Lancet - Opinion Pieces on Male Circumcision

Lancet Publishes Opinion Pieces Responding to Studies Finding That Male Circumcision Reduces Men's HIV Infection Risk

[thanks to the Kaiser HIV/AIDS Daily Report for this item]

The Lancet in its May 12 issue published several opinion pieces responding to studies conducted in Kenya and Uganda and published in the Feb. 23 issue of the journal that found routine male circumcision could reduce a man's risk of HIV infection through heterosexual sex by 65% (Kaiser Daily HIV/AIDS Report, 2/23). Summaries of the opinion pieces appear below.

• Robert Bailey et al., Lancet: "Whatever the mechanisms leading to [HIV] infection, there is no longer any doubt" that circumcision decreases HIV risk, Bailey of the Division of Epidemiology and Biostatistics at the University of Illinois-Chicago and colleagues write in an opinion piece. The authors add that although a meta-analysis of the three trials "would be welcome," the studies' findings "are so consistent that such an analysis is likely only to strengthen the conclusions." In addition, the authors say that "[a]necdotes and speculation should not trump the consistent evidence" from the trials and 40 other observational studies (Bailey et al., Lancet, 5/12).
  
  
• Devon Brewer et al., Lancet: The "epidemiological mechanism" for reduced HIV incidence among the studies' participants "remains unclear," Brewer of Interdisciplinary Scientific Research and colleagues write. According to the authors, additional studies that "involve comprehensive assessment of transmission modes" are needed to "determine the mechanism" that leads to reduced HIV incidence and to "understand whether interventions aside from circumcision would more directly, effectively and inexpensively activate this mechanism" (Brewer et al., Lancet, 5/12).
  
  
• George Denniston and George Hill, Lancet: The studies have been "marred by poor science," and the basis for circumcision "has been overturned," Denniston and Hill from Doctors Opposing Circumcision write in an opinion piece. They write that "[g]iven the contradictory evidence, whether male circumcision will worsen or improve HIV infection is uncertain," adding that additional studies are needed before circumcision programs are implemented (Denniston/Hill, Lancet, 5/12).
  
  
• Seth Kalichman et al., Lancet: Although the studies' results are "clearly important for HIV prevention, the benefits of male circumcision could be negated by behavior that increases HIV risk, especially by a drop in condom use or a rise in sexual partners," Kalichman, a professor of psychology at the University of Connecticut, and colleagues write. The authors add that an "accurate assessment of the population impact of male circumcision needs to consider both the risk-reducing and potentially risk-enhancing effects of this procedure" (Kalichman et al., Lancet, 5/12).
  
  
• Nigel O'Farrell et al., Lancet: "[U]ndertaking mass male circumcision in selected populations in Africa will be a huge task," O'Farrell of the Ealing Hospital in London and colleagues write. The authors add that until a circumcision program is "successfully rolled out," uncircumcised men should be "advised to achieve good standards of penile hygiene" because other studies "have shown that penile wetness is associated with HIV in uncircumcised men" (O'Farrell et al., Lancet, 5/12).