British Medical Journal: http://www.bmj.com/rapid-response/2011/10/28/circumcision-prevents-hiv-infection-medical-myth
Lamptey has produced a useful and valuable review of the AIDS epidemic.1 Unfortunately, he advocates male circumcision to reduce HIV infection. In reality, the view that male circumcision can reduce or eliminate HIV infection is not supported by recent evidence.This idea originated in the 1980s when the late Aaron J. Fink, M.D., proposed that circumcision could prevent HIV infection.2 Dr. Fink was a noted proponent of male circumcision.2 There seems to have been little science and a lot of promotion of male circumcision behind his claim.
Several early studies seemed to indicate that male circumcision had a protective effect against HIV infection.3 Later, the Rakai project identified viral load and genital ulcers as the primary determining factors in HIV infection.4 In addition to other previously identified methodological flaws, the early studies did not control for viral load,3 they cannot be considered to be scientifically valid.
Circumcision proponents have published several opinion pieces that argue that male circumcision prevents HIV infection.5,6 The authors, however, have been unsuccessful in convincing medical authorities of the value of circumcision in reducing HIV transmission/reception. The Council on Scientific Affairs of American Medical Association calls male circumcision a "non-therapeutic procedure" and said that "circumcision cannot be responsibly viewed as 'protecting' against such infections."7 UNAIDS says that relying on male circumcision is "like playing Russian roulette with two bullets in the gun instead of three."8
The origin of the hypothesis that circumcision prevents HIV infection9,10 suggests that the true motivation of circumcision advocates may be the preservation of the outmoded practice of non-therapeutic male neonatal circumcision in North America, not the prevention of HIV infection in Africa and elsewhere.
Recent evidence shows male circumcision to be of no value in preventing HIV transmission reception in both heterosexual and homosexual contacts.4,11 The medical evidence now indicates that the statement, "male circumcision prevents HIV infection" should be regarded as a medical myth.
Executive Secretary, Doctors Opposing Circumcision
2442 NW Market Street, Seattle, Washington 98107, USA
- Lamptey PR. Reducing heterosexual transmission of HIV in poor countries. BMJ 2002;324:207-211.
- Position Statement on the Use of Male Circumcision to Limit HIV Infection. San Anselmo, California: NOCIRC, 2001.
- de Vincenzi I, Mertens T. Male circumcision: a role in HIV prevention?AIDS 1994;8(2): 153-160.
- Gray RH, Wawer MJ, Brookmeyer R, et al. Probability of HIV-1 transmission per coital act in monogamous, heterosexual, HIV-1-discordant couples in Rakai, Uganda. Lancet 2001; 357: 1149-53.
- Halperin DT, Bailey RC. Male circumcision and HIV infection: 10 years and counting. Lancet 1999;354:1813-1.
- Szabo R, Short RV. How does male circumcision protect against HIV infection?BMJ 2000;320:1592-1594.
- Council on Scientific Affairs, American Medical Association. Report 10: Neonatal Circumcision. Chicago: American Medical Association, 1999.
- UNAIDS. Report on the global HIV/AIDS epidemic. Geneva: UNAIDS, June 2000: p.71.
- Fink AJ. A possible explanation for heterosexual male infection with AIDS. N Engl J Med 1986;315:1167.
- Fink AJ. Newborn circumcision: a long-term strategy for AIDS prevention. J R Soc Med. 1989;82(11):695.
- Grulich, AE, Hendry O, Clark E, et al. Circumcision and male-to-male sexual transmission of HIV. AIDS 2001; 15(9):1188-1189. Web: http://faculty.washington.edu/gcd/DOC/
Competing interests: None declared