Talk:Circumcision and HIV

Outdated/fringe POV

Prcc27 evidently wants[1] to re-insert this 2010 "viewpoint" material. It's WP:UNDUE and a bit fringey so this would harm the article I think. Bon courage (talk) 05:09, 6 October 2022 (UTC)

I am okay with cleaning up older content, but I feel this would be problematic to the section if newer recommendations are lacking or not as thorough as older recommendations. Keep in mind, we actually have older content than the KNMG viewpoint in that paragraph right now (from 2007). We have had the fringe argument many times on this talk page before, and there was never a consensus to treat KNMG as “fringe”. There was a split view about whether their viewpoint is “fringe” or a “significant minority viewpoint”. Regardless, the original consensus has not changed thus far. Prcc27 (talk) 05:18, 6 October 2022 (UTC)

I'm not see any justification, or even argument, for inserting this content (and yes, there is yet more old cruft that needs removing too). It's just an outdated unimportant fringey view. Is there anything at all in its favour? Bon courage (talk) 05:34, 6 October 2022 (UTC)

As stated in prior discussions, it is important to include recommendations from around the world, and to include significant minority viewpoints. The debate around the timing of circumcision and comparing and contrasting circumcision vs. other prevention methods is something the KNMG touches on, as well as something the other recommendations touch on. It is okay to use older sources when newer sourcing is lacking, as evident by the AAP (2012) and WHO (2007) sources being included currently. Prcc27 (talk) 05:51, 6 October 2022 (UTC)

I don't think we can undercut established science with fringe views. Those prior discussions never got anywhere anyway. We've already got some KNMG/Dutch stuff now. That's enough (maybe too much and should go too?). Bon courage (talk) 05:56, 6 October 2022 (UTC)

• The consensus was/is for KNMG to be included. The raw science belongs in the other sections. The recommendations section should show readers different perspectives on how the science should be applied. Prcc27 (talk) 06:21, 6 October 2022 (UTC)

  The consensus was/is for KNMG to be included ← don't think so. Where was this "consensus" assessed and recorded? If you want something like that maybe start an RfC if this thread doesn't result in something clear-cut. Bon courage (talk) 06:26, 6 October 2022 (UTC)

  View the archives. Start with the “2013 position paper of small Dutch medical organization - WP:MEDDATE and WP:REDFLAG” and “Recommendations section”. MEDDATE & MEDRS concerns were addressed there. Prcc27 (talk) 22:08, 6 October 2022 (UTC)

  I don't think there was ever a consensus to include KNMG. Prcc27 has just spoken more loudly than anyone else and threatened others who disagreed with his viewpoint. The fact remains that KNMG is an outlier and encyclopedias do not exist to give equal space to outliers. The AAP, ACOG, and CDC recommendations are mainstream, consistent with WHO recommendations, and that should be the end of it. Petersmillard (talk) 19:50, 6 October 2022 (UTC)

  You’re welcome to view the archives, there were others on board with KNMG. Also, I never threatened anyone. Please quit spreading lies! Prcc27 (talk) 22:03, 6 October 2022 (UTC)

@Prcc27 WHO sources were updated to 2020 and CDC/AAP/ACOG reconditions haven't changed 74.75.197.221 (talk) 21:05, 6 October 2022 (UTC)

There is a 2007 WHO quote in the article, and the expired AAP viewpoint is from 2012. Prcc27 (talk) 22:02, 6 October 2022 (UTC)

IP is Petersmillard just in case anyone is confused. Prcc27 (talk) 22:12, 6 October 2022 (UTC)

RfC: Is there a consensus surrounding circumcision and HIV + should it be in lead?

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

The two questions asked are:

• Is there a general consensus in the scientific community that circumcision reduces HIV/AIDS transmission in high-risk contexts: particularly sub-Saharan Africa?
• Is the strikethroughed material WP: DUE for the the lead? (e.g. version #1) In particular, the wording that has been struckthrough by Prcc27: who argues there is a substantive debate in the scientific community over the issue of circumcision's prophylactic effects against HIV/AIDS in the context of high risk populations?

Leading to the question:

• Which version is the best? Version #1, #2, or #3?

KlayCax (talk) 16:25, 7 October 2022 (UTC)

There has been a dispute among editors on whether the article should portray (medically performed) circumcision's prophylactic effect on HIV/AIDS transmission in high-risk contexts — in particular, sub-Saharan Africa — as a general consensus among scientists and how the lead should cover it. The full details of which can be seen in the edit history of the article and in the talk page above.

Per usual formatting: Text that has been deleted in each version of the lead is strikethroughed like this. Text that is added is bolded like this.

Version #1 (before reversion; note that this was added by me from statements already existant in the body):

Male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations.

The first academic paper suggesting a protective association between circumcision and reduced heterosexual HIV infection rates was published in 1986. Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials (RCT) were commissioned as a means to reduce the effect of any confounding factors. Trials took place in South Africa, Kenya and Uganda. All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, and hence it was concluded that it would be unethical to withhold the treatment in light of overwhelming evidence of prophylactic efficacy. WHO assessed the trials as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the three RCT trials. A scientific consensus since subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations.

In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions. Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections (STIs) from an infected female partner through vaginal sex. The evidence regarding whether circumcision helps prevent HIV is not as clear among men who have sex with men (MSM). The effectiveness of using circumcision to prevent HIV in the developed world is not determined.

Version #2 (original Prcc27's edit; deleting the lead paragraph, portraying the scientific community as divided on the issue): (See here for edit summary/justification.)

There is evidence that male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations.

The first academic paper suggesting a protective association between circumcision and reduced heterosexual HIV infection rates was published in 1986. Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials (RCT) were commissioned as a means to reduce the effect of any confounding factors. Trials took place in South Africa, Kenya and Uganda. All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, and hence it was concluded that it would be unethical to withhold the treatment in light of overwhelming evidence of prophylactic efficacy. WHO assessed the trials as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the three RCT trials. A scientific consensus since subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations.

