Abstract #394  -  From real life to real life : the circular debates about male circumcision and HIV prevention
Authors:   Presenting Author:   Dr Genevieve Paicheler - France
Additional Authors:
Aim: This presentation is a review of articles about the prophylactic character of male circumcision (MC) before and after the three randomized controlled trials (RCTs) which reached the conclusion that the risk of acquiring HIV by males is very significantly lowered by MC. It explores the way the protective effect of MC has been raised and what have been the reactions to this assumption inside and outside the scientific community of epidemiologists. It is particularly interested in highlighting the resistance to the evidence-based demonstration.
Method / Issue: Different databases and bibliographical data have been searched to gather the articles on MC published in professional medical journals from as early as 1986. These numerous and repetitious articles have been analysed with regard to the arguments used to agree with or to contest the prophylactic property of MC against HIV.
Results / Comments: Before the RCTs, the researchers have been very careful in their conclusions even if there were convergent data from the "real life" in favour of the protecting role of MC. But the methods of the epidemiologic investigations were too diverse and the role of the confounding variables not enough controlled. Besides, there were strong opponents to MC. At that stage, the contention was that only RCTs could bring final conclusions to the debates. After the evidence brought by the RCTs, the controversy was still not closed and the same criticism than before was expressed, irrespective of the results of the RCTs. Furthermore, the RCTs were questioned as they were considered too far from the "real life", taking place in artificial contexts and during a too short duration.
Discussion: This presentation will raise the question of the nature and credibility of evidence in scientific investigations. It will highlight the fact that there is always an emotional dimension in scientific argumentation and that it is difficult to fight prejudices, which means here judgments before experimentation, even among scientists. So science cannot be pure: it is socially contextualized and also extra-scientific dimensions are very important in scientific proceedings. Dramatisation is important in the debates: the use of strong metaphors sometimes close to rumours. Some loudspeakers of borderline disciplines with regard to epidemiology (ethics, anthropology, sociology) took part in this dramatization process, emphasizing the negative consequences of a prevention policy based on the scaling-up of MC.
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