AEGiS-NV: Medical circumcision will cut HIV infections

Important note: Information in this article was accurate in 2009. The state of the art may have changed since the publication date.

Medical circumcision will cut HIV infections

New Vision (Kampala) - September 25, 2009
Anne Abaho

With Uganda's high HIV prevalence, 5 - 15 men will need to be circumcised to prevent one HIV infection in the next 10 years. This was the expert review of mathematical models of the impact of male circumcision, organised by UNAIDS, WHO and the South African Centre for Epidemiological Analysis. The model was published in the journal, PLoS Medicine.

Trials in Uganda, Kenya and South Africa produced compelling evidence that circumcision reduces the risk of men acquiring HIV through heterosexual sex.

Experts studied six of the mathematical models that have been developed to estimate the likely impact of massive circumcision and concluded thus:

Reduced HIV incidence

That, over 10 years, one new HIV infection would be averted for every five to 15 men circumcised. In some circumstances, if 80% of men are circumcised, HIV incidence could be reduced by 30-50% in 10 years.

Costs saved

That circumcision would reduce the cost of managing HIV in the long run. If sh60,000 - sh120,000 is spent per adult circumcision and a life-time treatment cost per HIV infection requires $7,000 (sh14m) on first-line therapy only, we would save sh300,000 - 1,800,000 per infection prevented, calculated over a 10-year period.

Risky behaviour

That even if circumcised men believed they were protected fully against infection and increased their sexual risk-taking, it would have a "small effect" at the population level.

Women benefits

Women would then benefit indirectly because their likelihood of meeting an HIV-positive male partner would decline. Reductions in STDs in both men and women would reduce women's risk of acquiring HIV.

African countries

By July, Kenya, Namibia, Botswana, Zambia, Swaziland, Zimbabwe, Rwanda and South Africa had rolled out free circumcision in varying degrees. In Uganda, the situation analysis on universal circumcision was completed and budget drawn. But consultations with stakeholders are still being done.

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