The Protective Effect of Male Circumcision as a Faith Lift for the Troubled Paradigm of HIV Epidemiology in Sub-Saharan Africa

Auvert and colleagues present preliminary evidence for the protective effect of male circumcision on HIV acquisition. Their report also reveals several problems with the widely held assumption that penile-vaginal sex accounts for the overwhelming majority of HIV transmission in sub-Saharan Africa. We are baffled that the factor most strongly associated with incident HIV infection--attendance at "a clinic for a health problem related to the genitals" (rate ratio 5.7)--is neither highlighted nor specifically discussed. Given evidence for increased risk of acquiring HIV from treatment for sexually transmitted diseases (STDs) in sub-Saharan Africa (relative to untreated STDs) such a context for HIV acquisition should have been more assiduously explored especially regarding nosocomial transmission. (excerpt)

[1]  J. Sykes.  Male Circumcision Increases Risk for Females , 2006, PLoS medicine.

[2]  I. Clark.  PfHRP2 Measures Schizogony, Not Mechanical Blockage , 2006, PLoS medicine.

[3]  H. Young,et al.  Two Groups Not on All Fours , 2006, PLoS medicine.

[4]  A. Muula.  On Evidence in Support of Male Circumcision in HIV Prevention: What Next? , 2006, PLoS medicine.

[5]  J. Shelton.  Estimated Protection Too Conservative , 2006, PLoS medicine.

[6]  D. Brewer,et al.  Male Circumcision and HIV in Africa , 2006, PLoS medicine.

[7]  Richard Winkel.  Rush to Judgment , 2006, PLoS medicine.

[8]  Michael Glass.  Major Potential Confounder Not Addressed , 2006, PLoS medicine.

[9]  A. Dondorp,et al.  Authors' Reply: Response to Ian Clark , 2006, PLoS Medicine.

[10]  Emmanuel Lagarde,et al.  Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial , 2005, PLoS medicine.

[11]  W. Hall,et al.  A Landmark Paper in HIV Research? , 2005, PLoS medicine.

[12]  P. Cleaton-jones.  The First Randomised Trial of Male Circumcision for Preventing HIV: What Were the Ethical Issues? , 2005, PLoS medicine.

[13]  G. Supinski,et al.  Sepsis induces diaphragm electron transport chain dysfunction and protein depletion. , 2005, American journal of respiratory and critical care medicine.

[14]  Arjen Dondorp,et al.  Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial , 2005, The Lancet.

[15]  Kamolrat Silamut,et al.  Estimation of the Total Parasite Biomass in Acute Falciparum Malaria from Plasma PfHRP2 , 2005, PLoS medicine.

[16]  B. Lowe,et al.  Estimation of the sequestered parasite load in severe malaria patients using both host and parasite markers , 2005, Parasitology.

[17]  J. Zenilman.  Behavioral interventions--rationale, measurement, and effectiveness. , 2005, Infectious disease clinics of North America.

[18]  N. Low,et al.  HIV and male circumcision--a systematic review with assessment of the quality of studies. , 2005, The Lancet. Infectious diseases.

[19]  Orc Macro,et al.  Tanzania HIV/AIDS Indicator Survey 2003-04 , 2005 .

[20]  R. Bailey,et al.  Acceptability of male circumcision and predictors of circumcision preference among men and women in Nyanza Province, Kenya , 2005, AIDS care.

[21]  R. Bakare,et al.  Risk factors for HIV infection among special treatment clinic attendees in Ibadan, Nigeria. , 2004, African journal of medicine and medical sciences.

[22]  Domenico Vitale,et al.  Multiorgan failure is an adaptive, endocrine-mediated, metabolic response to overwhelming systemic inflammation , 2004, The Lancet.

[23]  J. Potterat,et al.  Still not understanding the uneven spread of HIV within Africa. , 2004, Sexually transmitted diseases.

[24]  K. Maitland,et al.  Pathophysiology of severe malaria in children. , 2004, Acta tropica.

[25]  J. Potterat,et al.  Establishing valid AIDS monitoring and research in countries with generalized epidemics , 2004, International journal of STD & AIDS.

[26]  Julie A Simpson,et al.  An ultrastructural study of the brain in fatal Plasmodium falciparum malaria. , 2003, The American journal of tropical medicine and hygiene.

[27]  G. Moyle.  Once-daily therapy: Less is more , 2003, International journal of STD & AIDS.

[28]  I. Clark,et al.  The pathophysiology of falciparum malaria. , 2003, Pharmacology & therapeutics.

[29]  Stuart Brody,et al.  Assessing the role of anal intercourse in the epidemiology of AIDS in Africa , 2003, International journal of STD & AIDS.

[30]  R. Haugh,et al.  The money issue. , 2003, Hospitals & health networks.

[31]  Stuart Brody,et al.  Let it be sexual: how health care transmission of AIDS in Africa was ignored , 2003, International journal of STD & AIDS.

[32]  D. Brewer,et al.  Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm , 2003, International journal of STD & AIDS.

[33]  R. Hayes,et al.  Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis , 2000, AIDS.

[34]  P. Watts,et al.  Parameters of Human Immunodeficiency Virus Infection of Human Cervical Tissue and Inhibition by Vaginal Virucides , 2000, Journal of Virology.

[35]  K. O'Hara,et al.  The effect of male circumcision on the sexual enjoyment of the female partner , 1999, BJU international.

[36]  I. de Vincenzi,et al.  A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners , 1994 .

[37]  R. Rothenberg,et al.  HIV epidemiology in Africa: rich in conjecture poor in data. Reply [letter] , 2004 .

[38]  L. Barenzi.  Circumcised men less likely to get HIV. , 1997 .