Male circumcision and HIV prevention

doi:10.1136/bmj.321.7274.1467/a

BMJ 2000;321:1467 ( 9 December )

Letters

Male circumcision and HIV prevention

Some science would not have gone amiss

Nature has not made a design error

No case was made for circumcising unconsenting children

More studies need to be done before widespread circumcision is implemented

Authors' reply

Summary of rapid responses

Some science would not have gone amiss

The first 150 words of the full text of this article appear below.

EDITOR $---$ While a number of studies suggest an association between the foreskin and HIV infection, a simple tallying of studies,such as performed by Szabo and Short,¹ is unscientific andmisleading. Meta-analysis suggests that men engaging in high riskbehaviours may be placed at further risk by having a foreskin,but in the general population circumcision status is not a significantfactor. It also showed an important degree of heterogeneity betweenstudies, calling into question the validity of the summary results.²The multiple confounding factors influencing sexual behaviourand HIV susceptibility make it irresponsible to place blame onnormalanatomy.

Langerhans' cells in the preputial mucosa are nothing new: all mucosal tissues have Langerhans' cells. Szabo and Short didnot report Langerhans' cell concentrations in comparison withother mucosal tissues, their concentration in the glans, foreskinremnant, and circumcision scar in circumcised men, the presenceof associated T cell . . . [Full text of this article]