Circumcision and HIV infection

The debate over circumcision and HIV in the medical literature has not been resolved. Furthermore, the discussion does not apply to neonatal circumcision. Children are not sexually active. They can weigh the issue for themselves when they are old enough to consent.

In a review of the literature, de Vincenzi and Mertens concluded that ...lack of distinction between susceptibility and infectivity, inadequate control for confounding variables, potential selection bias and misclassification of exposure, inappropriate choice of a comparison group, and publication bias, may lead to under- or overestimation of the association [between circumcision and HIV status]. It is difficult to predict the net effect of these sources of bias. Furthermore, the magnitude of the association varies strongly between studies and its crude measure is overestimated in some reports.

de Vincenzi, I, and Thierry Mertens (1994) Male circumcision: a role in HIV prevention? AIDS 8: 153-160

Surick et al (cited in Vincenzi (1994)) found that 17.7% of uncircumcised men and 8.4% of circumcised men misclassified themselves, throwing serious doubt on any study relying on self-reporting, especially where the number of men in either category is small.

One widely cited study, Kreiss et al.(1992), dealt with HIV in circumcised and intact gay men. However, as Hugh Young points out, Kreiss assumes that men choose their sexual partners regardless of their circumcision status. The existence of magazines and clubs for circumcised men and others for whole men indicates thatthis is not so.

Kreiss, Joan and Hopkins S. (1992) The association between circumcision status and HIV infection among homosexual men. VIIIth International AIDS Conference, Amsterdam (Abstract PoC 4091)]
Kreiss, Joan and Hopkins S. (1993) The association between circumcision status and HIV infection among homosexual men. J. Infections Diseases 168:1404-8]

The conclusion was toned down in the second of these two reports on the same study.

In February 1996, Scientific American printed an article by two Australian non-epidemiologists, JC Caldwell and P Caldwell, dealing with an apparent correlation between HIV infection and uncircumcised populations in Africa. This is a purely geographical study, and did not actually examine any patients. de Vincenzi and Mertens (1994), two years earlier, had criticized this study design. For further analysis of the Caldwell article, see Fleiss and Hodges (1996) and Falk (1996).

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