Issues arising from lobby of UN to outlaw circumcisionBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7519.781 (Published 29 September 2005) Cite this as: BMJ 2005;331:781
All rapid responses
Hill and Geisheker correctly note that the Lancet declined to publish Auvert's study,1 but in describing this as 'not encouraging' neglect the fact that their own source stated that this was for reasons unrelated to the data and scientific content.2
The authors may care to read a recent report in Science, in which the reasons for the rejection of the study were explained.3 In essence, it was due to ethical disagreement concerning how men were informed of their HIV status.
As noted by the authors, the abstract of Auvert's study is available.4 Hill and Geisheker proceed to make a number of criticisms, with varying degrees of validity.
The authors appear to object to randomised controlled trials in which participation is voluntary, complaining that participants were willing to be circumcised. It is unclear how any trial might be conducted with unwilling participants, since this would surely be unethical. Perhaps the authors would care to explain?
The authors go on to speculate that, had the trial continued, it would have shown that circumcision delays - rather than prevents - infection. In a sense, and given an infinite number of exposures, this is correct. I wonder whether the authors would apply similar reasoning and describe safer sex as 'delaying the inevitable'?
The authors suggest that participants were not allowed to use condoms. It is unclear how they inferred this from the study, especially as the researchers were careful to control for condom use when presenting the results.
The authors state that condom use and sex education must be preferred. While it is certainly true that these are largely effective and highly desirable, they are not incompatible with circumcision. Indeed, the combination might reasonably be expected to be most effective. Sadly, in many African countries there are many difficulties in persuading people to use condoms.5-7 There is thus a pressing need to find alternative, culturally acceptable measures.
Auvert's study demonstrates a clearly protective effect of circumcision against this devastating disease.4 How many more lives must be lost while these illogical, emotive, ill-informed and highly speculative protests continue?
- Hill G, Geisheker JV. Issues arising from lobby of UN to outlaw circumcision. BMJ 2005;331:781
- 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. http://www.aegis.org/news/wsj/2005/WJ050701.html
- Cohen J. AIDS research. Male circumcision thwarts HIV infection. Science 2005 Aug 5;309(5736):860
- Auvert B, et al. 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
- Varga CA. Young people, HIV / AIDS, and intervention: barriers and gateways to behaviour change. Dev Bull 2000 Jun;(52):67-70.
- James S, et al. Young people, HIV/AIDS/STIs and sexuality in South Africa: the gap between awareness and behaviour. Acta Paediatr 2004 Feb;93(2):264-9.
- Sloan NM, Myers JE. Evaluation of an HIV/AIDS peer education programme in a South African workplace. S Afr Med J 2005 Apr;95(4):261-4.
Competing interests: No competing interests