Debating male circumcision for HIV prevention: a one-sided argument does not represent a legitimate 'controversy' analysis--reply to de Camargo et al

How Much Do They Know? An Analysis of the Accuracy of HIV Knowledge among Youth Affected by HIV in South Africa

HIV/AIDS prevalence rates in South Africa are among the highest in the world. The key to reducing transmission is the dissemination of accurate knowledge. Here, we investigate the accuracy of HIV/AIDS knowledge among youth affected by the disease. Data from the Fourth South African National HIV, Behaviour and Health Survey (2012) are used and a weighted sample of 4 095 447 youth (15-24 years old) who have known or cared for someone with HIV/AIDS are analyzed. Results show that more than one-third (40.37%) of youth in South Africa are affected by the disease. One-quarter of the affected youth have 75% accurate knowledge of the virus, while only 10% have 100% accurate knowledge. Rural place of residence (odds ratio [OR] = 0.61) and looking for work (OR = 0.39) are less likely to have accurate knowledge. Youth without disabilities (OR = 2.46), in cohabiting (OR = 1.69), and in dating (OR = 1.70) relationships are more likely to have accurate knowledge. In conclusion, in order to reduce HIV incidence and combat HIV myths, efforts to improve the accuracy of HIV knowledge among youth affected by the disease are needed. There should be more community-based campaigns to target unemployed youth in the country.

Critical evaluation of arguments opposing male circumcision: A systematic review

OBJECTIVE

To systematically evaluate evidence against male circumcision (MC).

METHODS

We searched PubMed, Google Scholar, EMBASE and Cochrane databases.

RESULTS

Database searches retrieved 297 publications for inclusion. Bibliographies of these yielded 101 more. After evaluation we found: Claims that MC carries high risk were contradicted by low frequency of adverse events that were virtually all minor and easily treated with complete resolution. Claims that MC causes psychological harm were contradicted by studies finding no such harm. Claims that MC impairs sexual function and pleasure were contradicted by high-quality studies finding no adverse effect. Claims disputing the medical benefits of MC were contradicted by a large body of high-quality evidence indicating protection against a wide range of infections, dermatological conditions, and genital cancers in males and the female sexual partners of men. Risk-benefit analyses reported that benefits exceed risks by 100-200 to 1. To maximize benefits and minimize risks, the evidence supported early infant MC rather than arguments that the procedure should be delayed until males are old enough to decide for themselves. Claims that MC of minors is unethical were contradicted by balanced evaluations of ethical issues supporting the rights of children to be provided with low-risk, high-benefit interventions such as MC for better health. Expert evaluations of case-law supported the legality of MC of minors. Other data demonstrated that early infant MC is cost-saving to health systems.

CONCLUSIONS

Arguments opposing MC are supported mostly by low-quality evidence and opinion, and are contradicted by strong scientific evidence.

CDC's Male Circumcision Recommendations Represent a Key Public Health Measure

Frisch and Earp, opponents of male circumcision, have criticized draft recommendations from the CDC that advocate counseling men and parents of newborn boys in the United States about the benefits and risks of male circumcision. We provide a rebuttal to Frisch and Earp's criticisms and contend that the recommendations are entirely appropriate and merit consideration for policy development.