Date of this Version


Document Type

Letter to the Editor

Publication Details

Postprint of:
Boyle, G. J. (2004). Male circumcision and risk of HIV-1 infection. The Lancet, Vol.363, Iss. 9425; pg. 1997
Published by Elsevier Ltd.
Access the published version online.


The probability of acquiring HIV-1 is a function of exposure to risk and the likelihood of transmission when exposed to risk. The study is silent on this point, but few, if any, of the Muslim men in the study acquired HIV-1. It follows that the prevalence of HIV-1 among Muslims in Pune must have been very low. If their sexual relations did not expose the Muslim men to risk then it is likely that this, rather than any possible circumcision-dependent difference in the transmission rate, explains the difference in the rate of acquisition of HIV-1 by men of different religions. One could argue that HIV-1 prevalence among Muslims is low precisely because most Muslim men are circumcised, but this is the very point requiring proof. Pooling Muslim men with non-Muslims to find a lower incidence of HIV-1 in circumcised men obscures that requirement, besides introducing a host of confounding factors.