Adult Male Circumcision Could Reduce the HIV Epidemic in Africa

Even modest programs advocating adult male circumcision can substantially prevent HIV infections and should be implemented immediately, researchers at Yale School of Medicine reported recently at the 16th International AIDS Conference in Toronto.

Yale medical student and public health doctoral candidate Kyeen Mesesan and co-authors in the Department of Epidemiology and Public Health at Yale School of Medicine conducted the research. They developed a mathematical model to examine the potential impact of programs to increase the prevalence of male circumcision in Africa using the township of Soweto in South Africa as an example. 

They found that a program to increase adult male circumcision rates in Soweto by targeting for example, 10 percent of uncircumcised adult men each year for five years, could prevent 32,000 infections and decrease 20-year HIV prevalence from 17 to 14 percent.

Because effective HIV vaccines may not be available for another 10 to 20 years, adult male circumcision programs could be a successful way to manage HIV transmission as part of a comprehensive package of HIV prevention programs. Mesesan cautioned that circumcision would not provide 100 percent protection from HIV infection.

“It reduces transmission but will not provide complete protection from getting HIV,” she said. “For this reason, sexual risk behavior will still play an important role in the success of a potential program. If wide-spread condom use decreased by 30 percent, for example, the circumcision program would prevent only 18,000 infections.”

For about 20 years scientists have noticed the link between countries with high circumcision rates and a reduced incidence of HIV transmission. A number of epidemiological studies have confirmed that link.

The first randomized controlled trial of adult male circumcision involved 3,000 men and was conducted by French researchers in Orange Farms, South Africa. Early analysis of the study showed that circumcising men reduced female to male HIV transmission by 61 percent. The trial was stopped immediately so circumcision could be offered to all participants. The scientific community is now awaiting results from two other male circumcision trials in Uganda and Kenya.

Mesesan said if these trials also show a significant reduction in HIV transmission, researchers and policy makers would need to consider whether large-scale implementation of adult male circumcision programs should be added to the current arsenal of HIV prevention tools. She stresses that counseling will still be necessary to combat potential increases in high-risk sexual behaviors.

Co-authors on the abstract, titled “The Potential Benefits of Expanded Male Circumcision Programs in Africa: Predicting the Population-Level Impact on Heterosexual HIV Transmission in Soweto,” include Douglas K. Owens of the Palo Alto VA and Stanford University Department of Medicine and David Paltiel, associate professor in the Department of Epidemiology & Public Health at Yale School of Medicine.