Circumcision Stops HIV

Circumcision is preventing tens of thousands of cases of HIV infection, a new study

from Zimbabwe has confirmed this week.
In 2007, trials first began to show that men who had been circumcised are significantly less
likely to contract HIV. Compared with uncircumcised individuals, the HIV infection rate was
up to 80% lower in the individuals who had had their foreskins removed.
This level of protection is sufficient for the precedure to be regarded as a form of surgical
vaccine, and led to the roll-out of a range of internationally-funded initiatives aiming to
increase circumcision rates, by 2015, to at least 80% of sexually-active men living in 14
countries. These were areas with traditionally low-levels of circumcision previously and a
high prevalence of HIV infection.
One of these geographies is Zimbabwe where, in the 1990s, about one third of the population
was HIV infected; today, it is about 14%.
To establish the impact, if any, of circumcision within communities in Zimbabwe, Imperial
College scientist Jessica McGillen and her colleagues have now constructed a series of
mathematical models, which they have calibrated using household survey data on prevalence
and risk behaviours, as well as circumcision coverage data. The results are published in PLoS
ONE.
Overall, more than one million men have undergone circumcision in the country, preventing,
co-author John Stover suggests, in the region of 80,000 cases of HIV so far. This number, he
predicts, will scale to over half a million cases of HIV prevented over the next 15 years since
many of the participants in the voluntary medical male circumcision programme were not yet
sexually active.
The uptake of circumcision was initially slightly slower than expected owing, the team
speculate, to uncertainty around the procedure. Consequently, the date to reach the 80%
target has been pushed back to 2021.
But, Stover explains, if 80-90% of the male population can be accessed by the
programme, "the benefits will be huge". And there is also an added return: "The cost of the
programme is offset by the money saved on anti-retroviral drugs."
What will the strategy be once the target level is achieved though? Will the focus shift from
targeting teenagers and men in their early twenties to promoting circumcision of newborns?
"That's being debated at the moment," says Stover. "Circumcision is simpler and cheaper,
with fewer side effects, when done in the neonatal period. But the system is very much set up
around reaching out to older age groups, and to switch targets might undermine the success
of the initiative."
The impact of HIV means that studies like the present one are important in determining
whether policies like voluntary medical male circumcision are effective and therefore
whether the funding is being well invested.
Overall, the importance of effective anti-AIDS interventions cannot be overstated. Every day
thousands of people die from an HIV-related infection and an equivalent number become
newly infected with the virus, 80% of them in sub-Saharan Africa. Alongside education and
safe sex messages, and until an effective vaccine is produced, circumcision remains the most
effective tool we have in combating one of the worst pandemics to afflict the human race.