The study’s comparison between Denmark and sub-Saharan Africa is flawed.
Recently, the Danish epidemiologist Morten Frisch published a study in which he concludes that circumcision of boys does not reduce the risk of HIV transmission among men in Denmark.
Statens Serum Institut (SSI) promotes the study and this conclusion on the Institute’s website.
There is nothing new or surprising about the fact – as found in the study – that male circumcision has no effect on HIV transmission in Denmark. There are two main reasons for this:
- In Denmark, according to SSI’s own figures, HIV is primarily transmitted among men who have sex with men (MSM).
Male circumcision has no effect on transmission of HIV among MSM.
Therefore, WHO, UNAIDS etc. do not recommend male circumcision to prevent HIV among MSM.
- The low occurrence of HIV in Denmark makes the overall risk of contracting HIV through heterosexual transmission extremely low. (In fact, the study finds zero (0) HIV-infected circumcised Danish men in its data sample, see table 1.)
HIV transmission in sub-Saharan Africa
Whereas the low occurrence of HIV among Danish men, both circumcised and uncircumcised, is unsurprising, Morten Frisch then proceeds to generalize these findings to sub-Saharan Africa, claiming that circumcision of boys is equally without effect there.
This generalization is highly problematic because the patterns of transmission differ significantly between Denmark and sub-Saharan Africa.
In sub-Saharan Africa, the vast majority of transmission is through heterosexual contact. Against this type of transmission, male circumcision has been found to reduce the risk of transmission by app. 60% in high-risk settings. This has been shown by large, randomized trials conducted in Uganda, Kenya, and South Africa.
Since 2007, WHO has recommended male circumcision services as one of several preventive measures in the HIV-AIDS prevention programs. These programs are now implemented in 15 countries in sub-Saharan Africa which have been identified as high-risk areas, and they have contributed to a reduction in HIV transmission in recent years.
The context in Denmark
For years, Morten Frisch has been a vocal proponent of criminalization of non-medical circumcision of boys in Denmark (including a citizen proposal advocating up to 6 years of prison for parents who have their son circumcised).
We fear that Morten Frisch’s comparison between Denmark and Africa may in fact be yet another attempt to bolster his anti-circumcision agenda in Denmark.
However, sowing doubt about the African HIV-AIDS prevention programs is a hazardous strategy. Casting doubt on the validity and effectiveness of the prevention programs may potentially lead to fewer participants in these programs. In that case, the cost may ultimately be counted in human lives.