Male Circumcision is Not the HIV ‘Vaccine’ We Have Been Waiting For!

Abstract

Over the past several months some researchers and health organizations have proclaimed circumcision to be a compelling and important new HIV tool. A recent commentary claims that circumcision is “at least as good as the HIV vaccine we have been waiting for praying for and hoping to see in our lifetimes”. Thousands of African men now line up to get circumcised in the mistaken belief that it will save them from HIV as some developing nations -lacking even rudimentary medical care and clean drinking water -rush to implement mass circumcision programs with encouragement and millions of pledged dollars from the US government. In addition there are calls for implementing mass neonatal circumcision. The push to institute mass circumcision in Africa following the three randomized clinical trials (RCTs) conducted in Africa is based on an incomplete evaluation of real-world preventive effects over the long-term -effects that may be quite different outside the research setting and circumstances with their access to resources sanitary standards and intensive counseling. Moreover proposals for mass circumcision lack a thorough and objective consideration of costs in relation to hoped-for benefits. No field-test has been performed to evaluate the effectiveness complications personnel requirements costs and practicality of proposed approaches in real-life conditions. These are the classic distinctions between efficacy and effectiveness trials and between internal validity and external validity. Campaigns to promote safe-sex behaviors have been shown to accomplish a high rate of infection reduction without the surgical risks and complications of circumcision and at a much lower cost. For the health community to rush to recommend a program based on incomplete evidence is both premature and ill-advised. It misleads the public by promoting false hope from uncertain conclusions and might ultimately aggravate the problem by altering people’s behavioral patterns and exposing them and their partners to new or expanded risks. Given these problems circumcision of adults and especially of children by coercion or by false hope raises human rights concerns.