Author Affiliations: Institute for Global Health, Vanderbilt Epidemiology Center, and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
In the late 1980s, an ecological association between high rates of male circumcision and low human immunodeficiency virus (HIV) prevalence in Africa was noted from epidemiologic, geographic, and ethnographic data.1 A meta-analysis of epidemiological studies published prior to 2000 suggested a statistically significant protective association between circumcision and HIV infection among African heterosexual men.2 A causal relationship between HIV risk reduction and male circumcision seemed likely; there was biological plausibility and consistency between studies. The studies, however, did not confirm that circumcision predated HIV risk reduction or that confounding factors might not explain the association.
Vermund SH, Qian H. Circumcision and HIV Prevention Among Men Who Have Sex With Men: No Final Word. JAMA. 2008;300(14):1698–1700. doi:10.1001/jama.300.14.1698
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