BMJ  2005;331:781 (1 October), doi:10.1136/bmj.331.7519.781

Letter

Issues arising from lobby of UN to outlaw circumcision

EDITOR—Hopkins Tanne's news item on a US group lobbying the UN to outlaw circumcision conflates two unrelated stories into one.¹ The first is Hess's call for UN action to declare male circumcision a human rights violation, the second the self described, randomised controlled trial of circumcision by Auvert et al to prevent transmission of HIV from women to men.² The Wall Street Journal reports that the Lancet refused to print this report, so only the scant information from the abstract is available.³ The private peer review at the Lancet that resulted in a refusal to print the article is not encouraging, and public scrutiny is therefore speculative.

Several observations, however, are possible from the abstract. The study purports to be a randomised controlled trial, yet the men were not selected at random. Auvert et al eliminated those men who were not willing to be circumcised, so selection has entered into the picture.²

The Auvert study claims circumcision reduces but does not eliminate infection with HIV.² The authors terminated the study early. Had the study continued for its planned length, it would probably have shown that circumcision merely delays infection.

In the Auvert study doctors tracked black men while they became infected with HIV. Apparently, the participants were not given or allowed to use condoms because this would have disturbed the experiment. This is reminiscent of the infamous Tuske-gee syphilis study, in which newly discovered penicillin was withheld so that the study could continue.⁴

If Auvert et al ultimately plan to subject children to circumcision in an effort to prevent HIV infection, this would be unacceptable from a human rights and ethical perspective.⁵ Bioethics requires the most conservative treatment,⁵ and condoms and sex education must therefore be preferred.

iconbuster{at}earthlink.net
Doctors Opposing Circumcision, Suite 42, 2442 NW Market Street, Seattle, WA 98107-4137, USA

Doctors Opposing Circumcision, Suite 42, 2442 NW Market Street, Seattle, WA 98107-4137, USA

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Competing interests: None declared.

References

1. Hopkins Tanne J. US group lobbies UN to outlaw male circumcision. BMJ 2005;331: 422. (20-27 August.)[Free Full Text]
2. Auvert B, Puren A, Taliaard D, Lagarde E, Sitta R, Tambekou J. Impact of male circumcision on the female-to-male transmission of HIV. Third IAS conference on HIV pathogenesis and treatment, Rio de Janeiro, 24-27 July 2005. www.ias-2005.org/planner/Abstracts.aspx?AID=2675
3. Schoofs M, Lueck S, Phillips MM. Study says circumcision reduces AIDS risk by 70%. Findings from South Africa may offer powerful way to cut HIV transmission. Wall Street Journal 2005 July 5: A1.
4. Bhopal R. Spectre of racism in health and health care: lessons from history and the United States. BMJ 1998;316: 1970-3.[Free Full Text]
5. Fox M, Thomson M. A covenant with the status quo? Male circumcision and the new BMA guidance to doctors. J Med Ethics 2005;31: 463-9.[Abstract/Free Full Text]

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