In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions. Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections (STIs) from an infected female partner through vaginal sex. The evidence regarding whether circumcision helps prevent HIV is not as clear among men who have sex with men (MSM). The effectiveness of using circumcision to prevent HIV in the developed world is not determined.

Version #3 (new Prcc27's suggested edit; preserving the original wording of the first sentence and deleting the overview of the subject in the lead, arguing it's not a consensus that it prevents HIV/AIDS in high-risk populations):

Male circumcision reduces the risk of human immunodeficiency virus (HIV) transmission from HIV positive women to men in high risk populations.

The first academic paper suggesting a protective association between circumcision and reduced heterosexual HIV infection rates was published in 1986. Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials (RCT) were commissioned as a means to reduce the effect of any confounding factors. Trials took place in South Africa, Kenya and Uganda. All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, and hence it was concluded that it would be unethical to withhold the treatment in light of overwhelming evidence of prophylactic efficacy. WHO assessed the trials as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the three RCT trials. A scientific consensus since subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations.

In 2020, the World Health Organization (WHO) reiterated that male circumcision is an efficacious intervention for HIV prevention if carried out by medical professionals under safe conditions. Circumcision reduces the risk that a man will acquire HIV and other sexually transmitted infections (STIs) from an infected female partner through vaginal sex. The evidence regarding whether circumcision helps prevent HIV is not as clear among men who have sex with men (MSM). The effectiveness of using circumcision to prevent HIV in the developed world is not determined.

Thanks! KlayCax (talk) 16:25, 7 October 2022 (UTC)

Survey

• Yes, there is consensus that circumcision lowers risk of HIV; no, do not explain much in the lead The problem with explaining is that doing so communicates that the issue is debatable. It is not. There is an established scientific consensus. Any arguments to the contrary start from either exceptions not worth mentioning, or from fringe views. The highest medical authoritative sources are unambiguous and it would be WP:UNDUE to present dissenting, fringe views in the lead. Bluerasberry (talk) 17:17, 7 October 2022 (UTC)
• Version #1: (Note to other editors: That I started this RfC + have been directly involved in this discussion/dispute. See above on the talk page.) Both a brief summarization of the topic and the statement that there is a consensus is WP: Due and in line with other article related to scientific topics. Sources that state alternatively are WP: Fringe and shouldn't be included in the article.

Some relevant sources addressing the topic include:

Scientific American (2008) states: all three trials were stopped early due to the overwhelming evidence of circumcision's protective effect.

Thomas, et al. (2011) states: Overwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men.

Lie and Miller (2011) states: Only after the results of three RCTs were available was the public health community convinced that there was sufficient evidence to initiate provision of circumcision services in high prevalence areas

Holmes, Bertozzi, & Bloom (2017) states: Circumcision of adult males is 70 percent effective in reducing transmission from females to males based on three RCTs... (very strong evidence).

Piontek and Albani, (2019) states: Randomized controlled trials have demonstrated circumcision results in a 50–60% reduction in risk of acquiring HIV infection in heterosexual males. In three clinical trials performed in sub-Saharan Africa, uncircumcised men were randomly assigned to one of two groups. One group was offered immediate circumcision (treatment group) and those in the other group (control group) were offered circumcision at the end of the trial. All participants received HIV testing and counseling, condoms, and safe sex counseling. All three trials were stopped early due to the overwhelming evidence that circumcision offered a protective effect against HIV, and it was felt to be unethical to ask the control group to wait to be circumcised.

World Health Organization (2020) states: The evidence that circumcision reduces the risk of HIV infection in men is strong. Results come from diverse settings, span 32 years (1986 to 2017), and are very consistent... Data from three RCTs.

Sharma, et al. (2021) states: There is overwhelming immunological evidence in support of MC in preventing the heterosexual acquisition of HIV-1. KlayCax (talk) 18:52, 7 October 2022 (UTC)

• Version 1, the consensus seems to agree that circumcision lowers risk of HIV.--Ortizesp (talk) 21:54, 7 October 2022 (UTC)
• Version 2 (maybe even version 3). Is there a “general consensus”? Perhaps. But there are significant minority viewpoints that question the efficacy of circumcision for HIV prevention (i.e. the Royal Dutch Medical Association). That view should be given at least some coverage in the article (not necessarily in the lead), per WP:DUE. There is not a “universal consensus” that circumcision prevents HIV (especially when we are talking about the developed world). The lead proposal is UNDUE per reasoning I gave in previous sections on this talk page. Prcc27 (talk) 22:42, 7 October 2022 (UTC)
• Version 2. WP doesn't deal in absolutes, there's a significant minority viewpoint counter to the absolute claim, and the lead is no place for a paragraph of source detailia that dense.  — SMcCandlish ☏ ¢ 😼  21:58, 9 October 2022 (UTC)

  WP doesn't deal in absolutes Who knows? Perhaps we are The Sith? -- Emir of Wikipedia (talk) 20:56, 11 October 2022 (UTC)

• First choice: version 3, Second choice: version 2 (and this RfC is highly problematic in it's format). Two different changes should not be the subject of the same !vote as has been done here: as it stands, the way this RfC is formatted, it almost gives the impression that it was purposefully designed to the "split the !vote" between those wishing to support a strong the position that there is strong consensus in the sources for the prophylactic value of the procedures in question, dividing such !votes among options 2 and 3, whereas all !votes supporting a different read on the sources will be aggregated into a single choice, making it easier for that option to reach a higher threshold in responses. I'm going to AGF that this was not intentional--the OP seems to think that version 1 actually advances the argument for strong consensus, afterall; I am not sure I agree with that assessment, but regardless this is specifically why RfCs are not meant to be formatted in such a fashion where two different additions/deletions are contemplated at once. For that matter, there easily could have been a forth option here that dismissed both the proposed added and deleted content.

