CUTTING RISK: Is investing in an imperfect prevention method a wise attack on HIV/AIDS in Africa?
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For the Xhosa in South Africa, a boy's coming of age is often marked by an elaborate and lengthy set of rituals. One of the ordeals is circumcision, which is traditionally performed by a healer and occasionally leads to an ineffective cut, infection or even death. The young men who emerge from the ceremony healthy, however, achieve not only new social status but are also much less likely to become infected with HIV.
Adult male circumcision, in which the foreskin of the penis is surgically removed, has emerged as one of the more powerful reducers of infection risk. Some studies are finding that it decreases the odds that a heterosexual man will contract HIV by 57 percent or more. With HIV vaccine research still limping along, condoms being underused and the large-scale vaginal gel trial Vaginal and Oral Interventions to Control the Epidemic (VOICE) just called off early last week after disappointing results, the operation has been gaining ground.
For the past three years 13 countries in southern and eastern Africa at the heart of the HIV/AIDS epidemic have been on a mission to circumcise 80 percent of their men by 2015 in an effort to cut in half the rate of sexual transmission of the disease from 2011 levels. And a new series of nine papers, published online Tuesday in PLoS Medicine, assesses whether the ambitious goals could work—and whether they are worth it.
The analyses "give a pretty optimistic assessment," says Atheendar Venkataramani, a resident physician and researcher at Massachusetts General Hospital, who was not involved in the new papers. But from his own research in the field, he says, he is inclined to share the optimism.
Cutting costs
Because HIV and AIDS are still incurable, infection means a lifetime of antiretroviral therapy. So with more people getting infected every day, the cost of treatment for the ever growing global HIV population is increasing. A surgical procedure, such as a circumcision, is not cheap either, but when compared with indefinite treatment, the one-time cut is poised to be a cost saver.
The estimated price tag for all of the 13 countries (Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe) to reach the 80 percent male circumcision rate by 2015 would be somewhere on the order of $1.5 billion, the authors of one of the papers suggest. To keep that saturation constant for another 10 years would cost a further $500 million. These 20.3 million circumcisions, however, could prevent some 3.4 million new HIV infections in both men and women, according to the new findings. From 2016 to 2025, after accounting for the initial expenditures, the programs would save some $16.5 billion.
Previous research had concluded that male circumcision programs would be cost-effective, but this is some of the first large-scale work to incorporate information specific to country—and in some cases, region—to assess costs and savings. The recent data can go straight to the countries' respective ministers of health and, perhaps even more important, to the countries' ministers of finance, points out Emmanuel Njeuhmeli of the U.S. Agency for International Development, who is a co-author of several of the papers. "Understanding the science is not enough—they need to have the resources," he says of the countries' health ministries. And that can be a lot to ask of a sub-Saharan African country such as Lesotho, which has a GDP of $2.1 billion and where much of the population lacks even basic medical care.
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27 Comments
Add CommentMany professionals have criticized the studies claiming that circumcision reduces HIV transmission. See http://www.davidwilton.com/files/ajpmgreenetal2010-pub1.pdf. They have various flaws. Presumed authorities that cite the studies have other agendas. Journalists have an obligation to present different views on controversial issues. Circumcision causes physical, sexual, and psychological harm. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Please see http://www.circumcision.org/hiv.htm for more information.
Reply | Report Abuse | Link to thisThe author of this article should go read the comments section of this article http://www.scientificamerican.com/article.cfm?id=circumcision-and-aids, where it is rightly pointed out the evidence is far from conclusive that circumcision has emerged as "the more powerful reducers of infection risk." Or at least, say, this article http://en.wikipedia.org/wiki/Circumcision_and_HIV.
Reply | Report Abuse | Link to thisThe CDC's own document on circumcision
Reply | Report Abuse | Link to thishttp://www.cdc.gov/hiv/resources/factsheets/pdf/circumcision.pdf (pdf)
Mentions the same studies as the author, showing a significant reduction in HIV transmission in Africa but also notes that these results haven't been replicated in the US which should send up some warning flags. In the same vein, why are rates both of circumcision and of HIV higher in the US than in Europe?
