AIDSMAP: Contrary evidence for treatment-as-prevention “demands giant pause,” contrary evidence for male circumcision not so much

With so much room for things to go wrong, the rush to roll out male circumcision has perplexed most dispassionate observers. Yet similar doubts regarding treatment-as-prevention has gained detractors calling for a “a giant pause” in light of a few studies showing real world conditions at odds with clinical trial results.

The Journal of AIDS has published a paper casting doubt on the use of treatment as prevention. The accompanying editorial is one that never appeared in the context of male circumcision and a similar disparity in real world conditions amid the results of the African RCTs.

In an accompanying editorial, Dr Myron Cohen says that the results “demand a giant pause” and show that the ability of HIV treatment to reduce the risk of transmission outside the setting of clinical studies is uncertain.


Quote above, from the AIDSMAP article
image / flickr / genvessel / constant gardener

The distinction between the real world and clinical studies is key. It is also key to the conundrum of the three RCTs in support of male circumcision and the reality we have seen with higher rates of HIV among circumcised men in places like Swaziland and Losotho.


Wany L et al. HIV transmission among serodiscordant couples: a retrospective study of former plasma donors in Henan, China. J Acquir Immune Defic Syndr, 55: 232-38, 2010.

Cohen MS HIV treatment as prevention: to be or not to be? J Acquir Immune Defic Syndr, 55, 137-8, 2010.

Link: Does ‘real world’ study cast doubt on use of HIV treatment as prevention? – Aidsmap

About David Wilton

fronterizo, public defender, intactivist, gay
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2 Responses to AIDSMAP: Contrary evidence for treatment-as-prevention “demands giant pause,” contrary evidence for male circumcision not so much

  1. Joseph Lewis says:

    That sounds like an optimistic future for circumcision advocates riding the HIV gravy train.
    TOO optimstic.
    It assumes that men will both buy into circumcision AND into wearing condoms.
    It is a complete blunder to be promoting a dubious alternative to condoms which would far supplant circumcision, even if studies were 100% accurate. African men are already on record saying the sole purpose they are getting circumcised is to diss condoms.
    In at least one news article, a traditional healer continues to encourage circumcision despite the fact that a lot of his “patients” are coming in seeking treatment for STIs, because the men are using their circumcisions as excuses to forgo condom use.
    The latest Swaziland demographic health survey indicates that HIV+ circumcised men far outnumber HIV+ intact men 22% vs 20%.
    Swaziland – DHS 2006-2007 – 22 vs 20
    Page 256 in the PDF
    Other countries where circumcision has failed to prevent AIDS:
    Cameroon – DHS 2004 – 4.1 vs 1.1 (91% circumcised)
    Page 17 in the PDF
    Ghana – DHS 2003 – 1.6 vs 1.4 (95.3% circumcised)
    page 13 in the PDF
    Lesotho – DHS 2004 – 22.8 vs 15.2
    page 13 in the PDF
    Malawi – DHS 2004 – 13.2 vs 9.5 (20% circumcised)
    page 10 in the PDF
    Rwanda – DHS 2005 – 3.8 vs 2.1
    page 10 in the PDF
    This last June, Malaysian AIDS Council vice-president Datuk Zaman Khan reported that 72% of HIV/AIDS cases were Muslim (where all boys and men are circumcised).
    This can only end in disaster.
    The storm cloud is going to burst sooner or later.
    The question that needs to be asked is, when it does, will organizations like the WHO, UNAids and UNICEF own their mistake?
    Will Bill Gates let his charity organization own the fact that he contributed to the promotion of needless mutilation, the violation of the basic human rights of minors, and in exacerbating the HIV/AIDS problem in Africa?
    Or will this be the black sheep nobody wants to talk about?

  2. Most of us who aren’t avid pro-circ advocates knew all too well that the results in the RTC’s wouldn’t translate to the real-world. You need look no further than the differences in rates between Europe and the U.S., or the difference in rates between circumcised and intact men in South Africa (where there is a higher rate of HIV among circumcised men in 6 out of 11 countries).
    My current concern is that they plan not only to circumcise most of South Africa, but to test them for HIV and give them condoms at the same time.
    HIV testing and condom distribution is a great thing, and will (without doubt) reduce HIV rates substantially. BUT, I fear they will claim the reduction is due to circumcision… and I’m fairly certain they will.
    If they use such a deceitful method to convince the public, they will then have what many will see as real-world evidence to back up the RTC’s, and I worry that very few will question it.

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