All that said, and assuming the RfC doesn't get a procedural close and a re-start, I think the corpus of sources as presented is pretty straightforward here: there is a clear scientific consensus on the existence of a statistically significant prophylactic effect of the medical procedures in question with regard to HIV infection rates (whatever the rest of the cultural conflict surrounding customs regarding circumcision). Version 3 most clearly aligns with the balance of the sources, but version 2 is marginally better than version 1. While version 1 does include reference to some of the more robust studies in question, I don't think the lead is the right place for this level of granularity, and I agree with others who have already noted that it actually undermines an accurate portrayal of the overall strength of the broader consensus. And if steps are not taken to reform the RfC, I certainly hope the closer takes the possible bias inherent in the way the !vote has been constructed into question. SnowRise ^{let's rap} 06:58, 10 October 2022 (UTC)

You're probably right. (And from the comments: there's not going to be a current consensus from the RfC.) I'm procedurally self-closing and restarting in a few days. KlayCax (talk) 04:35, 12 October 2022 (UTC)

• Version 2 is my first choice. Instead of striking the paragraph, though, I would change it to something representative of the past three decades of research and not just the beginning. I remember reading that circumcision increased the transmission rate in one study, but it was because the men were resuming sexual activity before they were fully healed. Darkfrog24 (talk) 01:14, 12 October 2022 (UTC)

Discussion

• It's not a debatable point which needs consensus (an odd circumstance which requires WP:RS/AC sourcing); it's just settled science. Any "debate" seemingly died years ago (except in fringe circles and on this Talk page). Bon courage (talk) 16:36, 7 October 2022 (UTC)

I obviously agree with you. But there were dissenting voices (including other IP editors) who kept reverting the paragraph + wording that stated there was a consensus. (As I'm sure you're aware.) I felt like the start of a RfC was the only way to definitely establish a consensus on the matter + the wording within the lead. Or else we would be going back and forth upon this topic for monthsc: without anything productive occuring + and more reversions/edit wars. KlayCax (talk) 18:37, 7 October 2022 (UTC)

• Relevant links from discussions above:

Scientific American (2008) states: all three trials were stopped early due to the overwhelming evidence of circumcision's protective effect.

Thomas, et al. (2011) states: Overwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men.

Lie and Miller (2011) states: Only after the results of three RCTs were available was the public health community convinced that there was sufficient evidence to initiate provision of circumcision services in high prevalence areas

Holmes, Bertozzi, & Bloom (2017) states: Circumcision of adult males is 70 percent effective in reducing transmission from females to males based on three RCTs... (very strong evidence).

Piontek and Albani, (2019) states: Randomized controlled trials have demonstrated circumcision results in a 50–60% reduction in risk of acquiring HIV infection in heterosexual males. In three clinical trials performed in sub-Saharan Africa, uncircumcised men were randomly assigned to one of two groups. One group was offered immediate circumcision (treatment group) and those in the other group (control group) were offered circumcision at the end of the trial. All participants received HIV testing and counseling, condoms, and safe sex counseling. All three trials were stopped early due to the overwhelming evidence that circumcision offered a protective effect against HIV, and it was felt to be unethical to ask the control group to wait to be circumcised.

World Health Organization (2020) states: The evidence that circumcision reduces the risk of HIV infection in men is strong. Results come from diverse settings, span 32 years (1986 to 2017), and are very consistent... Data from three RCTs.

Sharma, et al. (2021) states: "There is overwhelming immunological evidence in support of MC in preventing the heterosexual acquisition of HIV-1.""

Version #1 is the best. (Per these sources, discussion above, and various other reasons.) More about it is stated in survey subsection. KlayCax (talk) 18:46, 7 October 2022 (UTC)

All are written bad even if the science is right. What makes a 2020 reiteration of settled science so notable? Emir of Wikipedia (talk) 13:10, 9 October 2022 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

The evidence on HIV prevention is very unclear

There are a great number of studies that show it has not effect, r even increases infection rates. So why is the lede so adimant that its only a good thing? Tiggy The Terrible (talk) 13:51, 6 November 2022 (UTC)

I agree. 2013 meta analysis, and a 2022 study from Canada finds no correlation with HIV. https://www.hindawi.com/journals/isrn/2013/109846/https://www.auajournals.org/doi/10.1097/JU.0000000000002234 Gastropod Gaming (talk) 00:47, 25 September 2023 (UTC)

Neither of those meets WP:MEDRS - the 2013 van Howe paper isn't published in a medline indexed journal, and the Candian study - is a single study. We cannot use lower quality sources to undercut the conclusions of higher quality ones such as a WHO policy statement. MrOllie (talk) 01:00, 25 September 2023 (UTC)

The 2013 meta analysis is a DOI link. I should've linked the Pubmed. Here's the Pubmed:

https://pubmed.ncbi.nlm.nih.gov/23710368/

And the single Canadian study shows how HIV transmission may not apply in the first world. Gastropod Gaming (talk) 12:39, 25 September 2023 (UTC)

Both weak sources, of no use to this article. Bon courage (talk) 12:43, 25 September 2023 (UTC)

A meta analysis from pubmed is "weak"? Really now? & the second one still highlights regional differences. Gastropod Gaming (talk) 17:59, 30 September 2023 (UTC)

Don't known what "from pubmed" is meant to mean, but PMID:23710368 is in a weak, non-MEDLINE journal. We have really strong sources, so why scrape the barrel? Bon courage (talk) 18:04, 30 September 2023 (UTC)

