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Two studies in Africa link male circumcision to lower risk of HIV

Rating

4 Star

Two studies in Africa link male circumcision to lower risk of HIV

Our Review Summary

The story describes the design of the two similar studies of male circumcision and reduced HIV in African men who engage in heterosexual intercourse. The story provides both absolute and relative data; however, we are not told if there was a placebo group (sham operation) and/or blinding of evaluators.  The story does not mention that the results of these studies have not yet been reviewed in a peer-reviewed journal, and material in this story is from press conferences and government press releases.

The story mentions male circumcision as a method of reducing the transmission of HIV, but it appropriately notes safer sex practices such as condom use for greater protection against HIV.  The story provides absolute numbers, but what is not mentioned is that the absolute number of avoided infections will be low in lower prevalence populations, so the risks of complications may outweigh the potential benefits for an individual at low risk. 

The story notes that this is a routine surgical procedure with few compilations and mentions potential harms of male circumcision such as mild infections, but there is no peer-reviewed data listed on rates of complications from this or other clinical trials.  What is stressed in the press release, but not the article, is that this procedure should only be performed by a medical professional who can also provide appropriate post-operative care during the healing period. Availability of safe circumcision and safe postoperative care is far from certain around the world. The story does not mention the cost of adult male circumcision outside of a clinical trial, and it is not clear whether insurance companies cover this procedure for adult males in the U.S. when no acute problem exists.

The story quotes an NIH official for perspective on the results of these studies.  But since the NIH sponsored the study, he does have an interest in its outcome.  There are experts who would disagree with public health-related mass circumcision programs, for reasons both cultural and related to quality of life.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not mention the cost of adult male circumcision outside of a clinical trail.  It is also not clear whether this is a reimbursible procedure for adult males in the USA when no acute problem exists.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story appropriately describes the design of the two similar studies and provides both absolute and relative evidence that male circumcision reduces a man's risk of acquiring HIV via heterosexual sex. The story also mentions that the trials were stopped early because the benefit of male circumcision so significantly reduced the risk of acquiring HIV that it would be unethical to continue a trial in which uncircumcised men were not offered this protection.  What is not mentioned is that the absolute number of avoided infections will be low in lower prevalence populations, so the risks of complications may outweigh the potential benefits for an individual of low risk.   

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story mentions potential harms of male circumcision such as mild infections.  These are treatable and rare, especially when the procedure is performed by a trained medical professional. However, it is difficult to assess the negative consequences of surgery as no publication of adverse events is reviewable.  It is also possible that side effects or negative consequences in the real-world (rather than a clinical trial) would be more common.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story doesn't explain whether there was a placebo arm of the study.  Was there a sham operation?  If so, were patients and evaluators blinded regarding treatment?  This is a key indicator of study quality that is not commented upon.  (One could posit that there is a reduced frequency of sexual encounters after this surgery, and this is the critical predictor of reduced acquisition of HIV, not the surgery itself.)

Does the story commit disease-mongering?

Satisfactory

 The story does not engage in disease mongering. 

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes an NIH official for perspective on the results of these studies.  But since the NIH sponsored the study, he does have an interest in its outcome.  It also quoted representatives of the World Health Organization and the Global AIDS Alliance.  There are experts who would disagree with public health-related mass circumcision programs, for reasons both cultural and related to quality of life.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions male circumcision as one method of reducing the transmission of HIV.  But the story also mentions safer sex practices such as using condoms for better protection against HIV.  

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story reports on two large studies of male circumcision and reduced HIV in African heterosexual men.  We are not told if these studies have been reviewed in a peer-reviewed journal or where they will be published.

The results of these studies may be applicable regardless of geography: While more male infants are routinely circumcised in the U.S. than in Africa,  this surgery is available for uncircumcised adult men in the U.S. who wish to reduce their risk of HIV transmission from heterosexual sex.  Other protection against the HIV is still necessary. The story does note that this is a routine surgical procedure with few compilcations. What is stressed in the press release, but not the article, is that this procedure should only be performed by a medical professional who can also provide appropriate post-operative care during the healing period. Availability of safe circumcision and safe postoperative care is far from certain around the world.

Does the story establish the true novelty of the approach?

Satisfactory

It is clear from the story that the link between male circumcision and HIV prevention was noted as long ago as the late 1980s. 

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story used several independent experts for comment, so it appears unlikely that it relied solely or largely on a news release. 

Total Score: 8 of 10 Satisfactory

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