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Since the article was published, I found the following news articles that mention unhygienic male circumcision, especially by traditional circumcisers, is common in Mozambique:
http://www.plusnews.org/IndepthMain.aspx?InDepthID=61&ReportID=73304
http://photos.state.gov/libraries/mozambique/164103/nguluvep/ej2011port.pdf
- competing interests: none
- Invited by the author to make a review on this article? :
- Experience and credentials in the specific area of science:
I am the author.
- Publications in the same or a related area of science: Yes
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I corresponded privately with Dr. Vaz and she told me that she was unable to post a reply to my question. With her permission, I summarize her response here.
Dr. Vaz said that in Mozambique, the terms “escarificação/tatuagem” are understood to refer to scarification practices as I described in the article as well as to incisions made by traditional healers when administering herbal remedies for illnesses.
Therefore, an unknown proportion of 2009 Mozambique AIS respondents who reported exposure to scarification may have been scarified in response to illness symptoms. This means that it is possible that some of the association between scarification and HIV infection could be due to “reverse causation”, or already infected persons seeking treatment (scarification in this case) in response to symptoms of HIV infection. However, “reverse causation” is not a possible explanation for any of the positive association between male circumcision and HIV infection.
- competing interests: None
- Invited by the author to make a review on this article? :
- Experience and credentials in the specific area of science:
I am the author.
- Publications in the same or a related area of science: Yes
- References: None
The first version of this article contained several errors. I had made a mistake in managing the data and inadvertently excluded many children under age 12 from analysis. The analyses reported in the first version of the article included only one child under age 12 per household (from those households that had one or more children under age 12). The corrected results reported in the current version of this article (posted September 23, 2011) include all children under age 12. The revised results are similar to the earlier results based on the incomplete data, and do not change any of the interpretations or conclusions.