PUBMED is not scraping the barrel; PUBMED is MEDLINE. You could read that here, or you could've thought for a second before edit warring & shitting yourself in a audience of people who don't have lukewarm IQs (https://www.nlm.nih.gov/medline/index.html) Francis e Dec's warrior (talk) 18:38, 30 September 2023 (UTC)

No, that is plainly incorrect. As the link you cite says: MEDLINE content is searchable via PubMed and constitutes the primary component of PubMed, - that means Pubmed contains other material besides MEDLINE content. The van Howe paper being discussed here is an example of that. MrOllie (talk) 18:43, 30 September 2023 (UTC)

Pubmed is an indiscriminate listing. The minimum standard for medical content is considered to be the MEDLINE index. MrOllie (talk) 18:11, 30 September 2023 (UTC)

RFC on the Royal Dutch Medical Association

Which version of the Royal Dutch Medical Association's recommendations should be included in the article, the full version or the shortened version?

• Full version: "Because the evidence that circumcision prevents HIV mainly comes from studies conducted in Africa, the Royal Dutch Medical Association (KNMG) in 2010 questioned the applicability of those studies to developed countries. Circumcision has not been included in their HIV prevention recommendations. The KNMG viewpoint document said that the relationship between HIV transmission and circumcision was unclear, and that behavioral factors seemed to have more of an effect on HIV prevention than circumcision. The KNMG also said that the choice of circumcision should be put off until an age when a possible HIV risk reduction would be relevant, so that boys could decide for themselves whether to undergo the procedure or choose other prevention alternatives. This KNMG circumcision policy statement was endorsed by several Dutch medical associations."
• Shortened version: "Because the evidence that circumcision prevents HIV mainly comes from studies conducted in Africa, the Royal Dutch Medical Association (KNMG) in 2010 questioned the applicability of those studies to developed countries. Circumcision has not been included in their HIV prevention recommendations."

Some users have argued that the Royal Dutch Medical Association (KNMG) viewpoint is WP:FRINGE and out-of-date, while others have argued that the KNMG recommendations qualify as a "significant minority viewpoint" per WP:DUE and that it is important to include recommendations on circumcision & HIV from different regions of the world. Prcc27 (talk) 00:20, 20 November 2022 (UTC)

• Full version: The Royal Dutch Medical Association is a large medical organization with over 65,000 doctors and medical students as members. The recommendations section of the article, is where "significant minority viewpoints" belong. Of course, if we get more up-to-date and higher quality recommendations, we should replace the older recommendations with the newer ones. But it is worth noting, that the AAP's viewpoint is technically expired, and that there is a quote from The WHO's 2007 viewpoint which is currently in the article, that is actually older than the KNMG viewpoint. Prcc27 (talk) 00:28, 20 November 2022 (UTC)
• Full version. I tend to agree with Prcc27's points, and in reading the two versions, I find the longer one is considerably more informative about KNMG's position (the additional material is not fluff or blather).  — SMcCandlish ☏ ¢ 😼  06:34, 20 November 2022 (UTC)
• Full. The Dutch Royal Medical Association is a major institution with a minority viewpoint. Also, the full version gives more details and isn't fluff. — ^Clyde!_Franklin! 21:14, 20 November 2022 (UTC)

• Shortened version: I'm not sure if it's fringe or not but it is certainly a bit out of date and not needing every detail. Other out of date viewpoints in the article can also be appropriately um trimmed or replaced with newer ones if available. BogLogs (talk) 23:49, 22 November 2022 (UTC)

• Shorter summary of the KNMG position. Let me preface this by saying I think the KNMG stance is, at most, FRINGE-adjacent, not truly fringe: yes, it is a significant minority opinion in some respects as compared against consensus medical science on the topic, but let's remember that we are talking about legitimate national-scale body representing tens of thousands of physicians, and at least some of what it has to say on the topic is not altogether controversial. The timeliness issues does raise some concerns in terms of WP:DUE, but sources in Wikipedia articles covering this topic are kind of all over the place on the timeline of research as is.

All of that said, the portions that come in under the extended version are definitely those which are either a) closest to fringe statements, relative to the broad corpus of research, such as the claim that "the relationship between HIV transmission and circumcision was unclear" (the particulars may be up for debate but consensus research is pretty clear about the existences of a statistically significant observable relationship), or b) so non-controversial I'm not sure it bears lengthening the article and muddying the waters to include it, as with "behavioral factors seemed to have more of an effect on HIV prevention than circumcision" (no researchers that I have ever heard of are really arguing that the effects of circumcision are at the same scale of impact as the factors of the sex acts engaged in by individuals, their choice of whether to use safe sex practices, their choices with regard to sexual partners, and their medication choices, the only really physiologically relevant "behavioural factors" at play here, making this rather something of a strawman argument that doesn't do much to inform the reader of the actual dimensions of legitimate medical debate about this topic).

Meanwhile, the shorter version still includes the less fringe-y and informative content: "Because the evidence that circumcision prevents HIV mainly comes from studies conducted in Africa, the Royal Dutch Medical Association (KNMG) in 2010 questioned the applicability of those studies to developed countries." Now this in itself is still a little wishy-washy in terms of the grounds on which it takes issue with the majority/consensus research position, because obviously there is no significant observed physiological difference between African and non-African peoples which would lead to statistically different outcomes for individuals exposed to HIV; that is to say, a circumcised African and a circumcised non-African would (on average) get just as much benefit (or just as little, depending on your position) when exposed to HIV--so there are some problems with that statement as framed. But I presume the KNMG would explain this position more fully as "in non-African contexts, the benefits of circumcision on the larger epidemiological scale might render different statistical outcomes in terms of benefits to the larger population resulting from the practice." That's a questionable argument in itself, insofar as the KNMG doesn't point to countervailing research outside of Africa in support of that possibility, so much as casts doubt on the existing Africa-centric research, but that possibility does nevertheless get the statement farther past the smell test than some other aspects of their position. And then of course "Circumcision has not been included in their HIV prevention recommendations." is just simply perfectly factual.

