Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia

Abstract

Objective: To conduct a critical review of recent proposals that widespread circumcision of male infants be introduced in Australia as a means of combating heterosexually transmitted HIV infection.

Review: A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries

“…Here we critique opinions of MC opponents (Boyle & Hill, 2011; Chin, 2011; Conroy, 2011; Darby, 2011; Darby & Van Howe, 2011; Forbes, 2011; Paix, 2011; Travis et al, 2011). These misrepresent credible research, and cite questionable websites, superseded publications, outlier studies, non-peer-reviewed book chapters and discredited paediatric policy statements (Schoen, Oehrli, Colby, & Machin, 2000; Morris, Bailis, Castellsague, Wiswell, & Halperin, 2006; Morris et al, 2012b).…”

“…Deaths from medical MC are exceedingly rare, as Darby and Van Howe (2011) confirm. They are mostly from general anaesthesia, local anaesthesia being safer.…”

“…Van Howe’s other anti-MC claims have been refuted (Bailis, 1998; Castellsague, Albero, Cleries, & Bosch, 2007; Schoen, 1997, 2007; Waskett & Morris, 2007, 2008; Waskett, Morris, & Weiss, 2009). Contrary to Darby and Van Howe (2011)’s claim that “it will be many years before we learn whether the current African circumcision programs have succeeded”, a large-scale MC roll-out has demonstrated 76% HIV protection (Auvert et al, 2011). …”

“…Claims that MC is “highly mutilating”, “seriously impairs penile function” (Paix, 2011) and “amputates healthy, functional, protective, erogenous tissue” (Boyle & Hill, 2011) have led vulnerable men to falsely believe their sexual problems stem from their infant circumcision, leading them to “feel angry and mutilated, even to the point of psychological disturbance” (Darby & Van Howe, 2011), resorting to mutilating “foreskin restoration” (Walter & Streimer, 1990). In reality, sexual dysfunction, especially with age, is either more common (Laumann, Maal, & Zuckerman, 1997; Richters, Smith, de Visser, Grulich, & Rissel, 2006) or no different (Collins et al, 2002; Ferris et al, 2010; Masood et al, 2005) in uncircumcised versus circumcised men.…”

“…Boyle and Hill (2011) and Darby and Van Howe (2011) repeat claims opposing medical MC for HIV prevention in sub-Saharan Africa (Gisselquist et al, 2009; Green, McAllister, Peterson, & Travis, 2008; Green et al, 2010; Van Howe, 1999; Van Howe & Storms, 2011) shown previously to be seriously flawed (Banerjee et al, 2011; Morris et al, 2011b; Moses, Nagelkerke, & Blanchard, 1999; O’Farrell & Egger, 2000; Wamai et al, 2008, 2011; Wamai & Morris, 2011; Wawer et al, 2011). A dated opinion piece by Fleiss, Hodges, and Van Howe (1998) cited by Paix (2011) contradicts research.…”