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Criticisms of African trials fail to withstand scrutiny: male circumcision does prevent HIV infection.
J Law Med. 2012 Sep; 20(1):93-123.JL

Abstract

A recent article in the JLM (Boyle GJ and Hill G, "Sub-Saharan African Randomised Clinical Trials into Male Circumcision and HIV Transmission: Methodological, Ethical and Legal Concerns" (2011) 19 JLM 316) criticises the large randomised controlled trials (RCTs) that scientists, clinicians and policy-makers worldwide have concluded provide compelling evidence in support of voluntary medical male circumcision (VMMC) as an effective HIV prevention strategy. The present article addresses the claims advanced by Boyle and Hill, demonstrating their reliance on outmoded evidence, outlier studies, and flawed statistical analyses. In the current authors' view, their claims portray misunderstandings of the design, execution and interpretation of findings from RCTs in general and of the epidemiology of HIV transmission in sub-Saharan Africa in particular. At the same time they ignore systematic reviews and meta-analyses using all available data arising from good-quality research studies, including RCTs. Denial of the evidence supporting lack of male circumcision as a major determinant of HIV epidemic patterns in sub-Saharan Africa is unsubstantiated and risks undermining the evidence-based, large-scale roll-out of VMMC for HIV prevention currently underway. The present article highlights the quality, consistency and robustness of the scientific evidence that underpins the public health recommendations, guidance, and tools on VMMC. Millions of HIV infections will be averted in the coming decades as VMMC services scale-up to meet demand, providing direct benefits for heterosexual men and indirect benefits for their female partners.

Authors+Show Affiliations

Department of African-American Studies, Northeastern University, Boston, Massachusetts, United States of America. r.wamai@neu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23156651

Citation

Wamai, Richard G., et al. "Criticisms of African Trials Fail to Withstand Scrutiny: Male Circumcision Does Prevent HIV Infection." Journal of Law and Medicine, vol. 20, no. 1, 2012, pp. 93-123.
Wamai RG, Morris BJ, Waskett JH, et al. Criticisms of African trials fail to withstand scrutiny: male circumcision does prevent HIV infection. J Law Med. 2012;20(1):93-123.
Wamai, R. G., Morris, B. J., Waskett, J. H., Green, E. C., Banerjee, J., Bailey, R. C., Klausner, J. D., Sokal, D. C., & Hankins, C. A. (2012). Criticisms of African trials fail to withstand scrutiny: male circumcision does prevent HIV infection. Journal of Law and Medicine, 20(1), 93-123.
Wamai RG, et al. Criticisms of African Trials Fail to Withstand Scrutiny: Male Circumcision Does Prevent HIV Infection. J Law Med. 2012;20(1):93-123. PubMed PMID: 23156651.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Criticisms of African trials fail to withstand scrutiny: male circumcision does prevent HIV infection. AU - Wamai,Richard G, AU - Morris,Brian J, AU - Waskett,Jake H, AU - Green,Edward C, AU - Banerjee,Joya, AU - Bailey,Robert C, AU - Klausner,Jeffrey D, AU - Sokal,David C, AU - Hankins,Catherine A, PY - 2012/11/20/entrez PY - 2012/11/20/pubmed PY - 2013/1/10/medline SP - 93 EP - 123 JF - Journal of law and medicine JO - J Law Med VL - 20 IS - 1 N2 - A recent article in the JLM (Boyle GJ and Hill G, "Sub-Saharan African Randomised Clinical Trials into Male Circumcision and HIV Transmission: Methodological, Ethical and Legal Concerns" (2011) 19 JLM 316) criticises the large randomised controlled trials (RCTs) that scientists, clinicians and policy-makers worldwide have concluded provide compelling evidence in support of voluntary medical male circumcision (VMMC) as an effective HIV prevention strategy. The present article addresses the claims advanced by Boyle and Hill, demonstrating their reliance on outmoded evidence, outlier studies, and flawed statistical analyses. In the current authors' view, their claims portray misunderstandings of the design, execution and interpretation of findings from RCTs in general and of the epidemiology of HIV transmission in sub-Saharan Africa in particular. At the same time they ignore systematic reviews and meta-analyses using all available data arising from good-quality research studies, including RCTs. Denial of the evidence supporting lack of male circumcision as a major determinant of HIV epidemic patterns in sub-Saharan Africa is unsubstantiated and risks undermining the evidence-based, large-scale roll-out of VMMC for HIV prevention currently underway. The present article highlights the quality, consistency and robustness of the scientific evidence that underpins the public health recommendations, guidance, and tools on VMMC. Millions of HIV infections will be averted in the coming decades as VMMC services scale-up to meet demand, providing direct benefits for heterosexual men and indirect benefits for their female partners. SN - 1320-159X UR - https://www.unboundmedicine.com/medline/citation/23156651/Criticisms_of_African_trials_fail_to_withstand_scrutiny:_male_circumcision_does_prevent_HIV_infection_ L2 - http://www.diseaseinfosearch.org/result/9735 DB - PRIME DP - Unbound Medicine ER -