Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns

In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventive measure based on three sub-Saharan African randomised clinical trials (RCTs) into female-to-male sexual transmission. A related RCT investigated male-to-female transmission. However, the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered. Why were the trials carried out in countries where more intact men were HIV-positive than in those where more circumcised men were HIV-positive? Why were men sampled from specific ethnic subgroups? Why were so many participants lost to follow-up? Why did men in the male circumcision groups receive additional counselling on safe sex practices? While the absolute reduction in HIV transmission associated with male circumcision across the three female-to-male trials was only about 1.3%, relative reduction was reported as 60%, but, after correction for lead-time bias, averaged 49%. In the Kenyan trial, male circumcision appears to have been associated with four new incident infections. In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain.     

Police and Alcohol Use: A Descriptive Analysis and Associations with Stress Outcomes

Alcohol misuse is a significant problem in police work. This study describes alcohol use correlates and examines psychological outcomes of stress associated with the use and level of alcohol by police officers. Measures: (1) AUDIT-Alcohol Use Disorders Identification Test; (2) demographics; (3) Center for Epidemiological Studies Depression scale; (4) Impact of Events Scale (PTSD); and (5) life events scale. The mean AUDIT score was M = 5.64 (low risk <8). Male officers had significantly higher scores in overall AUDIT total, hazardous alcohol use domain, and dependent symptoms domain (p = 0.004, 0.002, 0.031, respectively). Women officers in the hazardous drinking range on the AUDIT were significantly younger than women officers in the lower AUDIT range (p = 0.050). Males in the hazardous drinking range had significantly higher external life event scores than females (p = 0.037), suggesting a need for increased attention to the spillover effect of police work.     

Huawei,Cyber-Sovereignty and Liberal Norms: China’s Challenge to the West/Democracies

Journal of Chinese Political Science - As China’s global footprint expands and Sino-American competition intensifies, it is apparent that one of the most important arenas for competition...