The Role of Male Circumcision in the Prevention of Human Papillomavirus and HIV Infection

Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa (The Journal of Infectious Diseases 2009;199:14–19)

Background.  A causal association links high-risk human papillomavirus (HR-HPV) and cervical cancer, which is a major public health problem. The objective of the present study was to investigate the association between male circumcision (MC) and the prevalence of HR-HPV among young men.

Methods.  We used data from a MC trial conducted in Orange Farm, South Africa, among men aged 18–24 years. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios (PRRs) were assessed using univariate and multivariate log Poisson regression.

Results.  In an intention-to-treat analysis, the prevalences of HR-HPV among the intervention and control groups were 14.8% (94/637) and 22.3% (140/627), respectively, with a PRR of 0.66 (0.51–0.86) ( ). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results.

Conclusions.  This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women.

Trial registration.  ClinicalTrials.gov identifier: NCT00122525.

Full Study

Commentary: The Role of Male Circumcision in the Prevention of Human Papillomavirus and HIV Infection (The Journal of Infectious Diseases 2009;199:1–3)

 

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Medical ‘Conscience Rule’ Is Issued

Medical ‘Conscience Rule’ Is Issued

The Bush administration, as expected, announced new protections on Thursday for health care providers who oppose abortion and other medical procedures on religious or moral grounds.

“Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience,” Michael O. Leavitt, the secretary of Health and Human Services, said in a statement on his department’s Web site.

The rule prohibits recipients of federal money from discriminating against doctors, nurses and health care aides who refuse to take part in procedures because of their convictions, and it bars hospitals, clinics, doctors’ office and pharmacies from forcing their employees to assist in programs and activities financed by the department.

“This rule protects the right of medical providers to care for their patients in accord with their conscience,” Mr. Leavitt said.

The Bush administration had signaled its intention to issue the measures, which are part of a flurry of regulations it is announcing before President-elect Barack Obama takes office. The new president will be able to undo the regulations, and is virtually certain to, given his previous comments on the issue. But undoing them will be a time-consuming process.

The measures announced on Thursday, sometimes described collectively as the “conscience rule,” were issued just in time to take effect before the start of the new administration. They will go into effect 30 days after their publication in the Federal Register on Friday. Recipients of funds from the Department of Health and Human Services are required to certify their compliance with the rule by October 2009.

“If, despite the department’s efforts, compliance is not achieved, H.H.S. officials will consider all legal options, including termination of funding and the return of funds paid out in violation of the non-discrimination provisions,” Mr. Leavitt said.

Opponents of abortion, including the United States Conference of Catholic Bishops and the Catholic Health Association, which represents Catholic hospitals, support the new regulations and say they are needed to protect health-care providers from being forced to perform abortions and sterilizations.

They are opposed by the National Association of Chain Drug Stores, the American Hospital Association and the American Medical Association, among others. Opponents contend that the regulations are a threat to a woman’s right to choose to have an abortion, and that they are not needed in any event because the Civil Rights Act of 1964 already prohibits employment discrimination based on religion.

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Then parents need to have the same rights to have a conscience law in every state that allows them to refuse vaccines as it is a medical procedure :)