On the whole, I don't see a strong argument for the WP:WEIGHT value of the elements included in the longer version, whereas I can see the benefit of the shorter version. I'd also like to note that (though I am sure it was a subconscious and unintentional choice, there seems to me to be some rhetorical bias built into how the two choices are presented here in terms of the nomenclature of the RfC: the "full version" of the "KNMG's recommendations" is just the summary of their position as advanced by one of our editors. The choice therefore is not between a "full" or "shortened" version, but rather between a longer and shorter version, and there's a suggestion in the language employed that we are somehow taking something naturally fulsome and cutting it down for convenience. That's not really appropriate framing any more than if the choices had been labelled a "punchy" version and "verbose" version, imo. Not a huge thing, but worth noting as something that could introduce bias into the discussion. Additionally, looking at the dispute as it is framed further up on the talk page, it seems the dispute was about whether to include the KNMG's positions at all, not how much of their position to include, so including nothing probably should have been offered as an option here. That said, I didn't look at the edit history of this dispute, so there may have been movement/discussion/compromise on the foundational issue of whether to include KNMG positions at all which took place in edit summaries. SnowRise ^{let's rap} 20:31, 23 November 2022 (UTC)

“Behavioral factors seemed to have more of an effect on HIV prevention than circumcision” isn’t a strawman argument. It is a statement that KNMG ties into their view, that circumcision does not have a significant effect on national HIV prevalence, between the different countries.

“The relationship between HIV transmission and circumcision was unclear” is not undue, when you read the entire paragraph, which adds context to that statement.

Questioning the applicability of those studies to developed countries makes sense for two reasons: MSM HIV rates vs. Men who have sex with women and considering that the predominant HIV strain is different in Africa vs. other parts of the world. I’m not going to try to interpret their reasoning, but the KNMG’s argument here, does not seem far off from the mainstream view on generalizability to developed countries.

I wanted to avoid “fuller” (doesn’t work grammatically) and “original”. But “shorter” and “longer” would have been better alternatives. Prcc27 (talk) 02:10, 24 November 2022 (UTC)

“Behavioral factors seemed to have more of an effect on HIV prevention than circumcision” isn’t a strawman argument. It is a statement that KNMG ties into their view, that circumcision does not have a significant effect on national HIV prevalence, between the different countries.

Well, it's both. The sub-argument/proof being advanced by the KNMG towards the larger interpretation here is that "other factors exist which have a bigger impact". But researchers advancing evidence of the empirically observable effect of circumcision on likelihood of infection aren't contesting that, and it simply doesn't serve to impact the findings about physiological, biophysical effects observed in the research on individual transmission, even if the cost-benefit in different regional contexts were brought into question by the general medical establishment--it's a red herring with regard to what consensus conclusions have been reached, or more formally a irrelevant conclusion. And we in our discretion as to considering WP:WEIGHT have to decide if it is worth including in our summary of statements and positions which describe the bounds of the academic debate on this issue, per WP:ONUS: not everything verifiable is necessary or advisable for inclusion, and I just don't think this statement is.

“The relationship between HIV transmission and circumcision was unclear” is not undue, when you read the entire paragraph, which adds context to that statement.

Well, I just re-read the section, and I still find that, again, though I would not describe the complete position as summarized as really FRINGE, as some have described, this is surely the most fringe-leaning element of the KNMG position presented here. It's at best a half-accurate summary of the state of research: the existence of a direct statistical (and statistically relevant) relationship is generally agreed upon by the scientific establishment examining this issue. The degree of the effect, however, is a little more subject to disagreement. Again, this is a matter of WP:WEIGHT, and these calls aren't super obvious: I would define this as a "reasonable minds may vary" area of the topic, and we are after all talking about an attributed set of statements. Nevertheless, I still think this is dead weight and more likely to muddy the waters than to clarify the present state of research for the reader.

Questioning the applicability of those studies to developed countries makes sense for two reasons: MSM HIV rates vs. Men who have sex with women and considering that the predominant HIV strain is different in Africa vs. other parts of the world. I’m not going to try to interpret their reasoning, but the KNMG’s argument here, does not seem far off from the mainstream view on generalizability to developed countries.

Sure, I mean, again, it's a close call, but that's why I come down the way I do on the rest of the content and support its inclusion, even though it requires asking the reader to parse a fine distinction regarding personal infection risk in the individual physiological context and the epidemiological risk on the population scale. But under a weight analysis, I can't support all of the proposed content as due.

I wanted to avoid “fuller” (doesn’t work grammatically) and “original”. But “shorter” and “longer” would have been better alternatives.

I mean, I almost didn't mention it: it's not like its a big enough effect to really throw the discussion, but I thought it and the other matter with the framing (and probably that one somewhat more so) were still worth bearing in mind. SnowRise ^{let's rap} 03:02, 24 November 2022 (UTC)

