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Scarification and Male Circumcision Associated with HIV Infection in Mozambican Children and Youth

Submited on: 15 Sep 2011 05:59:11 AM GMT

Published on: 15 Sep 2011 03:19:24 PM GMT

appropriate

Posted by Dr. Paula Vaz on 29 Sep 2011 04:37:56 PM GMT

1	Is the subject of the article within the scope of the subject category?	Yes
2	Are the interpretations / conclusions sound and justified by the data?	Yes
3	Is this a new and original contribution?	Yes
4	Does this paper exemplify an awareness of other research on the topic?	Yes
5	Are structure and length satisfactory?	Yes
6	Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience?	No
7	Can you suggest any reductions in the paper, or deletions of parts?	No
8	Is the quality of the diction satisfactory?	Yes
9	Are the illustrations and tables necessary and acceptable?	Yes
10	Are the references adequate and are they all necessary?	Yes
11	Are the keywords and abstract or summary informative?	Yes

Other Comments:
This is a very interesting article that raises the problematic of the horizontal transmission of HIV. I am convinced that this type of transmission is accountable for a non negligible amount of HIV contaminations in poor settings.

These results are consistent with other published articles on nosocomial transmission. However there are some limitations that were not mentioned:
1. The national database was done on a cross-sectional evaluation and in this context the estimates of HIV infection are not accurate as we can’t exclude the possibility of those on the window period that were not re tested.
2. One of the premises of the author is that scarification is not done in response to illness symptoms, which is not true in our country. In Mozambique, scarification is often used as a mean to treat chronic or persistent illness and many children seen in the hospital for chronic illness present scarifications, this might work as confounder for HIV infection and change the interpretation of the results.
Competing interests:
no
Invited by the author to review this article? :
Yes
Have you previously published on this or a similar topic?:
Yes
References:
Vaz P, Pedro A, Le Bozec S, Macassa E, Salvador S, Biberfeld G, Blanche S, Andersson S. Nonvertical, nonsexual transmission of human immunodeficiency virus in children. Pediatr Infect Dis J 2010;29:271-274
Experience and credentials in the specific area of science:

I have a cohort of HIV positive children and adolescents born of HIV seronegative mothers, on clinical follow up for more than 10 years.
How to cite: Vaz P .appropriate[Review of the article 'Scarification and Male Circumcision Associated with HIV Infection in Mozambican Children and Youth ' by Brewer D].WebmedCentral 2011;2(9):WMCRW00976

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Thank you very much for your review, Dr. Vaz. You are correct that with a cross-sectional design, there is a possibility that some persons classified as uninfected have in fact seroconverted and are in the several week long window period of detection by ELISA tests. However, in a serosurvey of a population with an annual HIV incidence no more than a few percent, such as in Mozambique, such misclassifications will be infrequent, if not rare. Moreover, it is not clear that such misclassifications would bias any estimates of associations with HIV infection. The questions in the 2009 Mozambique AIS about scarification refer to “escarificacao/tatuagem”. I understood this as a practice for decorating the body as described in the references I cited. I thought “escarificacao/tatuagem” is different from the practice of traditional healers cutting incisions into the skin for administering herbal remedies to treat illnesses. Do Mozambicans interpret “escarificacao/tatuagem” to apply to both practices, or just the former?
Responded by Dr. Devon D Brewer on 29 Sep 2011 07:39:05 PM

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