Male Circumcision
What Works
1. Male circumcision reduces HIV acquisition for men and may reduce transmission for women.
A randomized controlled study from 2002 to 2004 of 3,274 young, sexually active, heterosexual men in South Africa found that with 18 months of follow- up, 60% fewer men who had been circumcised acquired HIV as compared to men who had not been circumcised. There were 20 men who acquired HIV among those who had been circumcised, an incidence rate of 0.85 per 100 person years and 49 men who acquired HIV among men who had not been circumcised, an incidence rate of 2.1 per 100 person years. Male circumcision was offered to the control group at the end of trial. At each of four visits, each participant was invited to a counseling session of 15 to 20 minutes delivered by a certified counselor about HIV. Condoms were provided. STIs were screened and treatment. No deaths occurred due to circumcision. Circumcision was conducted by general practitioners and resulted in a limited and reasonable number of adverse events.
Auvert, B., D. Taljaard, E. Lagarde, J. Sobnigwi-Tambekou, R. Sitta and A. Puren. 2005. “Randomized, Controlled Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial.” PLoS Medicine 2 (11): e298.
A randomized controlled trial of 2,784 men aged 18 to 24 years in Kisumu, Kenya, with a follow up of 24 months found that 22 men who were circumcised acquired HIV compared to 47 men who had not been circumcised. The two-year HIV incidence was 2.1% in the circumcision group and 4.2% in the group of men who had not been circumcised. Circumcised men had a reduction in the risk of acquiring HIV of 53%. Adjusting for non-adherence to treatment and excluding four men who tested HIV-positive prior at enrollment in the study, the protective effect of circumcision was 60%. “Circumcision will be most effective if it is not perceived as a stand-alone procedure, but as one component of a full suite of HIV prevention and reproductive health services, including HIV testing and counseling, diagnosis and treatment of sexually transmitted infections, condom promotion, [and] behavioral change counseling and promotion….”.
A randomized trial in Rakai, Uganda with 4,996 uncircumcised HIV-negative men aged 15 to 49 years of age found that HIV incidence over 24 months was .66 cases per 100 person years among men who were circumcised and 1.33 cases per 100 person years among men who delayed circumcision for 24 months, with an estimated efficacy of 51%..
Gray, R., G. Kogozi, D. Serwadda, F. Maumbi, S. Watya, F. Nalugoda, N. Kiwanuka, L. Moulton, M. Chaudhary, M. Chen, N. Sewanakambo, F. Wabwire-Mangen, M. Bacon, C. Williams, P. Opendi, S. Reynolds, O. Laeyendecker, T. Quinn and M. Wawer. 2007. “Male Circumcision for HIV Prevention in Men in Rakai, Uganda: A Randomised Trial.” The Lancet 369: 657-666.