Circumcision is largely a very safe procedure and if a fully informed adult would like to be circumcised, I have no issues with his choosing to do so, but I think that recommending circumcision as a means of reducing the spread of HIV and performing the procedure on a child has some ethical considerations. Circumcision is not reversible, and does carry some risks.
We need to determine why these studies found a reduction in HIV transmission in circumcised men but other studies have not. Were there problems with the studies? Correlation is not causation. Even if the studies are well done, that doesn't necessarily mean it's the circumcision that protected the men. It could be that in a culture that doesn't normally circumcise, men willing to remove skin from their penis in the hopes of preventing HIV are simply more dedicated to protecting themselves.
You cannot double blind a study on circumcision in adult men. Guys know if you take parts of their penis away and you cannot choose to expose people to HIV to see if they'll contract the disease. But that doesn't mean we cannot take what has been found so far and do further study before making any conclusive statements.
All this is to say that I think this article is far too ready to accept findings that should be viewed with a bit more skepticism.
This article has so many problems, where do I begin?
Reply | Report Abuse | Link to this9 articles from Harvard Medical Society? So what? The main circumcision advocate at the Harvard Medical Society is Dr. Daniel T. Halperin. He is not a medical doctor. His degrees are in Latin American studies, and Anthropology. He publishes with Dr. Robert Bailey, also not a medical doctor, but somehow a co-author of a Kenyan HIV study. In Dr. Bailey's own words:
'Kenya is furthest along, with about 330,000 circumcisions, a third of the government’s goal, which exceeds the international health agencies’ goal. “We’re hacking away at it every month,” Dr.Bailey said. “Those foreskins are flying.”'
http://www.nytimes.com/2011/09/27/health/27circumcision.html?pagewanted=all
Dr. Bailey is not a medical doctor or even a medical epidemiologist, but rather holds degrees in Anthropology and behavioral epidemiology.
When we remove these two from the equation, there is still Dr. Tomlinson. Dr. David Tomlinson is chief expert to the World Health Organization on circumcision. He invented the "improved" Gomco, the "improved"
Plastibell and the "improved" Accu-circ. Obviously, it is a conflict of interest for him to hold the position, when he stands to make money from each of these circumcision clamps sold.
Here Dr. Tomlinson is quoted in the advertising brochure for the Accu-circ.
http://todayshospitalist.com/index.php?b=articles_read&cnt=647
and an ad:
http://www.kentecmedical.com/media/document/AccuCircWorkshopBrochure.pdf
They make it seem so safe, comfortable, and marketable.
Why is it that New Zealand stopped routine circumcision, yet it has one of the lowest HIV infection rates in the world? Why does the US continue the practice, and have one of the highest? The French and Danes don't circumcise, and their infection rates are 1/10th that of the US.
Why is Scientific American so quick to jump on the circumcision bandwagon?
Did circumcision help any of the nearly 1 million mostly circumcised Americans who have died of AIDS?
Wouldn't condoms cost less, and allow people to keep 60% of the nerves of their genitals?
Scientific American is not exactly earning the public's trust, with bad science like this.
Have they ceded science to people like this?
http://www.edenfantasys.com/sexis/body/bad-science-doesnt-justify-circumcision-1017111/
Excuse me, I'm feeling a bit sick to my stomach.
Circumcision is largely a very safe procedure?
Reply | Report Abuse | Link to thisIt doesn't have any great prevention powers:
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102282676.html
http://journals.lww.com/stdjournal/Abstract/2011/11000/Circumcision_and_Acquisition_of_Human.16.aspx
It's dangerous:
http://articles.latimes.com/2011/sep/26/health/la-he-circumcision-20110926
http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html
http://indiancountrynews.net/index.php?option=com_content&task=view&id=7526&Itemid=131
http://www.nbrlawfirm.com/Medical-Malpractice/Blogs/toddler-dies-after-circumcision-at-manhattan-hospital
Everybody knows it. They keep their mouths shut, because it is medical big business. Estimates of meatal stenosis, a scarring of the urinary opening seen almost exclusively on circumcised boys, run from 2–10% [Frank, 2000]. Hidden penis is another unintentional consequence.
80% of adult American males are circumcised, and have been for decades,but this hasn't stopped HIV/AIDS here. U.S. cemeteries are full of circumcised men who died from AIDS.
