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Auvert RCT does not justify neonatal circumcision

Posted by plosmedicine on 30 Mar 2009 at 23:47 GMT

Author: George Hill
Position: Executive Secretary
Institution: Doctors Opposing Circumcision
Submitted Date: October 28, 2005
Published Date: October 28, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Friday, October 28, 2005

The Editor
PLoS Medicine

Dear Editor:

Auvert et al.[1] confirm previous findings[2] that excision of the erogenous prepuce[3]
produces changes in sexual behavior as men compensate for the loss of sexual
satisfaction[4] with more and varied sexual activity.

Female-to-male sexual transmission is only one of several possible disease vectors.
Circumcision apparently would not prevent male-to-female transmission nor would it
prevent transmission by unsafe health care,[5] so the overall value in fighting the
pandemic may be limited.

Whatever the value of circumcision may be in delaying infection in adult males, this
study cannot be used to justify non-therapeutic neonatal circumcision, which still occurs
in several developed nations. Bioethicists now see non-therapeutic circumcision of
children as an unethical operation.[6,7] Moreover, circumcised newborn boys now face a
new heightened risk from epidemic levels of community methicillin-sensitive
Staphylococcus aureus,[8] which provides a good reason to avoid elective surgery,
including neonatal circumcision.

Vaccine to prevent and cure HIV infection is likely to be available by the time today's
newborns become sexually active. Gori et al. reported progress in developing a
therapeutic vaccine to maintain CD4 counts in HIV+ patients.[9] More recently, Merck
and Company reported important progress in developing an immunity vaccine that could
be available to the public within seven years,[10] so circumcision as a prophylactic
measure against HIV is likely soon to be outmoded by HIV vaccine.

George Hill
Executive Secretary
Doctors Opposing Circumcision
Suite 42
2442 NW Market Street
Seattle, Washington 98107-4137


1. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005)
Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV
Infection Risk: The ANRS 1265 Trial. PLoS Med 2(11): e2

2. Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA
1997;277(13):1052-7. Abstract available at: http://jama.ama-

3. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44. Available at:

4. Denniston GC, Hill G. Circumcision in adults: effect on sexual function. Urology

5.Gisselquist D, Potterat JJ, Brody S. Let it be sexual: how health care transmission of
HIV was ignored. Int J STD AIDS 2003;14:148-61.

6. Hellston SK. Rationalising circumcision: from tradition to fashion, from public health
to individual freedom??critical notes on cultural persistence of the practice of genital
mutilation. J Med Ethics 2004;30:248-53.Available at:

7. Fox M, Thomson M. A covenant with the status quo? Male circumcision and the new
BMA guidance to doctors. J Med Ethics 2005;31(8):463-9. Available at:

8. Doctors Opposing Circumcision. Epidemic Methicillin-Resistant Staphylococcus
Aureus: Dramatically Increased Risk for Circumcised Newborn Boys. Special Statement
October 23, 2005. Available at:

9. Gori A, Trabattoni D, Rizzardini G, et al. Immune modulation in HAART-naive,
asymptomatic HIV-infected individuals undergoing therapeutic vaccination with HIV-1
whole killed vaccine. Presented at the 3rd IAS Conference on HIV Pathogenesis and
Treatment, Rio de Janeiro, 24-27 July 2005.

10. Warren King. HIV vaccine results are promising. Seattle Times, Saturday, October
22, 2005. Available at:

No competing interests declared.