title: Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Australian Capital Territory.
authors.forename: Robert
authors.initials: R
authors.lastname: Darby
authors.forename: Robert
authors.initials: R
authors.lastname: Van Howe
mesh_terms: D001315:Australia; D002944:Circumcision, Male; D019317:Evidence-Based Medicine; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D020010:Heterosexuality; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000635:transmission