Reply | Report Abuse | Link to thisI read three articles that all said circumcision in Africa will SPREAD the virus from the use of unclean instruments.
Safe? Circumcision kills more than 100 baby boys each year in the United States and another hundred in Africa each year.
From the USAID report "LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS"
Reply | Report Abuse | Link to this"There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups "believe that circumcised men do not need to use condoms".
http://www.info.gov.za/issues/hiv/survey_2009.htm
From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
"the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission."
The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract
ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
News stories like this positively makes me seethe with anger. Are we living in the Middle Ages?? Uncritical organized circumcision (genital mutilation) of huge numbers of people is completely insane and should be categorized as a breach of human rights. What has gone on in America for decades is in itself appalling. The evidence for (and esp. the causes of) any beneficial effect is ridiculously flimsy, and there are always better alternatives. It says in one of the linked SciAm articles: "Whereas the current analysis could only detect gene sequences that were specific to bacterial families, the researchers are now working to identify the specific species that presumably cannot survive on circumcised penises." Well, then, the answer is to make some ointment that will kill the (possibly) harmful bacteria - it's madness to start chopping off people's foreskins, drastically changing their genital sensitivity and natural physiology.
Reply | Report Abuse | Link to thisI cannot figure out why there apparently are somebody with deep vested interests in mass circumcision. Are these people selling something that will make then rich off mass circumcision? Or is it some ideological thing, like a Zionist conspiracy (and no, I sincerely doubt that)? Or is this movement driven by people who are circumcized themselves and therefore think everybody else should be, too? I don't understand it. Can somebody explain it to me? My best guess is that this is apparently an issue that can get substantial funding (from who knows where), and hence keep a bunch of well-paid researchers working, who understandably want to keep their jobs and hence conclude that their work is really, really important. Sigh. The medicinal-industrial complex is no different from all other large corporations: when they get to be a certain size, their main goal is to keep themselves in operation, regardless of what they actually do. So sad.
The answer to your question is all of the above.
Reply | Report Abuse | Link to thisCircumcised men are far more likely to believe they are being objective when they recommend circumcision for someone else, but a Canadian study showed it is simply emotional bias.
Is there a big conspiracy? Yes. There are a handful of people, who get off on circumcision, all know each other, and publish articles together. They stand up for each other's research or publications, and swear to its truth. They belong to circumcision fetish organizations. They control wikipedia entries.
Do people make money? The AMA cops to about 200 million a year from circumcision. Other people estimate that it is a billion a year, or more.
Sick stuff? Putting baby cutting ahead of "first, do no harm? You bet. What is the Upton Sinclair quote?
"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"
Odd, that the UK, Canada, New Zealand, and Australia put down the scalpel, but we can't slap it out of the doctor's hand.
Then, you have the complicity of those easily fooled, who should know better. Like, say, a scientific organization.
Take a look at circleaks.org.
Reply | Report Abuse | Link to thisThey have the guts to publish specifics, because they can back up the truth with evidence from the perps.
Thanks. An honest-to-gosh self-serving circumcision lobby. With power enough to dominate the science and news flow on the subject. Christ.
Reply | Report Abuse | Link to thisThis article serves as a useful reminder that powerful religious, ideological and economic interests can distort research and science journalism.
Reply | Report Abuse | Link to thisWow, Scientific American is back in Middle Ages!
Reply | Report Abuse | Link to thisCan public hangings stem the crime epidemic in America?
Some times SciAm shocks the life out of me with articles like this one. I reckon they couldn't find a male reporter nave enough to write this article or to even agree to it's valueless and phoney research. I am almost 100% sure that Mrs. Harmon was not circumcised and has no idea just how brutally dangerous it is to little boys, and even more so to older boys...does she even care as long as they do not have that foreskin.
Reply | Report Abuse | Link to thisTommy, with all the proof you have given here against circumcision in preventing HIV, in fact, circumcision does not prevent anything except sexual feelings during intercourse, those billions of dollars American taxpayers are shelling out to the African agenda will cloud all the doctors' vision around the world and millions of little boys and young men will be brutalized because of it. These clueless people scare the life out of me.
