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To the Editor: We thank Brewer et al. for this study, whose conclusions—in light of the 3 recent randomized trials demonstrating high efficacy of male circumcision (MC) as a means of reducing female-to-male transmission of HIV—emphasize the essential point that if MC is to be promoted as an intervention against HIV infection, then ensuring that the surgical procedure is safe and hygienic must be considered an absolute priority. We have made similar points recently in the Journal of Medical Ethics; all 3 previously mentioned randomized controlled trials have likewise discussed this vital point. We are glad to see this message emphasized in Annals of Epidemiology, but we wish to offer several critical remarks in regard to this study.