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Auvert and colleagues present preliminary evidence for the protective effect of male circumcision on HIV acquisition. Their report also reveals several problems with the widely held assumption that penile-vaginal sex accounts for the overwhelming majority of HIV transmission in sub-Saharan Africa. We are baffled that the factor most strongly associated with incident HIV infection--attendance at "a clinic for a health problem related to the genitals" (rate ratio 5.7)--is neither highlighted nor specifically discussed. Given evidence for increased risk of acquiring HIV from treatment for sexually transmitted diseases (STDs) in sub-Saharan Africa (relative to untreated STDs) such a context for HIV acquisition should have been more assiduously explored especially regarding nosocomial transmission. (excerpt)

The Protective Effect of Male Circumcision as a Faith Lift for the Troubled Paradigm of HIV Epidemiology in Sub-Saharan Africa