Male circumcision and HIV prevention: is there really enough of the right kind of evidence?

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We recognise that many of those advocating rapid implementation of male circumcision are motivated by a deep desire to halt this pandemic, yet so too are those of us, similarly motivated, who are wary of the indecent haste with which the discussion about male circumcision has been swept up in a tide of enthusiasm based on only one, albeit significant, part of the evidence base needed for recommending such a radical public health initiative. This is partly a ‘‘means and ends’’ discussion: do the ends justify the means? It is also a ‘‘ways and means’’ discussion: how is this to be done and at what cost? Moreover, there are epistemological and political questions: what is at stake, how is that defined and by whom, what evidence suffices, who decides and on what basis?

At the moment, the enthusiasm for male circumcision is proffered to displace the disappointment of previous ‘‘silver’’ or ‘‘magic’’ bullets that have not worked as well as we had hoped. It is a dreadful pandemic, to be sure; but that does not mean we should lose sight of the fact that care, judgement, experience and knowledge are required before action. Evidence is but one form of this, and the determination not to harm others through haste or expedience must prevail.