Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia
Article first published online: 4 OCT 2011
© 2011 The Authors. ANZJPH © 2011 Public Health Association of Australia
Australian and New Zealand Journal of Public Health
Volume 35, Issue 5, pages 459–465, October 2011
How to Cite
Darby, R. and Van Howe, R. (2011), Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. Australian and New Zealand Journal of Public Health, 35: 459–465. doi: 10.1111/j.1753-6405.2011.00761.x
- Issue published online: 4 OCT 2011
- Article first published online: 4 OCT 2011
- Submitted: February 2011 Revision requested: April 2011 Accepted: June 2011
- sub-Saharan Africa;
- random clinical trials;
- medical ethics;
- human rights
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.