s risks, especially if performed by medical personnel or traditional healers without proper training. Moreover, immediately after circumcision, men may be at a higher risk of acquiring infections (which is why the participants were asked to not to have sex for six weeks after the operation). A further concern is that circumcised men, considering themselves to be "protected," might be more likely to engage in unsafe sex. Research is also needed to find out whether male circumcision only has a preventive effect on female to male transmission, or whether it may also reduce male to female transmission or male to male transmission. In addition, it will be important to determine the mechanism by which circumcision exerts its apparent protective effect.

Three articles published in PLoS Medicine alongside the trial discuss some of these issues further:

• In an editorial, the PLoS Medicine editors discuss the peer review of the paper and their reasons for publishing it.
• Peter Cleaton-Jones, chair of the ethics committee that approved the trial, looks at the ethical issues surrounding the trial.
• Nandi Siegfried, lead author of a recent Cochrane systematic review of male circumcision and HIV, considers the trial's strengths and weaknesses.

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Contact: Paul Ocampo
press@plos.org
415-624-1224
Public Library of Science
24-Oct-2005

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