Thursday, February 23, 2012

(NEWZIMBABWE) Impact of male circumcision on HIV doubted

COMMENT - The efficiency of circumcision in preventing HIV infection is entirely based on 3 surveys, 2 of which were 'stopped short for effect', which is stastitical jargon for saying that the researchers stopped the survey, as soon as they had the data they wanted. In other words, there is no scientific evidence that circumcision prevents HIV infection. There are billions of dollars in grants and aid (i.e., debt) available. UNAID$ is continuously involved in medical fraud. They are the ones who fought tooth and nail to maintain the Antenatal Clinic Surveys as a basis for estimating national HIV prevalence rates, even when it was clear ANC's massively overstate HIV prevalence among the general population in Africa. For detail on why these studies are unscientific, see comments added below the article.

Impact of male circumcision on HIV doubted
22/02/2012 00:00:00
by Gilbert Nyambabvu

MALE circumcision is a dangerous distraction in the fight against HIV/AIDS, researchers have warned insisting that contrary to widespread claims the procedure only reduces transmission rates by no more than 1.3 percent.

Zimbabwe is among several countries in sub-Saharan Africa that have launched mass male circumcision campaigns after the World Health Organisation (WHO) and UNAIDS recommended the procedure in 2007 as an effective HIVAIDS preventive measure.

The WHO/UNAIDS recommendation was based on clinical trials carried out in Kenya, South Africa and Uganda which suggested that circumcision could reduce female-to-male HIV transmission by up to 60 percent.

Thousands of men have undergone the surgical nip and tuck since Zimbabwe launched the campaign in 2009 with promoters enthusiastically claiming that if at least 80 percent of the adult male population was circumcised about 750 000 cases of HIV infections could be prevented.

But new research has cast doubt on the supposed efficacy of the procedure with an article in the December Australian Journal of Law and Medicine citing numerous flaws in the Kenya, South Africa and Uganda studies.

Researchers Gregory J. Boyle and Gregory Hill claimed the 60 percent reduction in transmission was only relative with the absolute reduction rate actually no more than 1.3 percent.

Boyle and Hill said: “What does the frequently claimed ‘60 percent relative reduction’ in HIV infections actually mean?

“Across all the three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18 percent) became HIV positive while among the 5,497 controls 137 (2.49 percent) became HIV positive.

“So the absolute decrease in HIV infection was only 1.31 percent, which is statistically not significant.”

The authors of the article insisted that the WHO/UNAIDS recommendation “uncritically accepted” the findings of the Kenya, South Africa and Uganda trials, in the process ignoring a vast body of contradictory evidence.

“Examination of epidemiological data shows that male circumcision does not provide protection against HIV transmission in several sub-Saharan African countries including Cameroon, Ghana, Lesotho, Malawi, Rwanda and Tanzania all of which have higher prevalence of HIV infection among circumcised men,” they said.


“In Malawi, the HIV prevalence rate is 13.2 percent among circumcised men and 9.5 percent among those who are intact. (Again) in Cameroon prevalence among those circumcised is 5.1 percent compare to 1.5 percent for those who are intact.

“If male circumcision reduces HIV transmission as the trials claim then why is HIV prevalence much higher in the United States (where most men are circumcised) than in developed countries where most men are intact (such as Europe, the United Kingdom and Scandinavia)?”

The article warns that relying on male circumcision in the fight against HIV/AIDS is especially dangerous for sub-Saharan Africa women because circumcised men could still acquire and transmit the virus to their sexual partners.

“Evidence suggests that mass circumcision programs may exacerbate the HIV epidemic among women (and) under these circumstances it would be irresponsible and unethical to advocate mass circumcision programmes in southern Africa,” the article concludes.

“Male circumcision is a dangerous distraction and a waste of scarce resources that should be used for known preventive measures (such as condoms which are 80 percent effective.”



The evidence that circumcision stops HIV infection in men is extremely thin. The policy is based on three studies, all carried out around the same time, in South Africa, Kenya and Uganda.

In all cases the number of seroconverting men was very small compared to the study size, and in two cases studies were stopped early, increasing the risk of documenting bias. In their review of randomized clinical trials that have been stopped early, VM Montori et al concluded:

"RCTs stopped early for benefit are becoming more common, often fail to adequately report relevant information about the decision to stop early, and show implausibly large treatment effects, particularly when the number of events is small. These findings suggest clinicians should view the results of such trials with skepticism."

Randomized trials stopped early for benefit: a systematic review.
It is alarming that such a drastic policy as mass circumcision would be based on such thin evidence.

(South Africa, 2006) Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial

(Kenya, 2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.

(Uganda, 2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.

CONCLUSIONS: RCTs stopped early for benefit are becoming more common, often fail to adequately report relevant information about the decision to stop early, and show implausibly large treatment effects, particularly when the number of events is small. These findings suggest clinicians should view the results of such trials with skepticism.

JAMA. 2005 Nov 2;294(17):2203-9.
Randomized trials stopped early for benefit: a systematic review.

^ Mills, J.; N. Siegfried (October 2006). "Cautious optimism for new HIV/AIDS prevention strategies.". Lancet 368 (9543): 1236.

doi:10.1016/S0140-6736(06)69513-5. PMID 17027724.

""The inferences drawn from the only completed randomised controlled trial (RCT) of circumcision could be weak because the trial stopped early.

In a systematic review of RCTs stopped early for benefit, such RCTs were found to overestimate treatment effects. When trials with events fewer than the median number (n=66) were compared with those with event numbers above the median, the odds ratio for a magnitude of effect greater than the median was 28 (95% CI 11--73).

The circumcision trial recorded 69 events, and is therefore at risk of serious effect overestimation. We therefore advocate an impartial meta-analysis of individual patients' data from this and other trials underway before further feasibility studies are done.".

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At 10:06 PM , Blogger MrK said...

From 2004, in the Boston Globe:
Estimates on HIV called too high
New data cut rates for many nations

By John Donnelly, Globe Staff | June 20, 2004

And from 2006, in the Washington Post:

How AIDS in Africa Was Overstated
By Craig Timberg
Washington Post Foreign Service
Thursday, April 6, 2006

KIGALI, Rwanda -- Researchers said nearly two decades ago that this tiny country was part of an AIDS Belt stretching across the midsection of Africa, a place so infected with a new, incurable disease that, in the hardest-hit places, one in three working-age adults were already doomed to die of it.

But AIDS deaths on the predicted scale never arrived here, government health officials say. A new national study illustrates why: The rate of HIV infection among Rwandans ages 15 to 49 is 3 percent, according to the study, enough to qualify as a major health problem but not nearly the national catastrophe once predicted.

The new data suggest the rate never reached the 30 percent estimated by some early researchers, nor the nearly 13 percent given by the United Nations in 1998.

At 10:07 PM , Blogger MrK said...


The study and similar ones in 15 other countries have shed new light on the disease across Africa. Relying on the latest measurement tools,

['The latest statistical measurement tools', meaning statistically representatives samples of the general population (Demographic And Health Surveys or DHS's), also known as statistics 101 - MrK]

they portray an epidemic that is more female and more urban than previously believed, one that has begun to ebb in much of East Africa and has failed to take off as predicted in most of West Africa.

[Therefore skewing the number of True Positives toward the subsample of the population called pregant women at antenatal clinics. This does not address the number of false positives that this subsample attracts, because single ELisa screening tests are completely inappropriate for any woman who is or has been pregnant - too many false positives. - MrK]



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