Cut it! Male circumcision as an HIV prevention method?
June 26th, 2008 | by
roger |
A substudy of the randomised controlled trial (RCT) of male circumcision as an HIV prevention method in Kisumu, Kenya has found that there were virtually no differences in risk behaviour or in STI infections between circumcised and uncircumcised men (lay discussion).In the last two years three RCT of male circumcision where stopped prematurely when interim analysis showed that circumcision was highly efficacious in reducing HIV incidence (that is the number of new cases observed over a period of time).
However, concerns were raised that the perceived protective effect of circumcision would be counterbalanced by a behavioural disinhibition in the context circumcision protecting from HIV (Risk reduction does not equate protection).
in a substudy of the randomised controlled trial of male circumcision, Christine Matttson and colleagues observed that there was no evidence of this; “We found that no evidence to suggest that circumcised men engaged in increased risk behaviour after the [circumcicion] procedure” wrote the scientist from the University of Illiois in a study published in PloS One. Data for the belief that circumcision reduces risk of acquiring HIV were near-identical between circumcised and uncircumcised groups at the 12-month follow-up.
That’s encouraging but there is one problem, in both groups the belief that circumcision reduces risk of acquiring HIV increased from ~56% to 76%!
No explanation is provided in the paper as to why the belief that circumcision reduces risk of acquiring HIV increases. There is no discussion of the consequence of such belief either.
I’ll risk and explanation: Could it be that uncircumcised men do believe that circumcision reduces risks of acquiring HIV because they are part of a trial investigating just that and that uncircumcised men come to share this belief by proxy? In the long run, could this become a common belief? What the consequences would be?
This is not saying circumcision does not work, but this highlights how a belief could come to offset a succesfull HIV prevention method.
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