Whoa. Easy now. I'm sure there is an important issue here, but for most of the commenters here, you'd think you were having one of your legs cut off. It is comical to see peoples' fanatical tirades dismissing what they think is someone else's fanatical behavior.
Reply | Report Abuse | Link to thisI think awareness amoung backward societies of africa about HIV and ways by which it can cause AIDS must be popularized before cutting a chunk of penis.People must be motivated to take precautions seriously.
Reply | Report Abuse | Link to thisHere in India rituals of circumcision is considered to be very sacred.
I havent got surgery on my penis yet.I dont want to have on it either.
Stop the propaganda over male circumcision. It's atrocious to make money from the mutilation of the human body. Male or female.
Reply | Report Abuse | Link to thisDon't stop at describing is a 'mutilation', why not say 'institutionalized Nazi-like vicious sexual organ tissue torture and destruction with massive, life-long psycho-sexual side effects'...
Reply | Report Abuse | Link to thisIf circumcision prevents HIV, then "researchers" should have no problem explaining to us exactly how this happens.
Reply | Report Abuse | Link to thisHow does circumcision prevent HIV?
How can we be sure it's circumcision and not condoms and education?
The best any study does is give us skewed statistics and the ad-hoc/post-hoc assertion that it was indeed circumcision that caused the "reduction."
Let's look at the Big Three studies on which the WHO and any other "research" is based. What does that 60% figure actually mean? How was it obtained?
"60%" was the difference between intact and circumcised men who got HIV. 137 intact men got HIV vs. 64 circumcised men. When you consider that the studies involved 10,908 men, that difference becomes so miniscule so as to become insignificant. The real reduction was 1.31%. Hardly noteworthy.
But this is what the WHO endorsement is based on.
This despite the fact that the circumcised group was told to abstain from sex for 6 weeks after their operation. This despite the fact that the studies were ended early. This despite the fact that they were given condoms and education. This despite a whole other s**tload of other factors.
We're given a 60% figure, but even if this were true, what is it based on?
What is the hypothesis for these so-called "studies?" Isn't the Scientific American even going to get into how these studies are all based on pure bunk?
No, the Langerhans Cells DON'T transmit the HIV virus; they're actually quite effective at destroying the virus, as they secrete Langerin, which destroys HIV. No, studies have shown that Keratin layers DON'T make a difference in fending off the virus.
The latest hypothesis, that HIV survives in the bacterial environment in the preputial sac is a new hypothesis that has never been, nor ever will be tested. The new argument is that ulcerations that are caused by bacteria that live in the preputial sac "might" be what facilitates HIV transmission, but now they have to prove that all intact men got HIV because they suffered bacterial ulcerations.
You can claim that "circumcision reduces HIV by 60%" all day long, but like the Autism-vaccine link, you've got to provide a mechanism before you can make that claim.
And even if that claim were true, what about the fact that Marie Wawer discovered women were 50% more likely to get HIV from circumcised males? Or is that something the Scientific American is simply not going to report?
Promoting a dubious mode of "prevention" over what we know works conclusively is impertinent and obnoxious, not to mention ethically bankrupt.
Tommy, Figures do not lie but liars figure. In the southern part of the United States which group of people is mainly circumcised? Whites. Which group of people is mainly not circumcised? Blacks. Which group mainly has AIDS? Blacks. Which group mainly does not have AIDS? Whites.
Reply | Report Abuse | Link to thisBoth White and Black boys use the same Whores.
You would think the KKK created anti-circumcision movement among southern blacks to get them to die from AIDS. You would think the Republicans decided to retake California with the anti-circumcision movement there. A number of the Uncircumcised in the anti-circumcision movement in this area have already died of AIDS. ; It is reducing the number of Democrats.
Why don't you admit that it is mainly the uncircumcised part of the population that catches heterosexual AIDS instead of throwing statistics around willy-nilly. Or, are you a Republican trying to kill off more Democrats?
Do you suspect that the idea to circumcise Africans in order to protect them against HIV came about as a result of someone asking "What is the best way to protect people from HIV?" OR.. do you suspect that the idea came from someone who was thinking about circumcision first? I think it's pretty clear that the latter is the case. Upon realizing that, if you don't begin to see some ethical concerns, you need to open your eyes.