• Shortened version largely per Snow Rise. The long version is undue and needlessly takes Wikipedia into fringey territory. Bon courage (talk) 06:27, 24 November 2022 (UTC)
• Full version – It's better since it makes it clear why the Royal Dutch Medical Association took its position, and gives context for this minority position. Studies from the developing world are not always directly applicable to Western countries because of differences in wealth and behaviour. (The cost and ease of purchasing condoms, condom usage rates, sexual practices, preventative medication, access to clean water, etc. can all play a much larger role in HIV prevention; and thereby, swamp out any physiological benefits of circumcision. There is also the possibility that circumcised individuals could get a false sense of security from getting HIV, which would in fact result in risky sexual behaviour, which led to higher chances of HIV in comparison to a more cautious uncircumcised individual.) The full version makes it clear that what is important for the KNMG is empowering the individual with a toolkit of HIV preventing options that the person can chose from to avoid HIV infection. --Guest2625 (talk) 14:31, 24 November 2022 (UTC)
• Full version, simply because it gives a much clearer understanding of KNMG's position. Per Prcc27, it seems clear that KNMG's position is a significant viewpoint, not a FRINGE one. —Mx. Granger (talk · contribs) 10:37, 25 November 2022 (UTC)
• Full version, per Prcc27 A455bcd9 (talk) 19:17, 25 November 2022 (UTC)
• Shortened version - lean - Per SnowRise. I don't have an objection to including objections to extending the findings to developed countries. That's something that is mainstream (if not a majority view) within the scientific and medical communities. However, the 2010 KNMG statement was released before a consensus in the scientific community was established. There's almost no major, respected medical organization or even doctor today (as of 2022) that would state that VMMC doesn't reduce HIV transmission from HIV positive women to men in high risk populations. Questions of consent/ethics when it's done on minors (EIMC programs) are mainstream. Denying that vol. male circumcision in high-risk areas doesn't reduce transmission is WP: Fringe and is outdated. The KNMG statement saying it is uncertain that circumcision reduces the incidence of HIV transmission in high risk populations was written in (and before) 2010. A scientific consensus on the matter didn't emerge until ~2011-2013.

Some users have attempted to draw parallels with similar quotations dating back to the late-2000s/early-2010s in the article - such as the WHO or AAP - but this is an inaccurate comparison.

The large majority of these statements have been reiterated. (e.g. In 2020, WHO again concluded that male circumcision is an efficacious intervention for HIV prevention and that the promotion of male circumcision is an essential strategy.) The WHO first recommended it in 2007. It reiterated its recommendation in 2020. The KNMG position should be expanded, in my opinion. But denying a link between circumcision and HIV transmission in high risk areas is indisputably fringe, and it would be wrong for the article to include it. KlayCax (talk)

As I mentioned above - other sources have made similar statements.

Sharma, et al. (2021) states: MC is... strongly supported by the data from three large RCTs conducted in Africa right before that. It directly mentions the three RCT trials as part of the "overwhelming evidence" for circumcision in high risk contexts.

Scientific American (2008) states: all three trials were stopped early due to the overwhelming evidence of circumcision's protective effect.

Thomas, et al. (2011) states: Overwhelming evidence, including three clinical trials, shows that male circumcision (MC) reduces the risk of HIV infection among men.

In 2011, Lie and Miller (2011) states: Only after the results of three RCTs were available was the public health community convinced that there was sufficient evidence to initiate provision of circumcision services in high prevalence areas

Holmes, Bertozzi, & Bloom (2017) states: Circumcision of adult males is 70 percent effective in reducing transmission from females to males based on three RCTs... (very strong evidence).

Piontek and Albani, (2019) states: Randomized controlled trials have demonstrated circumcision results in a 50–60% reduction in risk of acquiring HIV infection in heterosexual males. In three clinical trials performed in sub-Saharan Africa, uncircumcised men were randomly assigned to one of two groups. One group was offered immediate circumcision (treatment group) and those in the other group (control group) were offered circumcision at the end of the trial. All participants received HIV testing and counseling, condoms, and safe sex counseling. All three trials were stopped early due to the overwhelming evidence that circumcision offered a protective effect against HIV, and it was felt to be unethical to ask the control group to wait to be circumcised.

World Health Organization (2020) states: The evidence that circumcision reduces the risk of HIV infection in men is strong. Results come from diverse settings, span 32 years (1986 to 2017), and are very consistent... Data from three RCTs.

And so on and so forth. There's numerous other metastudies and/or major medical organizations — easily findable online — that call the three RCTs provide "overwhelming", "very strong", or "strong" evidence. In the context of high-risk populations, anything to the contrary is a fringe perspective at this point.

It wasn't a fringe statement in 2010. It is now. It shouldn't be included in the article. KlayCax (talk) 16:18, 22 December 2022 (UTC)

• Short KNMG is not a mainstream global source so hardly merits attention anyway, 2010 was a long time ago and if this was an issue about which they cared they would have reiterated it, and the longer statement is prone to misinterpretation. Bluerasberry (talk) 15:39, 22 December 2022 (UTC)
• Short. Assuming for the sake of argument that the KNMG statement is further on the "significant minority view" side of the spectrum than on the "fringe" side, the short version is still better. The length of the summary outweighs significant majority sources like the most current meta-analysis. And the added content is not particularly on-topic or useful.
  • The whole bit about the "unclear" relationship" is evident from the short version
  • "behavioral factors" is obviously true, to the point of uselessness
  • I have no quarrel with "several Dutch medical associations" and would be fine with adding that into the short version. Maybe something like "the Royal Dutch Medical Association (KNMG) and seven other Dutch medical associations ..."
  Both versions do not make it clear enough that the KNMG recommendation is focused on male minors. I'd suggest tweaking to "Circumcision of male minors has not been ...". Assuming I get no takers on my suggestions, I'd still support the short version over the long. Firefangledfeathers (talk / contribs) 06:05, 4 January 2023 (UTC)
  • I obviously support including the part about several Dutch medical associations endorsing the KNMG viewpoint. That is clearly better than the shorter version. Prcc27 (talk) 22:40, 4 January 2023 (UTC)

RfC closure

Note I have raised a query about the just-closed RfC above, at WP:AN. Also note that OntologicalTree is going beyond the RfC decision to edit-war content into the lede calling the established science into question. Bon courage (talk) 16:36, 1 January 2023 (UTC)

• And now KlayCax is compounding the problem. A minor source from 2010 cannot be used to undercut weighty sources from more recent years. Furthermore for statements about "consenus" in science the high bar of WP:RS/AC sourcing is needed. Bon courage (talk) 17:05, 1 January 2023 (UTC)

Apologies. I haven't been involved in this RFC that much. (Until after 30 days were passed on it: Which I wasn't aware of until I checked watchlist.)

