NOT COMPLETE

In 2007, the World Health Organization put for guidelines on male circumcision recommending countries where HIV has spread to the general public to institute circumcision programs as part of a comprehensive package to reduce HIV [1].After convening experts from around the world at Montreux, Switzerland , The World Health Organization stated that the evidence places circumcision’s ability to reduce the risk of contracting HIV by approximately 60% ‘beyond reasonable doubt’. These findings were reaffirmed in the American Academy of Pediatrics 2012 guidelines on circumcision where they conclude that ‘the benefits of male circumcision outweigh the risks’ [2]. The most compelling evidence that circumcision reduces the risk of men contracting HIV from heterosexual sex (and likely insertive homosexual sex) comes from three randomized controlled trials [3,4,5]. There are also a number of other studies which indicate that circumcision reduces that risk of men contracting HIV as well []. Let’s start off by looking at the three randomized controlled trials on circumcision and HIV.

The three randomized control trials consisted of two independent groups working at universities in the United States, and one group came from researchers from France. The first one was published in October of 2005 and came from the French team, so lets start there (reference [3]). The study took place in South Africa and consisted of 3,274 uncircumcised men who randomly placed in the intervention group (group to undergo circumcision) or the control group (group to remain uncircumcised throughout the trial). The patients were followed up at 3, 6, 12, and 21 months after the trial began. At the 21 month follow up a total of 20 HIV cases were seen in the intervention group and 49 in the control group, given a 59% reduced chance of contracting HIV for circumcised men. The trial was planned on continuing for another 14 months, but the ethics board deemed it unethical to continue the trial and not offer circumcision to the control group given the strong evidence of the protective effect circumcision. The 59% protective effect of circumcision was unchanged when controlling for sexual risk factors like number of partners, condom use, and treatment for other STD’s

[1] World Health Organization Guidelines on Male Circumcision.   http://apps.who.int/iris/bitstream/10665/43751/1/9789241595988_eng.pdf

[2] 2012 American Academy of Pediatrics Guidelines on Circumcision.   http://pediatrics.aappublications.org/content/pediatrics/130/3/e756.full.pdf

[3] Randomized, Controlled Intervention trial of Male Circumcision for Reduction of HIV Infection Risk. Auvert et al.                                                           http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020298

 

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