Reply | Report Abuse | Link to thisIf you doubt that a circumcising culture DESIRES to continue cutting off foreskins, simply read this article, and note the example given about how despite many men dying in African tribes that practice the ritual traditionally, it is still seen as a good idea.
Circumcision has been around for a long time, and it has been promoted for almost every possible reason you can imagine.
This latest HIV reason is a huge waste of money and energy. We are focusing on a symptom instead of treating the REAL issues that cause the disease to be spread (i.e. total ignorance towards the way the disease is spread, lack of access to important safe-sex resources such as condoms, STI/STD testing, and even clean water)...circumcision is like slapping a band-aid on a bullet wound.
I think author Katherine Harmon should be ashamed for not doing more extensive research into this issue. Did she not notice that research has only shown protection in female-to-male transmission? Did she not read the male-to-female transmission study that actually showed infected men were more likely to give women HIV after being circumcised? (remember, male-to-female transmission is far more common than female-to-male). There is a reason why Swaziland has more circumcised men with HIV (22%) than intact men with HIV (20%) according to government figures.
It is a great shame that this Magazine, one that we should be able to count on for attention to quality, has sunk to this level of ignorant reporting. Where are the journalistic standards? If Scientific American can not be counted on to apply a critical eye towards this research, who will? What a let down.
PUT THE MONEY AND EFFORT INTO THE CORE PROBLEM.. ONLY THEN WILL YOU GIVE EACH PERSON THE ABILITY TO PROTECT THEMSELVES. A HERD-MENTALITY APPROACH THAT PHYSICALLY HARMS AS WELL AS PUTS MEN AT RISK IS NOT THE ANSWER.
Do not be fooled so easily!
Dr. Dean Edell discusses the misleading and unsound arguments in the current drive to circumcise Africa:
Reply | Report Abuse | Link to thishttp://www.youtube.com/watch?v=OlsUg0sdAtE
The focus on human penis cutting masterbation punishment calling it healthcare might be the most ridiculous severe lack of priority on life conceivable.
Reply | Report Abuse | Link to thisThe fact alone we do not and can not know how many thousands of US babies died from the traumatic penis skinning snip should tell a normal person CUTTING OFF HEALTHY SKIN IS NOT HEALTHCARE. Why would that not end the debate? Furthermore, how is it healthcare to disregard the future health, feelings and even lives of infant sons and causing the daughters extensive disadvantages trying to relate with only traumatized males for partners?
Who ever would think the most dangerous thing a us male can do in THE US is be born? And who would believe the greatest escape a baby male in the us will ever make is from supposed trusted people? What type of american thinkers put healthcare issues above a babys health, wellbeing safety and life?
Anyway, the answers are clear as to who thinks public sexual protection, hygeine, appearance etc is more important than baby skin.
I offer a fair solution. The best way to decide if laying open and skinning american male infants penis (penis reduction surgery at birth , or anytime reallY), called circumcsion) is humane or coherent, is ask the few guys who can afford to have their lost foreskins restored.
Did having their foreskins removed helped their world or the world in general in any way?
That should settle the matter as to whether or not cutting healthy babies is sane or not, based on opinions of victims. We know not to ask docs, cops or device manufacturers since they make fortunes over and over from sexual dysfuntion (viagra cialis etc- heart attacks from those on and on) and from traumatized circumcised adult males,disturbed traumatized children, and even law enforcement 85 percent of serial killers in the US most probably according to statistics were traumatized at birth or rather "circumcised", which means cutting around but it really cuts open and off the protective covering so the word "circumcision" is bordering on a lie, at best.
If circumcising infants,or any male not old enough to give INFORMED CONSENT (letting the parents and the person getting the procedure know it is traumatic removal of foreskin all natural normal male mammals are born and perfectly happy with and entitled to) is healthcare, I understand why low intellect people were ran out of other countries into the US.
The focus on human penis cutting masterbation punishment calling it healthcare might be the most ridiculous severe lack of priority on life conceivable.
Reply | Report Abuse | Link to thisThe fact alone we do not and can not know how many thousands of US babies died from the traumatic penis skinning snip should tell a normal person CUTTING OFF HEALTHY SKIN IS NOT HEALTHCARE. Why would that not end the debate? Furthermore, how is it healthcare to disregard the future health, feelings and even lives of infant sons and causing the daughters extensive disadvantages trying to relate with only traumatized males for partners?
