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A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

By Brian D. Earp 

* Note: this article has been re-posted at various other sites, sometimes with minor edits. This is the original and should be referred to in case of any discrepancies.

 

A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa may increase transmission of HIV

1. Experimental doubts 

A handful of circumcision advocates have recently begun haranguing the global health community to adopt widespread foreskin-removal as a way to fight AIDS. Their recommendations follow the publication of three [1] randomized controlled trials (RCTs) conducted in Africa between 2005 and 2007.

These studies have generated a lot of media attention. In part this is because they claim to show that circumcision reduces HIV transmission by about 60%, a figure that (interpreted out of context) is ripe for misunderstanding, as we’ll see. Nevertheless, as one editorial [2] concluded: “The proven efficacy of MC [male circumcision] and its high cost-effectiveness in the face of a persistent heterosexual HIV epidemic argues overwhelmingly for its immediate and rapid adoption.”

Well, hold your horses. The “randomized controlled trials” upon which these recommendations are based are not without their flaws. Their data have been harnessed to support public health recommendations on a massive scale whose implementation, it has been argued, may have the opposite of the claimed effect, with fatal consequences. As Gregory Boyle and George Hill explain in their extensive analysis of the RCTs:

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Wellcome Lecture in Neuroethics: Wayne Hall on the brain disease model of addiction

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Wellcome Lecture in Neuroethics: The brain disease model of addiction: Assessing its validity, utility and implications for public policy towards the treatment and prevention of addiction Wayne Hall, NHMRC Australia Fellow, University of Queensland Centre for Clinical Research Thursday 14 June, 5.30 – 7.00 p.m., Seminar Room 1, Oxford Martin School, 34 Broad St. ALL… Read More »Wellcome Lecture in Neuroethics: Wayne Hall on the brain disease model of addiction

European versus US attitudes to geoengineering

Casual observation suggests that among scientists researching geoengineering technologies there is a marked difference in attitude between Americans and continental Europeans. The United Sates is the home of the idea of the technofix, so American researchers tend to have more faith in the possibilities for technological intervention to control the global climate. There is a… Read More »European versus US attitudes to geoengineering

Crisis in the Catholic Church

Professor Tony Coady is Professorial Fellow in Applied Philosophy and Vice Chancellor’s Fellow at Melbourne University. He is currently visiting the University of Oxford as Leverhulme Visiting Professor at the Oxford Uehiro Centre for Applied Ethics. He is a Catholic.

In the early years of Queen Victoria’s reign, the famous Protestant historian Thomas Macaulay wrote admiringly of the Church of Rome and the Papacy commending their ancient lineage and current vitality. He saw no signs of decline and speculated that the Church “may still exist in undiminished vigour when some traveller from New Zealand shall, in the midst of a vast solitude, take his stand on a broken arch of London Bridge to sketch the ruins of St. Paul’s.” 

Today, Macauley’s assessment seems unduly optimistic. Scandals about clerical sexual abuse of children and the associated official evasion of responsibility as well as inflexible attitudes to so many of the values and dilemmas of the contemporary world have combined to undermine to a large extent the confident self-image and apparent cohesion that helped sustain the durability and vigour that enchanted Macaulay. Following a series of alarming revelations about the extent of clerical sex abuse in Ireland and the gross inadequacy of the hierarchy’s responses to it, coupled with the Irish Prime Ministers strong denunciation of the official Church’s record on the matter, the recent BBC program “The Shame of the Catholic Church” (broadcast 2/5/12) added further fuel to the blaze. Although the broadcast was primarily concerned with the abuse and evasion of church authority it also indicated the depth of the wider crisis in the Church.

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Should Peer Review be Rejected?

In most academic disciplines academics devote considerable energies to trying to publish in prestigious journals. These journals are, almost invariably, peer reviewed journals. When an article is submitted their editors send this out to expert reviewers who report on it and, if the article is judged to be of sufficient quality by those referees – who typically report back a few months later – and by the editor (and perhaps an editorial board), then it will be published (often after revisions have been made). If not, as in most cases, the author is free to try to publish the article in another journal. As anyone who has participated in this process can attest, it is very time consuming and often frustrating. The best journals only publish a small percentage of submissions and so an author who is targeting such journals may often have to submit the article several times; and in fields where the convention is that one should only submit to one journal at a given time (almost all fields) they may sometimes find that it takes a year or longer to have their paper accepted somewhere. Not only is this process very time consuming, it is often capricious as the referees that one’s paper is forwarded to may not be competent to assess the article in question and may be biased in various ways against (or for) one’s article. For these sorts of reasons many academics have wondered if there might be a better way.

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Bad seed is a robbery of the worst kind: prolific sperm donation and screening

New York Times writes about “In Choosing a Sperm Donor, a Roll of the Genetic Dice”: recipients of sperm donation have found out the hard way that there is a risk of genetic disease affecting their children. In at least one case a donor with a clean bill of health and who had, according to the laboratory, been tested for genetic conditions. Unfortunately he turned out to be a carrier for cystic fibrosis like the mother, and the child suffered. Other cases of transmission of genetic conditions to multiple children from a single donor have appeared, suggesting a need to do something. Is there an ethical need for ensuring genetic testing in the case of sperm donation – or is the problem that some donors father many children?

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‘Marriage is ONLY between a Man and a Woman’

A series of events have brought the issue of gay marriage to the fore. Nudged by the Vice President, Barak Obama came out in support. North Carolina, by contrast, voted to prohibit it. Closer to home, Mayor Boris Johnson recently put his foot down to prevent a religious group running the slogan ‘Not gay! Ex-gay, post-gay and proud. Get over it!’ on London buses. This was in response to an earlier ad from Stonewall which read ‘Some people are gay. Get over it.’ These events, of course, have triggered rekindling of the debate. What strikes me most about opposition to gay marriage is how bad many of the arguments against it seem to be.Read More »‘Marriage is ONLY between a Man and a Woman’

The Kansas Anti-Abortion Bill: An Affront to Autonomy

On Monday, the state of Kansas in the USA passed an anti-abortion bill which includes several morally controversial measures (http://www.huffingtonpost.com/2012/05/04/kansas-abortion-bill_n_1478706.html). One measure receiving a great deal of media attention is the provision to prohibit tax deductions for abortion insurance coverage, thus making a women’s ability to have an abortion far more dependent on her socio-economic status. This is of course an important issue, but I shall address an aspect of the bill which I find even more disagreeable.Read More »The Kansas Anti-Abortion Bill: An Affront to Autonomy