I was under the presumption that @OntologicalTree:'s edits were in line with the results of the RFC. @Bon courage:. You as well as anyone knows my position on the matter from past disputes.

In my opinion, the edits from @Prcc27: and @OntologicalTree: should probably be kept until someone reviews Trykid's closure. However, the RFC definitely needs to be reviewed. There was nowhere near a consensus on the matter. Most of the quality responses (such as @Snow Rise:'s) were directly against the RFC's results. KlayCax (talk) 17:12, 1 January 2023 (UTC)

Svoboda and Van Howe's comments are definitely WP: Fringe'y, though. They should be removed under either scenario. KlayCax (talk) 17:13, 1 January 2023 (UTC)

The RfC was tightly asking about whether to adopt one or other specific versions of text, it did not give cart blanche to insert fringe positions into the lede. I agree the close was poor. Bon courage (talk) 17:15, 1 January 2023 (UTC)

I agree. It's just that a narrow interpretation of the RFC closure brings its own problems. (Or at least invites clarification) How is it WP: Due to state that the Royal Dutch Medical Association denies/doubts a linkage between circumcision and there's a consensus on the matter that it does?

At the very least — for the average viewer — a narrow interpretation of the RFC leads the article into being: 1.) Not very clear 2.) Self-contradicting. KlayCax (talk) 17:28, 1 January 2023 (UTC)

We state the current accepted science. And we state what this minor medical body had as a "viewpoint" 13 years ago. There's no contradiction. Bon courage (talk) 17:35, 1 January 2023 (UTC)

It may not be a contradiction. At the very least, it's extensively confusing and unclear to the average reader.

Exactly why: 1.) The RFC was wrongly decided 2.) It's WP: Undue. 3.) Shouldn't be in the article. @Bon courage:. KlayCax (talk) 17:41, 1 January 2023 (UTC)

• Propose compromise - remove in 2024 if no updated source Both sides cannot have their way at this, but RfCs need to close somehow. Per WP:MEDDATE when a source is more than 5 years old then it is usually out of date. For this topic plenty of recommendations are published every year, and for this view, there is one respected publication from 13 years ago. I say keep the content in the article through 2023 to give anyone time to find a newer source. If no one finds one in the next year, then remove it without additional discussion in 2024. If this information is worth stating then giving all the medical organizations in the world 14 years to come up with something is long enough, especially when Wikipedia's standard is 5 years. Bluerasberry (talk) 20:54, 1 January 2023 (UTC)
  • The longer version of the KNMG paragraph, has been the consensus for the past few years. MEDDATE concerns did come up when I first proposed including the KNMG viewpoint, but we decided that MEDDATE did not apply, because the recommendations were being portrayed as a KNMG-specific viewpoint, not an indisputable scientific fact. Yes there are newer sources, but many of the newer sources are not as comprehensive as some of the most prominent sources during the 2010ish time period (e.g. old AAP and WHO statements). Prcc27 (talk) 05:55, 4 January 2023 (UTC)

    The consensus version was as was at the start of the RfC. Per WP:ONUS for inclusion of disputed content, consensus is needed. Bon courage (talk) Bon courage (talk) 08:14, 4 January 2023 (UTC)

    Prior to you and Petersmillard reverting me, consensus on the talk page had been established in favor of including the KNMG viewpoint. Yes consensus can change, but it was a consensus nonetheless. Prcc27 (talk) 22:51, 4 January 2023 (UTC)

    There was never consensus for your long version, and the article has existed without it for most of its existence. Inclusion of disputed content needs consensus. Bottom line: the long version is not going in without an RfC establishing that it belongs. Bon courage (talk) 07:23, 5 January 2023 (UTC)

    I obviously disagree. There was a consensus at the talk (even if weak consensus), and a consensus through editing. “My” long version was written with the collaboration of other users, it was not written unilaterally. This RfC has not been resolved yet, although it looks like “no consensus” will be the end result. But I think we should at least explore Blueraspberry’s compromise proposal and see if we can get a consensus on that. Prcc27 (talk) 20:28, 5 January 2023 (UTC)

    @Prcc27: It has been 13 years. Can you give a personal opinion of how long you expect this publication to be relevant? Are you thinking 15, 20, 30 years? To me this seems like a statement where anticipating an expiration date is a reasonable direction for conversation. Bluerasberry (talk) 16:25, 4 January 2023 (UTC)

    I do not have a crystal ball. I support including the longer version, even if that means having an expiration date as a compromise. But I do not think MEDDATE mandates an expiration date. Prcc27 (talk) 22:47, 4 January 2023 (UTC)

  • Thank you, Bon Courage. The current version is the appropriate one. It does acknowledge the Dutch statement, which is a clear outlier which contradicts WHO, CDC, and every other consensus statement. But it doesn't put it above the CDC statement (as it was previously) or give it a separate paragraph. Petersmillard (talk) 15:52, 4 January 2023 (UTC)

Prcc27 says that The KNMG circumcision policy statement was endorsed by several Dutch medical associations. The policy statement was initially released in 2010, but was reviewed again and accepted in 2022." However, there is no reference for the "reviewed again in 2022." Where is this documented? Petersmillard (talk) 00:38, 30 May 2023 (UTC)

• @Petersmillard: Thank you for bringing this concern to the talk, I updated the source. Prcc27 (talk) 01:26, 30 May 2023 (UTC)

