Hiv - Male Circumcision

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MALE CIRCUMCISION AND HIV It is not known definitively whether and to what degree providing circumcision to men in cultures where male circumcision is not practiced would result in a reduced incidence of HIV infection. Numerous observational studies indicate that circumcised men have lower levels of HIV infection than uncircumcised men. HIV prevalence is lower in populations that traditionally practice male circumcision than in those parts of Africa or Southeast Asia where most men are not circumcised. However, it is unclear to what extent this may be the result of a biological effect of circumcision or whether other factors, including cultural and social ones, may also play a role. Brian G. Williams, James O. Lloyd-Smith, Eleanor Gouws, Catherine Hankins, Wayne M. Getz, John Hargrove, Isabelle de Zoysa, Christopher Dye, and Bertran Auvert reports that a randomized controlled trial (RCT) has shown that male circumcision (MC) reduces sexual transmission of HIV from women to men by 60% (32%−76%; 95% CI) offering an intervention of proven efficacy for reducing the sexual spread of HIV. Using dynamical simulation models the team considers the impact of MC on the relative prevalence of HIV in men and women and in circumcised and uncircumcised men. Using country level data on HIV prevalence and MC, they estimate the impact of increasing MC coverage on HIV incidence, HIV prevalence, and HIV-related deaths over the next ten, twenty, and thirty years in sub-Saharan Africa. Assuming that full coverage of MC is achieved over the next ten years, the team considers three scenarios in which the reduction in transmission is given by the best estimate and the upper and lower 95% confidence limits of the reduction in transmission observed in the RCT. MC could avert 2.0 (1.1−3.8) million new HIV infections and 0.3 (0.1−0.5) million deaths over the next ten years in sub-Saharan

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