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Open Access Highly Accessed Research article

Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa

Nico JD Nagelkerke12*, Stephen Moses2, Sake J de Vlas3 and Robert C Bailey4

Author Affiliations

1 Department of Community Medicine, United Arab Emirates University, United Arab Emirates

2 Departments of Medical Microbiology, Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Canada

3 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

4 Division of Epidemiology, University of Illinois at Chicago, Chicago, USA

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BMC Infectious Diseases 2007, 7:16  doi:10.1186/1471-2334-7-16

Published: 13 March 2007

Abstract

Background

Recent clinical trials in Africa, in combination with several observational epidemiological studies, have provided evidence that male circumcision can reduce HIV female-to-male transmission risk by 60% or more. However, the public health impact of large-scale male circumcision programs for HIV prevention is unclear.

Methods

Two mathematical models were examined to explore this issue: a random mixing model and a compartmental model that distinguishes risk groups associated with sex work. In the compartmental model, two scenarios were developed, one calculating HIV transmission and prevalence in a context similar to the country of Botswana, and one similar to Nyanza Province, in western Kenya.

Results

In both models, male circumcision programs resulted in large and sustained declines in HIV prevalence over time among both men and women. Men benefited somewhat more than women, but prevalence among women was also reduced substantially. With 80% male circumcision uptake, the reductions in prevalence ranged from 45% to 67% in the two "countries", and with 50% uptake, from 25% to 41%. It would take over a decade for the intervention to reach its full effect.

Conclusion

Large-scale uptake of male circumcision services in African countries with high HIV prevalence, and where male circumcision is not now routinely practised, could lead to substantial reductions in HIV transmission and prevalence over time among both men and women.