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Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection

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Document pages: 25 pages

Abstract: Aim: To critically evaluate data and arguments by Van Howe defending hisstance opposing male circumcision (MC), in particular his meta-regressionanalyses evaluating the ability of MC to reduce HIV infection risk in heterosexualpopulations within and outside Africa. Methods: We performed metaregressionanalysis of log odds of HIV infection between uncircumcised andcircumcised men using a single covariate (MC prevalence) in the meta-regressionmodel involving the metareg package in STATA 13 for 103 populationsworldwide and for populations within Africa. The meta-regression of logodds and MC prevalence was fitted to a line, as were empirical Bayes estimatesresulting from post-estimation. Results: Our critical evaluation of Van Howe’sarguments attempting to undermine the scientific evidence in support of thebenefits of MC in protection of men against HIV during heterosexual intercourse,as well as other infections and conditions, together with his use of statisticsto support his beliefs, revealed serious flaws, obfuscation and missingdata. We therefore performed our own meta-regression analysis using a trivariatemodel. Doing so revealed that for MC prevalences of 50 , 75 and 100 for general populations within Africa, odds ratios for HIV risk in uncircumcisedvs. circumcised men were 1.35, 1.58 and 1.85, respectively. Our meta-regressionanalysis of data for all countries yielded similar findings. For a generalpopulation outside Africa with 100 MC prevalence, OR was 1.5. VanHowe failed to acknowledge that since MC prevalence in US whites (91 ) andblacks (76 ) exceeds 75 his results support MC having a protective effect inthose population groups. Conclusions: The protective effect of MC against HIV infection during heterosexual intercourse applies to populations both withinand outside Africa. The debate engineered by MC opponents, and led by VanHowe, now appears to have run its course. The scientific evidence has prevailed.

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