Circumcision is always one of the topics with the most spirited discussions on science blogs. Here, a brand new paper on PLoS-ONE will likely stir up the conversation yet again (hopefully on the annotations and discussions attached to the paper itself, so please go there if you have questions/comments on the study):
Size Matters: The Number of Prostitutes and the Global HIV/AIDS Pandemic by John R. Talbott
HIV/AIDS prevalence rates across countries of the world vary more than 500-fold from .06% in Hungary to 33.4% in Swaziland. One of the most cited research papers in the field, utilizing cross country regression analysis to analyze other correlates with this HIV prevalence data, is flawed in that it weights each country's results by the country's population.Based on cross-country linear and multiple regressions using newly gathered data from UNAIDS, the number of female commercial sex workers as a percentage of the female adult population is robustly positively correlated with countrywide HIV/AIDS prevalence levels. Confirming earlier studies, female illiteracy levels, gender illiteracy differences and income inequality within countries are also significantly positively correlated with HIV/AIDS levels. Muslims as a percentage of the population, itself highly correlated with country circumcision rates and previously found to be negatively correlated with HIV/AIDS prevalence, is insignificant when the percentage of commercial sex workers in a population is included in the analysis.
Conclusions/SignificanceThis paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries. An explanation is offered for why Africa has been hit the hardest by the AIDS pandemic and why there appears to be very little correlation between HIV/AIDS infection rates and country wealth.
Comments
Coturnix, what might explain the lack of spirited discussion you were expecting, going on 7 hours now?
My theory is this: You announced the existence of, and quoted from, the study. But you didn't comment on it, summarize it, analyze it, or tell us what you think about it.
What's interesting here is that it's still further reason to distrust the weak African trials, which make no compelling case for circumcising Africans, and even less for circumcising anyone else.
If you want to stir up a conversation, just say what you think about infant male genital mutilation. Medicine is sometimes boring, but ethics never are.
Posted by: colpen | June 21, 2007 2:22 AM
I guess I did not really want a discussion to transpire here - too busy to moderate comments right now. But I wanted to alert others to this study and watch what happens from the sidelines. I am sure it will be cited in the next circumcision war (and yes, I am personally against male circumcision, for emotional, more than scientific reasons).
Posted by: coturnix | June 21, 2007 2:26 AM
Thanks for alerting readers to it. This probably won't get as much news coverage as the dramatic hype surrounding the African trials.
Posted by: colpen | June 21, 2007 3:09 AM
BTW, to to the paper itself and see the heated exchange between Talbott and Halperin!
Posted by: coturnix | June 21, 2007 3:20 AM
Yes, thanks for the tips.
The rumor is that stopping the earlier studies prematurely may have screwed with the long time statistics, where men may recover earlier habits while the protection gained isn't sufficient.
And now for the paper. :-)
Some of us will fight with sheathed swords though. No fair.
Posted by: Torbjörn Larsson, OM | June 21, 2007 6:36 AM
What proportion of the prostitutes had been subjected to female circumcision ?
Posted by: MartinC | June 21, 2007 7:34 AM