Male circumcision and HIV prevention: Is there really enough of the right kind of evidence?
Male circumcision and HIV prevention: Is there really enough of the right kind of evidence?
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DOI：
10.1016/s0968-8080(07)29302-4
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发表时间：
2007-05-01
影响因子：
--
通讯作者：
Couch, Murray
中科院分区：
文献类型：
--
作者：
Dowsett, Gary W.;Couch, Murray
在2006年8月于多伦多举行的第十六届国际艾滋病大会上，世界成功抗击艾滋病的保证似乎站不住脚，或者至少是国际机构和新的艾滋病名人提供的新的积极的全球“旋转”的一部分（美国前总统比尔·克林顿、慈善家比尔和梅林达·盖茨、演员理查德·基尔和当时的联合国非洲艾滋病毒/艾滋病问题特使斯蒂芬·刘易斯）。事实上，这一流行病在撒哈拉以南非洲、南亚、东亚和中亚或亚太区域部分地区没有得到控制。即使在美国，在少数民族和种族人口中，艾滋病毒的流行率也在继续上升，如果不均衡的话。此外，在发达世界的同性恋社区中，长期以来一直是成功和早期预防努力的最佳范例，有人说流行病死灰复燃，而且在拉丁美洲和亚洲的男男性行为者中基本上是隐藏的流行病。针对这些令人担忧的迹象，多伦多会议上关于艾滋病毒预防的讨论集中在最近创造的“预防技术”概念上，这一概念虽然不包括行为改变，但确实包括宫颈屏障、使用抗逆转录病毒药物的暴露前预防、疱疹抑制、杀微生物剂、艾滋病毒疫苗，以及作为名单上的新成员，被誉为最直接的承诺，男性割礼。运用一个非常男性主义的比喻，男性包皮环切术在多伦多会议上经常被誉为最新的
AT the XVI International Conference on AIDS in Toronto in August 2006, assurances that the world was succeeding in fighting AIDS appeared shaky, or at least part of a new positive global ‘‘spin’’provided by the international agencies and the new AIDS celebrities (former US President Bill Clinton, philanthropists Bill and Melinda Gates, actor Richard Gere and the then UN Special Envoy for HIV/AIDS in Africa, Stephen Lewis). In fact, the pandemic is not under control in sub-Saharan Africa, in South, Eastern and Central Asia, or in parts of the Asia–Pacific region. Even in the USA, among minority ethnic and racial populations HIV prevalence continues to rise, if unevenly. Moreover, among the gay communities of the developed world, for so long the best examples of successful and early prevention efforts, there is talk of resurgent epidemics and of largely hidden epidemics among men who have sex with men in Latin America and Asia. 1 All is not well in the fight against HIV/AIDS.In response to these worrying signs, the discourse on HIV prevention at the Toronto conference focused on the recently coined notion of ‘‘prevention technologies’’which, while not including behaviour change, does include cervical barriers, pre-exposure prophylaxis with antiretroviral drugs, herpes suppression, microbicides, HIV vaccines, and as a newcomer to the list and, lauded as having most immediate promise, male circumcision. Deploying a very masculinist metaphor, male circumcision was often hailed at the Toronto conference as the newest