TITLE:
Expertise and Ideology in Statistical Evaluation of Circumcision for Protection against HIV Infection
AUTHORS:
Brian J. Morris, Gia Barboza, Richard G. Wamai, John N. Krieger
KEYWORDS:
Male Circumcision, Human Immunodeficiency Virus, HIV, Prevalence, Prevention, Meta-Regression, Global Health
JOURNAL NAME:
World Journal of AIDS,
Vol.7 No.3,
August
11,
2017
ABSTRACT: Aim: To critically evaluate data and arguments by Van Howe defending his
stance opposing male circumcision (MC), in particular his meta-regression
analyses evaluating the ability of MC to reduce HIV infection risk in heterosexual
populations within and outside Africa. Methods: We performed metaregression
analysis of log odds of HIV infection between uncircumcised and
circumcised men using a single covariate (MC prevalence) in the meta-regression
model involving the metareg package in STATA 13 for 103 populations
worldwide and for populations within Africa. The meta-regression of log
odds and MC prevalence was fitted to a line, as were empirical Bayes estimates
resulting from post-estimation. Results: Our critical evaluation of Van Howe’s
arguments attempting to undermine the scientific evidence in support of the
benefits of MC in protection of men against HIV during heterosexual intercourse,
as well as other infections and conditions, together with his use of statistics
to support his beliefs, revealed serious flaws, obfuscation and missing
data. We therefore performed our own meta-regression analysis using a trivariate
model. Doing so revealed that for MC prevalences of 50%, 75% and 100%
for general populations within Africa, odds ratios for HIV risk in uncircumcised
vs. circumcised men were 1.35, 1.58 and 1.85, respectively. Our meta-regression
analysis of data for all countries yielded similar findings. For a general
population outside Africa with 100% MC prevalence, OR was 1.5. Van
Howe failed to acknowledge that since MC prevalence in US whites (91%) and
blacks (76%) exceeds 75% his results support MC having a protective effect in
those population groups. Conclusions: The protective effect of MC against HIV infection during heterosexual intercourse applies to populations both within
and outside Africa. The debate engineered by MC opponents, and led by Van
Howe, now appears to have run its course. The scientific evidence has prevailed.