A study published in an international scientific journal recommending that Kenyan men be paid for volunteering for circumcision has raised ethical issues.
The study carried out by Dr Kawango Agot of Impact Research & Development Organisation and Dr Harsha Thirumurthy of the University of North Carolina, US, said by giving food vouchers worth about Sh1,350 ($15), more men especially, older ones, were seen to come in for the cut.
The study was published in the Journal of the American Medical Association in August but in the Christmas issue of the peer reviewed publication, an American surgeon claimed the male volunteers had been given misleading information, which is unethical.
Dr Adrienne Carmack, a urology surgeon in private practice in the US, has cast doubts on the very foundation on which Kenya's male circumcision for HIV prevention programme is based. Urology is the branch of medicine focusing on the urinary tract system and male reproductive organs.
Dr Carmack cited a study which the other authors had relied on to claim that male circumcision reduces the risk of acquiring HIV by up to 60 per cent.
The actual reduction in the rate of HIV acquisition, as per the study, he says was only 1.25 per cent.
"Describing a reduction of 1.25 per cent as 60 per cent protection is misleading," he said.
He goes on to argue that if volunteers were being informed that if they underwent the procedure they would reduce the risk of getting HIV by 60 per cent, then this was misleading and unethical because the protection would be under two per cent.
Disclosure level
"It is not stated what was disclosed, but I am concerned that the participants were only told that circumcision would 'prevent' HIV and 'reduce the risk of HIV acquisition up to by 60 per cent'," he said.
He says poor study participants need documented informed consent and other additional safeguards to protect them against exploitation.
In their rejoinder in the same journal, Dr Agot and Dr Thirumurthy insist that their work is based on evidence showing that male circumcision reduces the risk of getting HIV by 60 per cent, a fact they say is recognised by the Ministry of Health in Kenya.
They said that 500,000 voluntary male circumcisions have taken place in the country since 2007 when the programme began.
However, the two did not answer our email asking whether male circumcision has had any impact on the reduction of HIV in the country.
Dr Carmack told The Standard in an email that the authors, in their reply, did not adequately address his concerns.
This is the second time in as many months that a Kenyan paper is being cited on ethical issues in an international journal.
In November, BMC Research Notes retracted another study which had exposed pregnant women and their infants in Nairobi on an experimental HIV treatment using fake ethical approval certificate.
The researchers from four Kenyan universities and one Tanzanian research facility had claimed to have received ethical approval from Moi University Institutional Research and Ethics Committee (IREC).
But the IREC informed the journal that it had not issued such an approval, forcing the retraction of the study.