Well, it looks like this RfC still is not resolved. Since KNMG released a statement reaffirming their 2010 policy by saying "the above documents were reviewed in March 2022: content is still correct" wouldn't this make the WP:MEDDATE concerns moot? Is there anyone in the shorter summary camp that would like to change their !vote to the longer summary, in light of this information we did not have at the beginning of the RfC? @SMcCandlish:@ClydeFranklin:@BogLogs:@Snow Rise:@Bon courage:@Guest2625:@Mx. Granger:@A455bcd9:@KlayCax:@Bluerasberry:@Firefangledfeathers:@Petersmillard: Prcc27 (talk) 01:26, 30 May 2023 (UTC)

FWIW, my position on this hasn't shifted: it's a minority viewpoint but from a major medical organization, and now that they've reaffirmed their position in 2022, its relevance is renewed.  — SMcCandlish ☏ ¢ 😼  01:44, 30 May 2023 (UTC)

With that update, the case for including the longer summary is stronger. We should include the longer summary, possibly adjusted to mention that KNMG reaffirmed their position in 2022. —Mx. Granger (talk · contribs) 02:23, 30 May 2023 (UTC)

Mx. Granger, it probably makes sense in a situation like this, when you are responding to a post that ends with the express question "Is there anyone in the shorter summary camp that would like to change their !vote to the longer summary?", to flag in your response (calling for a change) that you were actually someone who supported a longer version in the previous !vote as well. Otherwise people might assume that you were one of the people specifically being queried and interpret your response as a change in the balance of the perspectives, when it isn't. SnowRise ^{let's rap} 05:33, 30 May 2023 (UTC)

Apologies for the lack of clarity – I supported the longer version before, and with this update I think the case for the longer version is even stronger. —Mx. Granger (talk · contribs) 13:12, 30 May 2023 (UTC)

My perspective also hasn't changed and I still favour the short version, all factors considered: in the original instance, I did not view the dated nature of the source as a major issue militating against it's use, so my previous !vote is already balanced in that respect. And I don't see much in the other !votes which suggest this was a major issue for other respondents. I mean, either the source is in date and worth using in general or it isn't. It's datedness is unlikely to be an issue for supporting some MEDRS content but not others. Rather, the !votes seemed to mostly focus on whether or not particular claims were fringe or due, and this detail of the org's support being "renewed" (for whatever that's worth) doesn't really impact the WP:WEIGHT analysis upon which the support for a shorter version generally relied. SnowRise ^{let's rap} 05:28, 30 May 2023 (UTC)

It inclines me to prefer the short version over deletion. Bon courage (talk) 05:31, 30 May 2023 (UTC)

Yeah, that's probably the best way to describe my take as well. I always thought of the shorter version as the reasonable middle ground solution between three options. There's something to discuss here, but there's a fair bit of nuance needed to insert any of it, even in the form of attributed statements, without creating false balance and unsettling our discussion of the subject by untethering it from WP:WEIGHT. I feel like there was already a fair bit of effort put into sorting out what content was useable and what was not, and taking another bite at that apple on account of this very trivial change in the posture of the sourcing is probably not going to lead to any improvement. SnowRise ^{let's rap} 05:42, 30 May 2023 (UTC)

I still think the short version is better, and my reasons for thinking so were not significantly tied to the MEDDATE concerns. Firefangledfeathers (talk / contribs) 15:43, 30 May 2023 (UTC)

"Misinformation about VMMC programs"

This section is completely misleading and should be removed. It is not compliant with WP:MEDRS. 2A06:5900:C09A:4800:65FA:19B4:B0CF:1238 (talk) 22:01, 16 June 2025 (UTC)

WP:MEDRS only applies to direct medical claims. That someone spread misinformation in a political speech or questions about whether or not the government should fund particular things aren't covered by MEDRS. Those tags were applied based on a misunderstanding of the relevant policies. MrOllie (talk) 22:58, 16 June 2025 (UTC)

User:MrOllie, the following is a direct medical claim:

The scientific consensus positions of major medical organizations, including that of the World Health Organization, is that circumcision is one of the most effective methods of preventing HIV transmission in high-risk locations.

You can't seriously deny that the above is a direct medical claim. None of the sources cited are compatible with WP:MEDRS. 2A06:5900:C09A:4800:2084:8AE3:95F8:2A45 (talk) 23:28, 16 June 2025 (UTC)

If that sentence is your concern, we can easily add another citation there. But obscuring that by filling the whole section with improper tags wasn't helpful. MrOllie (talk) 23:36, 16 June 2025 (UTC)

The whole section is already filled with presumptuous statements that cannot be verified by the cited sources. For example:

many members of the Republican Party, and other Western right-wing populists and national conservatives, who have falsely alleged that it is ineffective in reducing HIV transmission, portrayed it as a threat to masculinity, or an ineffective use of the dollars of taxpayers.

These are all sweeping claims that are not made in the cited sources. 2A06:5900:C09A:4800:2084:8AE3:95F8:2A45 (talk) 23:44, 16 June 2025 (UTC)

Adding a malformatted copyright case over a single sentence - which was properly cited, is also unhelpful. Kindly stop adding improper tags to the page (and edit warring about them). You will find it is very difficult to get your legitimate concerns taken seriously while you are also disrupting the page like this. MrOllie (talk) 23:45, 16 June 2025 (UTC)

Please read WP:PARAPHRASE. It's unhelpful to include excerpts of text verbatim, especially ones that are purely speculative, per WP:CRYSTAL. I'm not trying to disrupt anything, I'm just trying to make sure the appropriate tags are in place to alert readers and editors to these issues. 2A06:5900:C09A:4800:2084:8AE3:95F8:2A45 (talk) 23:53, 16 June 2025 (UTC)

I appreciate that you are trying to help, but what you are actually doing is disruptive. Slow down, constructively propose fixes on the talk page. Filling the page up with tags should be the last resort. MrOllie (talk) 00:04, 17 June 2025 (UTC)