Association of the ANRS-12126 Male Circumcision Project with HIV Levels among Men in a South African Township: Evaluation of Effectiveness using Cross-sectional Surveys

Auvert, Bertran; Taljaard, Dirk; Rech, Dino; Lissouba, Pascale; Singh, Beverley; Bouscaillou, Julie; Peytavin, Gilles; Mahiane, Séverin Guy; Sitta, Rémi; Puren, Adrian; Lewis, David A.

doi:10.1371/journal.pmed.1001509

Cited by 81 publications

(94 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In particular, Boyle and Hill failed to point out that the significant absolute adjusted risk reduction of 1.3% (actually 1.8%) was for the 2-year point of the RCTs. Follow-up studies have shown continuation, even enhancement, of the protective effect of MC against HIV with time (Auvert et al, 2013;Gray et al, 2012;Mehta et al, 2013). One might, therefore, expect a 1.3% (or rather 1.8%) reduction after 2 years to increase to 13% (or rather 18%) by 20 years.…”

Section: Discussionmentioning

confidence: 98%

Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe

Morris

Barboza

Wamai

et al. 2016

Global Public Health

View full text Add to dashboard Cite

A meta-analysis by Van Howe of 109 populations confirms the well-known association of male circumcision (MC) with reduced HIV prevalence. He then performed meta-regression adjusting for location, risk and MC prevalence. When one or two of these adjustments in combination were applied MC appeared protective, but when all three were introduced the association remained significant in high-risk populations, but not in general populations within Africa with a hypothetical MC prevalence of <25% or elsewhere with hypothetical MC prevalence of <75%. However, many MC prevalence values given differed from those reported in references cited (including all US studies). This and other problems invalidate his adjustments for MC prevalence, undermining most of his meta-regression results. Meta-regression is a highly sophisticated statistical tool and is prone to error if not applied correctly. The study contained a high risk of bias arising from confounding. We also question his use of crude, rather than adjusted, odds ratios and his inclusion of unpublished data, so precluding replication by others. Flawed statistics, opaque presentation of results and inclusion of previously repudiated arguments downplaying a role for MC in HIV prevention programmes should lead readers to be sceptical of the findings and conclusions of Van Howe's study.

show abstract

Section: Discussionmentioning

confidence: 98%

Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe

Morris

Barboza

Wamai

et al. 2016

Global Public Health

View full text Add to dashboard Cite

show abstract

“…In particular, Boyle and Hill failed to point out that the significant absolute adjusted risk reduction of 1.3% (actually 1.8%) was for the 2-year point of the RCTs. Follow-up studies have shown continuation, even enhancement, of the protective effect of MC against HIV infection with time [119] [120] [121]. One might therefore expect a 1.3% (or 1.8%) reduction after 2 years to increase to 13% (or 18%) by 20 years.…”

Section: What Makes An Expert?mentioning

confidence: 99%

Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection

Morris¹,

Barboza²,

Wamai³

et al. 2017

WJA

View full text Add to dashboard Cite

Aim: To critically evaluate data and arguments by Van Howe defending his stance opposing male circumcision (MC), in particular his meta-regression analyses evaluating the ability of MC to reduce HIV infection risk in heterosexual populations within and outside Africa. Methods: We performed metaregression analysis of log odds of HIV infection between uncircumcised and circumcised men using a single covariate (MC prevalence) in the meta-regression model involving the metareg package in STATA 13 for 103 populations worldwide and for populations within Africa. The meta-regression of log odds and MC prevalence was fitted to a line, as were empirical Bayes estimates resulting from post-estimation. Results: Our critical evaluation of Van Howe's arguments attempting to undermine the scientific evidence in support of the benefits of MC in protection of men against HIV during heterosexual intercourse, as well as other infections and conditions, together with his use of statistics to support his beliefs, revealed serious flaws, obfuscation and missing data. We therefore performed our own meta-regression analysis using a trivariate model. Doing so revealed that for MC prevalences of 50%, 75% and 100% for general populations within Africa, odds ratios for HIV risk in uncircumcised vs. circumcised men were 1.35, 1.58 and 1.85, respectively. Our meta-regression analysis of data for all countries yielded similar findings. For a general population outside Africa with 100% MC prevalence, OR was 1.5. Van Howe failed to acknowledge that since MC prevalence in US whites (91%) and blacks (76%) exceeds 75% his results support MC having a protective effect in those population groups. Conclusions: The protective effect of MC against How to cite this paper: Morris, B

show abstract

“…Biological studies have shown that the delicate tissue of the foreskin is vulnerable to microscopic lesions, which increases the risk of contracting HIV (Silverman, 2004). The foreskin also houses specialised Langerhans cells, which HIV and other pathogens can readily attach to (Halperin & Bailey, 1999;El-Hout & Khauli, 2007;Bhattacharjee, 2008;Auvert et al, 2013). Studies have shown that, by removing the foreskin, a man's risk of contracting HIV through peno-vaginal penetrative sexual intercourse may be reduced by approximately 60% (Bailey, Plummer & Moses, 2001;Siegfried et al, 2003;Auvert et al, 2005;Williams et al, 2006;Bonner, 2007;El-Hout & Khauli, 2007;Schoen, 2007).…”

Section: Vmamc For Hiv Preventionmentioning

confidence: 99%

Voluntary medical adult male circumcision for HIV prevention in South Africa: The tensions between medicalised modernity and traditional practices

Howard-Payne

2016

PINS

View full text Add to dashboard Cite

show abstract

Association of the ANRS-12126 Male Circumcision Project with HIV Levels among Men in a South African Township: Evaluation of Effectiveness using Cross-sectional Surveys

Cited by 81 publications

References 28 publications

Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe

Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe

Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection

Voluntary medical adult male circumcision for HIV prevention in South Africa: The tensions between medicalised modernity and traditional practices

Contact Info

Product

Resources

About