Male circumcision and prevention of HIV and sexually transmitted infections (original) (raw)

Male circumcision: Impact on human immunodeficiency virus and other sexually transmitted infections

2018

High-quality data show that male circumcision reduces the risk of human immunodeficiency virus type 1 (HIV) infection by approximately 70% during heterosexual intercourse. Three major lines of evidence support this conclusion: biological data suggesting that this concept is plausible, data from observational studies supported by high-quality meta-analysis, and three randomized controlled trials involving more than 11,000 participants, also supported by high quality meta-analyses. The evidence from these biological studies, observational studies, randomized controlled clinical trials, meta-analyses, and cost-effectiveness studies is conclusive. Besides reducing risk of HIV infection, male circumcision also reduces the risk of a number of other sexually transmitted infections, including: high-risk human papillomavirus types, genital herpes, Trichomonas vaginalis, Mycoplasma genitalium, syphilis, chancroid and genital ulcer disease. These strong data reinforce policy statements promoti...

Male Circumcision and HIV

Given the high prevalence of HIV-1 among circumcised Luo men (20%), any putative benefit of circumcision in reducing HIV-1 infection is limited. 1 Many factors aside from circumcision must be considered, including safer sex practices (eg, use of condoms).5 Agot and coworkers themselves stated that, “if performed under unhygienic conditions, circumcision itself could actually be responsible for transmitting the infection.” Thus, advocating mass circumcision as a strategy to counter spread of HIV-1 in sub-Saharan Africa could even contribute to further uncontrolled spread of the disease.

Male circumcision and the risk of HIV infection

The AIDS reader, 2005

Epidemiologic data have suggested that male circumcision is a major protective factor against male heterosexual HIV transmission and may explain the significant geographic differences in the prevalence of HIV observed within sub-Saharan Africa. To assess the evidence of the protective effect of male circumcision, African studies on its association with HIV infection were reviewed. These studies' systematic lack of control of important confounding factors makes the assessment of the association between male circumcision and HIV transmission very difficult and raises doubt about the validity of the current findings. Randomized trials are needed to determine the true strength of the association. Until then, a decision to recommend mass male circumcision to prevent HIV transmission in sub-Saharan Africa is premature and risky.

Male circumcision for HIV prevention: current research and programmatic issues

AIDS, 2010

Randomized controlled trials in sub-Saharan Africa have shown that adult male circumcision reduces the risk of HIV acquisition in men by about 60%. In this paper we review recent data on the association of male circumcision and HIV/STI in men and women. This includes a summary of data showing some evidence of an effect of male circumcision against genital ulcer disease, HSV-2 infection, HPV and Trichomonas vaginalis, but not Chlamydia trachomatis or Neisseria gonorrhea in men. Longitudinal studies among HIV discordant couples suggest that male circumcision may provide some direct long-term benefit to women, which may start after complete wound-healing. Circumcision may also protect against HIV acquisition in men who have sex with men and practice unprotected anal intercourse (either exclusively or predominantly), although this data is not consistent. To date, there is little evidence from the few studies available of either unsafe practices or reported increases in risky behaviour, or adverse changes in sexual satisfaction and function. As countries in southern and eastern Africa scale up services, operational research will likely be useful to iteratively improve programme delivery and impact, while identifying the best methods of integrating safe male circumcision services into HIV prevention strategies and strengthening health systems.