Thanks to Amber Craig for forwarding this bibliography. Republished and adapted from ICGI.org.
The costs and harms of male circumcision are significant, and there is inconclusive evidence that the use of male circumcision as a mass surgical intervention in the HIV battle would result in more benefit than harm. Numerous studies and articles raise serious cautions and concerns about the use of male circumcision.
The randomized controlled trials – circumcision and HIV:
Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med 2005;2(11): e2.
Summary/Results: 3,128 participants, 1546 circumcised (total of 3,274 initially randomized). Study halted after 21 months, 20 circumcised contracted HIV, 49 uncircumcised contracted HIV, 251 participants lost to follow-up.
Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet. 2007;369(9562):643-56.
Summary/Results: 2,784 participants, 1391 circumcised. Study halted after 24 months, 22 circumcised contracted HIV, 47 uncircumcised contracted HIV, 273 participants lost to follow-up.
Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Rakai, Uganda et al. Male circumcision for HIV prevention in men in: A randomised trial. Lancet. 2007;369(9562):657-66.
Summary/Results: 4,996 participants, 2474 circumcised. Study halted after 24 months, 22 circumcised contracted HIV, 45 uncircumcised contracted HIV, 179 participants lost to follow-up.
Studies since RCTs showing male circumcision is not significantly associated with lower HIV rates in general populations:
Talbott JR. Size Matters: The number of prostitutes and the global HIV/AIDS pandemic. PloS One. 2007;2(6): e543.
Conclusion: Once commercial sex worker patterns are factored in, male circumcision is not significantly associated with lower HIV.
Michel Garenne, African Journal of AIDS Research 2008, 7(1): 1–8
Conclusion: Male circumcision not associated with lower rates of HIV in African countries.
Millett G, Ding H, Lauby J, Flores S, Stueve A, Bingham T, et al. Circumcision Status and HIV Infection Among Black and Latino Men Who Have Sex With Men in 3 US Cities. J Acquir Immune Defic Syndr. 2007;46(5):643-650. (CDC)
Conclusion: Male circumcision was not associated with lower HIV in US MSM.
Turner, et al., Men’s circumcision status and women’s risk of HIV acquisition in Zimbabwe and Uganda. AIDS 2007, 21:1779-1789.
Conclusion: Male circumcision was not significantly associated with lower HIV risk in women.
Concerns raised regarding long-term benefit of studies halted early:
Montori VM, Devereaux PJ, Adhikari NK, et al.: Randomized trials stopped early for benefit: a systematic review. JAMA. 294, 2203-2209 (2005).
Conclusion: Benefits of studies stopped early often do not hold up in the long-term.
Mills E, Siegfried N. Cautious optimism for new HIV/AIDS prevention strategies. Lancet. 2006;368:1236.
Circumcision itself as cause of HIV transmission:
Brewer DD, Potterat JJ, Roberts JM, Brody S. Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania. Ann Epidemiol. 2007;17:217–26.
Circumcision complications:
Okeke LI, Asinobi AA, Ikuerowo OS, Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urology. 2006;6:21.
Conclusion: 20% complication rate from newborn circumcisions performed by medical practitioners in Nigeria.
Özdemir E. Significantly increased complication risks with mass circumcisions. Br J Urol 1997;80:136-9.
Conclusion: Complications from mass circumcisions are significant.
Muula AS, Prozesky HW, Mataya RH, Ikechebelu JI. Prevalence of complications of male circumcision in Anglophone Africa: a systematic review. BMC Urology 2007;7(4).
Conclusion: Male circumcision complications could be significant, more study is needed.
Increased risks to women:
Wawer M, Kigozi G, Serwadda D, et al. Trial of male circumcision in HIV+ men, Rakai, Uganda: effects in HIV+ men and in women partners. 15th Conference on Retroviruses and Opportunistic Infections. 3-6 February 2008. Boston, Abstract 33LB.
Reported Results: HIV rate for female partners of circumcised males was 14.4% over two years, compared to 9.1% among the women whose husbands had not been circumcised.
http://www.businessday.co.za/articles/topstories.aspx?ID=BD4A701607
Healthcare infrastructure burden/resource drain:
Ozgediz D, Riviello R (2008) The “Other” Neglected Diseases in Global Public Health: Surgical Conditions in Sub-Saharan Africa. PLoS Med 5: e121 doi:10.1371/journal.pmed.0050121
Risk compensation concerns:
Kalichman S, Eaton L, Pinkerton S: Circumcision for HIV prevention: Failure to account for behavioral risk compensation. PloS Med. 4(3), e137-138 (2007).
Gusongoirye D: Rwanda: Nothing can fight HIV/AIDS better than discipline. The New Times (Kigali) February 12, 2008.
http://allafrica.com/stories/200802120181.html
http://www.alertnet.org/db/blogs/51735/2008/06/16-145209-1.htm
Studies on other options to achieve HIV transmission reductions:
Low-Beer D, Stoneburner RL. (2004) Behaviour and communication change in reducing HIV: Is Uganda unique? Johannesburg: Centre For Aids Development, Research And Evaluation. 14 p.
McAllister RG, Travis JW, Bollinger D, Rutiser C, Sundar V. Cost to circumcise Africa. Intl J Mens Health. (In press).
Conclusion: Behavior change programs are more efficient and cost-effective than circumcision. Providing free condoms is less costly and more effective than circumcising, and at least 95-times more cost-effective at stopping the spread of HIV in sub-Saharan Africa.
Value of foreskin in HIV prevention:
de Witte L, Nabatov A, Pion M, Fluitsma D, de Jong, MAWP, de Gruijl, T, et al. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells. Nat Med. 2007;(3):367-71.
Commentary/editorial raising concern or urging caution about the use of male circumcision as an HIV prevention:
Dowsett GW, Couch M. Male circumcision and HIV prevention: Is there really enough of the right kind of evidence? Reprod Health Matters. 2007;15(29):33–44.
Green WL. et al. 2008. Circumcision in not the HIV ‘vaccine’ we have been waiting for! Future HIV Therapy 2(3)
Report analyzing use of male circumcision as HIV prevention:
Rozenbaum W, Bourdillon F, Dozon J-P, Hamamah S, Lowenstein W, Quantinet D, et al. Report on male circumcision: An arguable method of reducing the risks of HIV transmission. Conseil National du SIDA. 2007:1-10.
Other:
Deuchert E, Brody S. Plausible and Implausible Parameters for Mathematical Modeling of Nominal Heterosexual HIV Transmission. Ann Epidemiol. 2007;17(3):237-44.
Green, L., Glasgow, R., EVALUATING THE RELEVANCE, GENERALIZATION, AND APPLICABILITY OF RESEARCH Issues in External Validation and Translation Methodology. EVALUATION & THE HEALTH PROFESSIONS, Vol. 29 No. 1, March 2006 126-153
Gisselquist D, Points to Consider: Responses to HIV/AIDS in Africa, Asia, and the Caribbean, London: Adonis and Abbey, 2008. (Chapter 7)
