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The Journal of the Royal Society for the Promotion of Health, Vol. 125, No. 6, 259-265 (2005)
DOI: 10.1177/146642400512500607
© 2005 Royal Society for the Promotion of Health

HIV infection and circumcision: cutting through the hyperbole

Robert S Van Howe, MD, MS, FAAP

Marquette, Michigan 49855, USA Tel: +1 906 228 7454 rsvanhowe{at}mgh.org

J Steven Svoboda, JD (Harv)

Attorneys for the Rights of the Child, Berkeley, California, USA

Frederick M Hodges, DPhil (Oxon)

PO Box 5815, Berkeley, California 94705, USA

The objective of this study was to determine whether the justifications given for promoting mass circumcision as a preventive measure for HIV infection are reasonable and whether mass circumcision is a feasible preventive measure for HIV infection in developing countries.

The medical literature concerning the practice of circumcision in the absence of medical indication was reviewed regarding its impact on HIV infection and related issues. The literature was analysed with careful attention to historical perspective.

Our results show that the medical literature supporting mass circumcision for the prevention of HIV infection is inconsistent and based on observation studies. Even if the two ongoing randomised controlled trials in Africa show a protective benefit of circumcision, factors such as the unknown complication rate of the procedure, the permanent injury to the penis, human rights violations and the potential for veiled colonialism need to be taken into account. Based on the best estimates, mass circumcision would not be as cost-effective as other interventions that have been demonstrated to be effective.

Even if effective, mass circumcision as a preventive measure for HIV in developed countries is difficult to justify.

Key Words: Circumcision • HIV infection • informed consent • medical history • prophylaxis


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