Male Circumcision is Inappropriate for the Prevention of HIV

Last Updated 1/16/2022

Does Circumcision Prevent HIV Infection?

Studies conducted in Africa purport to show conclusively that male circumcision gives protection from HIV/AIDS.[1][2][3]

To summarize the study’s findings, it was found that males who had had circumcision had a 60% lower relative risk of contracting HIV than those who had kept their natural foreskin. During the two years of the research, this corresponded to an absolute risk reduction of roughly 1.3%.

Up to 3% of participants who had circumcision experienced problems, including erectile dysfunction. It is entirely speculative to say if those who have circumcisions will continue to have decreased risks throughout the rest of their lives.

Three factors lead NORMUK to believe that male circumcision is an ineffective intervention for strictly HIV prevention: bio-ethical concerns, a lack of real-world application, and scientific skepticism. This article’s intention is to push back on the conclusively of the study.

Bio-ethical Implications

Men should not be circumcised to protect themselves from HIV for the following overriding ethical reasons:

• It is not a proportionate intervention because it harms the body’s normal structure and function on its own. [4]
• Use of condoms, a less invasive measure, has been shown to be successful and is probably much more successful.[5][6]
• Male circumcision does not reduce [7][8][9][10] the risk of male-to-female transfer and may even increase it. [11]
• In actual African contexts, male circumcision will serve as a vehicle for the virus’ transmission and is likely to make the epidemic worse. [12][13][14][15][16][17]

Everyone is entitled to autonomy, which is the capacity to make an adult decision about what will happen to their own body. Adult men have the right to get circumcised if they believe it will protect them against HIV, but they also have the right to factual information about the likelihood of the therapy working, the dangers involved, and any side effects.

Disclosures required for circumcision for HIV prevention include:

• Rather than the thrilling seeming reduction in relative risk, the tiny reduction in absolute risk.
• There is uncertainty over whether the treatment will result in any lifespan reduction.
• The possibility of consequences, [18] particularly the potential for HIV transmission in an African environment.
• The possibility of endangering the female companion.
• The area of the penis that is most delicately sensitive is removed during male circumcision. [19]

It is never acceptable to take healthy body parts from healthy, non-consenting youngsters in order to stop sexually promiscuous adults from getting sick.

Real World Applicability

According to a number of lines of inquiry, the research’s conclusions do not correspond to any appreciable decline in HIV prevalence in the real world: –

• There is conflicting research regarding the association between circumcision and HIV in Africa, and it does not demonstrate a general decline in HIV because of circumcision. [20]
• The US is the only developed country in the world that circumcises the majority of its boys for nonreligious reasons, but this hasn’t stopped it from becoming the developed country with the highest HIV prevalence.[21]
• In general, countries with a high rate of circumcision perform poorly in comparison to European nations with a low rate of circumcision in terms of HIV prevalence.
• In a British study of gay men, circumcised males had a greater rate of HIV than non-circumcised men. [22]
• The impact of male circumcision could be countered by any increase in male-to-female transmission.
• In actuality, circumcision is carried out in not the cleanest environment in Africa. There is evidence that medical devices aid in the spread of HIV in Africa. Circumcision requirements will simply make the HIV problem worse.

Review of Science

The gold-standard of medical efficacy proof is not met by the African HIV research. The studies are vulnerable to “observer bias” because there was no blinding in place. Because they had previously published articles supporting male circumcision as a means of preventing HIV in Africa, the researchers were known to be biased.

Because the participants in the experiments thought that circumcision would shield them from HIV, they sought out guys who “wanted to get circumcised.” Since they alone were instructed to refrain from sex for six weeks, those who had circumcision in the research had less sex than those who did not.

There were many more trial participants who were “lost to follow-up” than there were those who really contracted the virus. This seriously calls into question the reliability of the study’s conclusions. [23]

Result of Studies

The studies came to an early conclusion. Studies that end early consistently overestimate the therapeutic benefits, according to research. [24][25]

In two well-established instances, a data-monitoring committee advised that the study be stopped early since there was no chance that the treatment would be shown to be unsuccessful, but the trial was carried out all the way to the finish.[26][27]

The treatment was found to be ineffective, in our opinion. Some have argued that promising results in experiments that were abandoned too soon only “reflect the existing prejudice” of the scientific community.

To hammer home the point, the research have been backed by a huge publicity campaign. Pictures of young African boys being rushed into glistening, sterile surgical rooms of the kind that are rare in Africa were shown on TV news in conjunction with the publication of the study.

African youngsters will actually have their circumcisions performed in the wild with a dirty knife that was just used on an HIV-positive boy. Promoting circumcision in Africa is so blatantly irresponsible.

Our Conclusion

The results on absolute risk are less interesting, whereas the researchers have highlighted dramatic reductions in relative risk. Even in areas with a high prevalence of HIV, circumcision carried more dangers than advantages. The risk to benefit ratio will be significantly larger in wealthy countries.

