Unique Identifier
21973253 
Authors
Darby R, Van Howe R.
Institution
Australian Capital Territory.
Title
Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia.
Source  
Aust N Z J Public Health. 2011 Oct;35(5):459-65. doi 10.1111/j.1753-6405.2011.00761.x
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 theytake 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.
© 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia.
Publication Type
Journal Article.  Review.