), not the misleadingly and frequently touted 60 percent (relative figure only). The 1.3 percent is not considered to be clinically significant.
This is offset (in a parallel Ugandan RCT trial–Wawer et al., 2009) by a 61 percent relative INCREASE (6 percent absolute INCREASE) in male-to-female HIV transmission when the male partner was circumcised. It was reported that “Circumcision of HIV-infected men did NOT reduce HIV transmission to female partners over 24 months…Condom use after male circumcision is essential for HIV prevention” (p. 229). Quite unethically, some women were NOT informed that their male partners were HIV positive (p. 230) AND 17 women in the intervention group were infected with HIV during the trial (p. 229). This trial was stopped prematurely (before the results became statistically significant) because of its “futility”. The preliminary findings did not support the pro-circumcisionists’ genital mutilation agenda.
On the basis of the empirical evidence disclosed in the published African RCT reports, these contrived studies should NOT be used in the formulation of public health policy. Indeed, there is now a growing number of published critiques of the African RCTs showing these studies to be invalid.
Ref: Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011;19:316-334.
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