title: Male circumcision to prevent syphilis in 1855 and HIV in 1986 is supported by the accumulated scientific evidence to 2015: Response to Darby.
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.
authors.affiliation: a School of Medical Sciences and Bosch Institute, University of Sydney , Sydney , NSW , Australia.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Morris
authors.affiliation: b Department of African-American Studies , Northeastern University , Boston , MA , USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wamai
authors.affiliation: c Section of Urology, University of Washington School of Medicine and VA Puget Sound Health Care System , Seattle , WA , USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Krieger
authors.affiliation: d Jhpiego, an affiliate of Johns Hopkins University , Washington , DC , USA.
authors.forename: Joya
authors.initials: J
authors.lastname: Banerjee
authors.affiliation: e Division of Infectious Diseases, Department of Medicine , David Geffen School of Medicine, University of California Los Angeles , CA , USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
mesh_terms: D017954:Africa South of the Sahara; D002944:Circumcision, Male / Q000266:history*; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D049672:History, 19th Century; D049673:History, 20th Century; D006801:Humans; D008297:Male; D012106:Research; D012725:Sexual Behavior; D013587:Syphilis / Q000517:prevention & control*
keywords: HIV; Male circumcision; Victorian era; sub-Saharan Africa; syphilis