that circumcision was well known to be as much a practice of the nobility as a Jewish religious rite, so that the racial-religious nexus was broken." These factors were absent in continental Europe. Rates in the Anglophonic world began to sharply diverge after 1945. Mid-20th century (1945–1985) After the end of World War II, Britain implemented a National Health Service. Douglas Gairdner's 1949 article "The Fate of the Foreskin" argued that the evidence available at that time showed that the risks outweighed the known benefits, leading to a significant reduction in circumcision incidence within the United Kingdom. In contrast to Gairdner, the influential American pediatrician Benjamin Spock argued in favor of circumcision in his work The Common Sense Book of Baby and Child Care. This led to rates in the United States significantly rising. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s, but stopped short of recommending against it. Modernity (1985–present) An association between circumcision and reduced heterosexual HIV infection rates was first suggested in 1986. Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors. Trials took place in South Africa, Kenya and Uganda. All three trials were stopped early by their monitoring boards because those in the circumcised group had a substantially lower rate of HIV contraction than the control group, and hence it was seen as unethical to withhold the procedure, in light of strong evidence of prophylactic efficacy. WHO assessed these as "gold standard" studies and found "strong and consistent" evidence from later studies that confirmed the results of the studies. A scientific consensus subsequently developed that circumcision reduces heterosexual HIV infection rates in high-risk populations; the WHO, along with other major medical organizations, have since promoted the widespread adoption of circumcision in high-risk populations as part of an overall program to reduce the spread of HIV. The Male Circumcision Clearinghouse website was formed in 2009 by WHO, UNAIDS, FHI and AVAC to provide current evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services. Society and culture The word