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    • "A textbook on meta-analyses [18] and a review of methods and techniques in meta-analyses [19] use this meta-analysis as an illustrative example of how Simpson's paradox can lead to incorrect results. Subsequent, correctly performed, metaanalyses found male circumcision to have a strong protective effect against HIV infection [20] [21]. "
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    ABSTRACT: We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for "sampling bias," (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention.
    05/2014; 2014:684706. DOI:10.1155/2014/684706
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    • "They also point out that campaigners encourage the mutilation of the male body without sufficient reliable scientific evidence (Boyle et al. 2002; Goldman 1997). Most recent controversies centre on two main issues: public health implications of scaling-up adult male circumcision due to the 'conclusive evidence that male circumcision offers significant protection for men from HIV infection' (Weiss et al. 2008) and the relevance of enforcing routine neonatal and child circumcision (Xu et al. 2009, 79) as a 'longer-term HIV prevention strategy' (UNAIDS 2010, 5–6). Despite the American Academy of Paediatrics having newly released guidelines on the health benefits of infant circumcision, 'especially with regard to a decrease in risk of acquiring a sexually transmitted infection' (The Lancet 2012), the procedure has not been universally recommended . "
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    ABSTRACT: In-depth repeat interviews with 14 male Japanese urologists and plastic surgeons are analysed to shed light on male circumcision: a procedure largely conducted at beauty clinics to deal with gender and sexual matters. The urologists strongly oppose male circumcision because it is a surgery promoted by plastic surgeons without any prophylactic benefit and which works only as a placebo. This suggests a critical public health matter within current international debates on adult and paediatric male circumcision. Urologists encourage the practice of the ‘informed parent’ to challenge male circumcision and promote penile hygiene. Plastic surgeons, in comparison, argue that male circumcision can be effectively used to deal with issues concerning male’s self-confidence, erectile dysfunction and premature ejaculation. Despite urologist and plastic surgeons exhibiting clear divergent positions, their viewpoint converge on the sexual script that sexuality arises from the genitals and the master narrative that the penis is central in the construction of masculinity.
    Critical Public Health 12/2013; 23(4). DOI:10.1080/09581596.2012.753409 · 0.88 Impact Factor
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    • "The variability in may reflect both biological (HIV transmission probability per coital act; p) and behavioral (frequency of unprotected coital acts in the partnership; n) cofactors that vary across SSA. Male circumcision is one evident biological cofactor as it affects p and varies in coverage across the African continent (Auvert et al., 2005; Bailey et al., 2007; Gray et al., 2007; Weiss et al., 2008). Our descriptive analysis of the DHS suggests that male circumcision coverage varies between 8.2% in Swaziland and universal coverage in other countries such as Congo-Brazzaville, Niger, Guinea, and Liberia (Chemaitelly et al., 2013). "
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    ABSTRACT: Background Representative and precise estimates for the annual risk of HIV transmission (ϕ) from the infected to the uninfected partner in a stable HIV-1 sero-discordant couple (SDC) are not available. Nevertheless, quantifying HIV infectiousness is critical to understanding HIV epidemiology and implementing prevention programs. Materials and methods We estimated ϕ and examined its variation across 23 countries in sub-Saharan Africa (SSA) by constructing and analyzing a mathematical model that describes HIV dynamics among SDCs. The model was parameterized using empirical measures such as those of the nationally representative Demographic and Health Surveys. Uncertainty and sensitivity analyses were conducted to assess the robustness of the findings. Results We estimated a median ϕ of 11.1 per 100 person-years across SSA. A clustering based on HIV population prevalence was observed with a median ϕ of 7.5 per 100 person-years in low HIV prevalence countries (<5%) compared to 19.5 per 100 person-years in high prevalence countries (>5%). The association with HIV prevalence explained 67% of the variation in ϕ, and suggested an increase of 0.95 per 100 person-years in ϕ for every 1% increase in HIV prevalence. Conclusions Empirical measures from cohort studies appear to underestimate HIV infectiousness in SSA. The risk of HIV transmission among SDCs appears also to vary across SSA, and this may have contributed to the contrasting HIV epidemic trajectories in this continent.
    Epidemics 11/2013; 6. DOI:10.1016/j.epidem.2013.11.001 · 2.38 Impact Factor
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