An article in Advocates of Youth that compares data between Europe and the United States.

In France, Germany, and the Netherlands, two things create greater, easier access to sexual health information and services for all people, including teens. They are: 1) societal openness and comfort in dealing with sexuality, including teen sexuality; and 2) pragmatic governmental policies. The result - better sexual health outcomes for French, German, and Dutch teens when compared to U.S. teens.

The United States has higher circumcison rates than non-circumcising Europe, but the United States has substantially higher HIV/STI rates, syphilis rates, gonorrhea rates, and chlamydia rates than Europe. This is not to say that circumcision rates account for the difference. Instead, other factors may be in play, such as societal openness and governmental policies as noted in the article. This information does lend to the conclusion that the Africa trials regarding circumcision and HIV infection would not be applicable to other cultures without addressing the factors noted in this article.