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Citation Information

Type Journal Article - Global Public Health
Title Male circumcision to prevent syphilis in 1855 and HIV in 1986 is supported by the accumulated scientific evidence to 2015: Response to Darby
Author(s)
Publication (Day/Month/Year) 2015
Page numbers 1-19
URL http://europepmc.org/abstract/med/26564989
Abstract
An article by Darby disparaging male circumcision (MC) for syphilis
prevention in Victorian times (1837–1901) and voluntary medical
MC programs for HIV prevention in recent times ignores
contemporary scientific evidence. It is one-sided and cites outlier
studies as well as claims by MC opponents that support the
author’s thesis, but ignores high quality randomised controlled
trials and meta-analyses. While we agree with Darby that risky
behaviours contribute to syphilis and HIV epidemics, there is now
compelling evidence that MC helps reduce both syphilis and HIV
infections. Although some motivations for MC in Victorian times
were misguided, others, such as protection against syphilis, penile
cancer, phimosis, balanitis and poor hygiene have stood the test
of time. In the absence of a cure or effective prophylactic vaccine
for HIV, MC should help lower heterosexually acquired HIV,
especially when coupled with other interventions such as
condoms and behaviour. This should save lives, as well as
reducing costs and suffering. In contrast to Darby, our evaluation
of the evidence leads us to conclude that MC would likely have
helped reduce syphilis in Victorian times and, in the current era,
will help lower both syphilis and HIV, so improving global public
health.

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