Who ever would think the most dangerous thing a us male can do in THE US is be born? And who would believe the greatest escape a baby male in the us will ever make is from supposed trusted people? What type of american thinkers put healthcare issues above a babys health, wellbeing safety and life?
Anyway, the answers are clear as to who thinks public sexual protection, hygeine, appearance etc is more important than baby skin.
I offer a fair solution. The best way to decide if laying open and skinning american male infants penis (penis reduction surgery at birth , or anytime reallY), called circumcsion) is humane or coherent, is ask the few guys who can afford to have their lost foreskins restored.
Did having their foreskins removed helped their world or the world in general in any way?
That should settle the matter as to whether or not cutting healthy babies is sane or not, based on opinions of victims. We know not to ask docs, cops or device manufacturers since they make fortunes over and over from sexual dysfuntion (viagra cialis etc- heart attacks from those on and on) and from traumatized circumcised adult males,disturbed traumatized children, and even law enforcement 85 percent of serial killers in the US most probably according to statistics were traumatized at birth or rather "circumcised", which means cutting around but it really cuts open and off the protective covering so the word "circumcision" is bordering on a lie, at best.
If circumcising infants,or any male not old enough to give INFORMED CONSENT (letting the parents and the person getting the procedure know it is traumatic removal of foreskin all natural normal male mammals are born and perfectly happy with and entitled to) is healthcare, I understand why low intellect people were ran out of other countries into the US.
ahnonever:
Reply | Report Abuse | Link to thisI think you might get your point over even better if you referred to circumcision as insane horrible dramatic personal penile genocidal massive mutilating major limb execution child murderous serial axe hacking disfigurement. (oh, and of course, lots more capital letters!)
Also, in the future, if you are going to include statements like, "I understand why low intellect people were ran out of other countries into the US," please put it first. Then everyone can know up front that nothing but paranoid and/or insane ramblings follow, and we can skip reading altogether.
Reply | Report Abuse | Link to thisThis article makes me ashamed to be a Scientific American subscriber. There's neither science nor sense in this article. Women in America are more likely to develop breast cancer than men in Africa are to develop AIDS. Why aren't we fighting breast cancer by performing prophylactic mastectomies on women and girls? That would be more humane than imposing circumcisions on undereducated populations who do not have the resources to make an informed choice; and significantly more humane than conducting unethical studies on poor minorities in Third World countries.
Reply | Report Abuse | Link to thisThe evolutionary functions of the male foreskin are well documented: lubrication, stretch receptors, apocrine glands, estrogen receptors, more specialized sexual nerve endings than any other part of the penis, a gliding mobile function, lymphatic vessels, immunological cells including plasma cells and Langerhans cells, and the enzyme lysozyme that actually *kills* HIV, to name a few. Outside of patriarchal religions and the anti-masturbatory frenzy of the Victorian era, it's only the Americans and their partners at UNAIDS who continue to experiment with male genital cutting, ridding men of these functions.
This article states that circumcision "decreases the odds that a heterosexual man will contract HIV by 57 percent or more." No citations are given, but I take it the author is referring to the African randomized clinical control trials (RCCTs) from South Africa, Uganda, and Kenya. On average, these data show that the circumcised groups had a 1.26% HIV rate compared to 2.67% in the control group. That does indicate a 47% (not 57%) relative risk reduction; but the absolute risk reduction is only 1.41% -- statistically insignificant! What's more, Boyle and Hill (2011) have found evidence in the RCCTS of researcher bias, missing controls, inadequate double blinding, sampling bias, lead-time bias (i.e., the circ'd group couldn't have sex after surgery, giving them 2 mos. added protection that wasn't corrected for), suspicious early termination of the studies (including circumcising the control group so no follow-up studies could be done), and more.
And guess what? Circumcised African men are more readily contracting and spreading HIV/AIDS because they believe they are protected! The problem's gotten worse because of circumcision!
http://blog.practicalethics.ox.ac.uk/2012/05/when-bad-science-kills-or-how-to-spread-aids/
Circumcision as an AIDS-preventative strategy is a political issue; it has no basis in real science and certainly no place in Scientific American.