Nevertheless, the researchers deserve praise for being the first to demonstrate through a Randomized Controlled Trial that circumcision is indeed an effective means of disease prevention. Why won’t they share their data with other academics outside of their exclusive group in light of this groundbreaking discovery?

Furthermore, is risking erectile dysfunction and other ramifications like penis size of circumcision worth the possible minor decrease HIV rates? We think that should be up to the person receiving the circumcision. The NORMUK members have expressed their opinions, and continuously say how their erection quality decreased so much after circumcision, that they had to turn to alternative methods like using FDA approved penis pumps. Otherwise they’d have to rely on medication the rest of their lives, just to get the level of satisfaction in the bedroom that they did prior to getting circumcised.

References

1 Auvert B, Taljaard D, Lagarde E, et. al. Randomized controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2005;12: 298.

2 Gray RH and colleagues. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet,2007:369;657-666.

3 Bailey RC and colleagues. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet,2007:369;643-656.

4 Taves D. The intromission function of the foreskin. Med Hypotheses. 2002; 59(2):180.

5 Agot K, Ndinya-Achola JO, Kreiss JK, Weiss NS. HIV-1 prevalence in circumcised versus uncircumcised Luo men from African instituted churches in rural Kenya. XIV World AIDS Conference. 2002.

6 Wainberg MA. The cutting edge on circumcision: reducing the risk. Parkhurst Exchange, Jan 2001.

7 Castilho EA, Boshi-Pinto C, Guimaraes MDG. Male circumcision and HIV heterosexual transmission. XIV World AIDS Conference. 2002.

8 Guimaraes MD, Vlahov D, Castilho EA. Postcoital vaginal bleeding as a risk factor for transmission of the human immunodeficiency virus in a heterosexual partner study in Brazil. Rio de Janeiro Heterosexual Study Group. Arch Intern Med. 1997; 157(12):1362-8.

9 Guimaraes M, Castilho E, Ramos-Filho C, et al. Heterosexual transmission of HIV-1: a multicenter study in Rio de Janeiro, Brazil. VII Intl Conf on AIDS. 1991.

10 Changedia SM, Gilada IS. Role of male circumcision in HIV transmission insignificant in Conjugal relationship. XIV World AIDS Conference. 2002.

11 Circumcision protects men from AIDS but might increase risk to women, early results suggest.International Herald Tribune, Tuesday, 6 March 2007.

12 Brewer DD, Brody S, Drucker E, Gisselquist D, Minkin SF, Potterat JJ, Rothenberg RB, Vachon F. Mounting anomalies in the epidemiology of HIV in Africa: cry the beloved paradigm. Int J STD AIDS. 2003; 14(3):144-7.

13 Gisselquist D, Potterat JJ, Brody S, Vachon F. Let it be sexual: how health care transmission of AIDS in Africa was ignored. Int J STD AIDS. 2003; 14:148-61.

14 Gisselquist D, Potterat JJ, Brody S. Running on empty: sexual co-factors are insufficient to fuel Africa’s turbocharged HIV epidemic. Int J STD AIDS. 2004; 15(7):442-52.

15 Gisselquist D, Potterat JJ. Heterosexual transmission of HIV in Africa: an empiric estimate. Int J STD AIDS. 2003; 14:162-73.

16 Gisselquist D, Rothenberg R, Potterat J, Drucker E. Non-sexual transmission of HIV has been overlooked in developing countries. Br Med J. 2002; 324(7331):235.

17 Nyindo M. Complementary factors contributing to the rapid spread of HIV-I in sub-Saharan Africa: a review. East Afr Med J. 2005; 82(1):40-6.

18 Williams N, Kapila L. Complications of circumcision. Br J Surg. 1993; 80:1231-1236.

19 Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, Van Howe RS. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007; 99(4):864-9.

20 Garenne M. Long-term population effect of male circumcision in generalised HIV epidemics in sub-Saharan Africa. African Journal of AIDS Research 2008, 7(1): 1–8.

21 GW Dowsett, M Couch. Reproductive Health Matters 2007;15(29):33–44.

22 Reid D, Weatherburn P, Hickson F, Stephens M. Know the score. Findings from the National Gay Men’s Sex Survey 2001.

23 Green LW et al. Male circumcision is not the HIV ‘vaccine’ we have been waiting for! Future HIV Ther. (2008) 2(3), 193–199.

24 Montori VM, Devereaux PJ, Adhikari NKJ, et al. Randomized trials stopped early for benefit: a systematic review. JAMA. 2005;294:2203-2209.

25 Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005;294:218-228.

26 Wheatley K, Clayton D. Be skeptical about unexpected large apparent treatment effects: the case of an MRC AML12 randomization. Control Clin Trials. 2003;24:66-70.

27 Slutsky AS, Lavery JV. Data safety and monitoring boards. N Engl J Med. 2004;350:1143-1147.