What makes a vaccine?

Well, the definitions say circumcision doesn't count. A vaccine is something that stimulates the immune system against the disease in question. Unless circumcision exposes the man to HIV antigens? I'm thinking not.

But what is the point of a vaccine? In epidemiologic terms, it is to a) prevent infection, b) prevent or decrease transmission, or c) prevent or decrease symptoms of the disease. So does circumcision count? I'm not sure.

Yes, we have good evidence that circumcised men are less likely to become infected. The bias involved, however, is overwhelming -- the differences in most of these studies that led to one man being circumcised rather than another stem from culture and religion. Could either of those factors affect, say, sexual behavior? Probably. Do we have a plausible biological reason for HIV preferring uncircumcised men? Not really, in my opinion, although there's a lot of hot air on the subject. We have a link. That's all we can really say.

So what do we do with a link, with a cultural action that may be protective? In my opinion, ignore it and push cultural acceptance of condoms and abstinence. We know they work and we know why. Until a real vaccine comes along.