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Review
. 2011 Oct;35(5):459-65.
doi: 10.1111/j.1753-6405.2011.00761.x.

Not a Surgical Vaccine: There Is No Case for Boosting Infant Male Circumcision to Combat Heterosexual Transmission of HIV in Australia

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Review

Not a Surgical Vaccine: There Is No Case for Boosting Infant Male Circumcision to Combat Heterosexual Transmission of HIV in Australia

Robert Darby et al. Aust N Z J Public Health. .

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.

Approach: These arguments are evaluated in terms of their logic, coherence and fidelity to the principles of evidence-based medicine; the extent to which they take account of the evidence for circumcision having a protective effect against HIV and the practicality of circumcision as an HIV control strategy; the extent of its applicability to the specifics of Australia's HIV epidemic; the benefits, harms and risks of circumcision; and the associated human rights, bioethical and legal issues.

Conclusion: Our conclusion is that such proposals ignore doubts about the robustness of the evidence from the African random-controlled trials as to the protective effect of circumcision and the practical value of circumcision as a means of HIV control; misrepresent the nature of Australia's HIV epidemic and exaggerate the relevance of the African random-controlled trials findings to it; underestimate the risks and harm of circumcision; and ignore questions of medical ethics and human rights. The notion of circumcision as a 'surgical vaccine' is criticised as polemical and unscientific.

Implications: Circumcision of infants or other minors has no place among HIV control measures in the Australian and New Zealand context; proposals such as these should be rejected.

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