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Open Access Highly Accessed Review

Male circumcision for HIV prevention: current evidence and implementation in sub-Saharan Africa

Richard G Wamai1*, Brian J Morris2, Stefan A Bailis3, David Sokal4, Jeffrey D Klausner5, Ross Appleton6, Nelson Sewankambo7, David A Cooper8, John Bongaarts9, Guy de Bruyn10, Alex D Wodak11 and Joya Banerjee12

Author Affiliations

1 Department of African-American Studies, Northeastern University, Boston, MA, USA

2 School of Medical Sciences, University of Sydney, Australia

3 Research & Education Association on Circumcision Health Effects, Bloomington, MN, USA

4 Behavioral and Biomedical Research, Family Health International, Research Triangle Park, NC, USA

5 Department of Medicine, University of California, San Francisco Department of Public Health, USA

6 College of Professional Studies, Northeastern University, Boston, MA, USA

7 Makerere University College of Health Sciences, Kampala, Uganda

8 Kirby Institute, St Vincents Hospital and University of New South Wales Sydney, Australia

9 Population Council, One Dag Hammarskjold Plaza, New York, NY, USA

10 Perinatal HIV Research Unit, New Nurses Home, Chris Hani Baragwanath Hospital, Johannesburg, South Africa

11 Alcohol & Drug Unit, St Vincent's Hospital, Sydney, Australia

12 Global Youth Coalition on HIV/AIDS, Pretoria, South Africa

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Journal of the International AIDS Society 2011, 14:49  doi:10.1186/1758-2652-14-49

Published: 20 October 2011

Abstract

Heterosexual exposure accounts for most HIV transmission in sub-Saharan Africa, and this mode, as a proportion of new infections, is escalating globally. The scientific evidence accumulated over more than 20 years shows that among the strategies advocated during this period for HIV prevention, male circumcision is one of, if not, the most efficacious epidemiologically, as well as cost-wise. Despite this, and recommendation of the procedure by global policy makers, national implementation has been slow. Additionally, some are not convinced of the protective effect of male circumcision and there are also reports, unsupported by evidence, that non-sex-related drivers play a major role in HIV transmission in sub-Saharan Africa. Here, we provide a critical evaluation of the state of the current evidence for male circumcision in reducing HIV infection in light of established transmission drivers, provide an update on programmes now in place in this region, and explain why policies based on established scientific evidence should be prioritized. We conclude that the evidence supports the need to accelerate the implementation of medical male circumcision programmes for HIV prevention in generalized heterosexual epidemics, as well as in countering the growing heterosexual transmission in countries where HIV prevalence is presently low.