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Submitted by Patricio V Marquez on
Colleague--Please note that accumulated scientific evidence that shows that male circumcision significantly reduces the incidence of HIV infection among men is from three landmark clinical trials in South Africa, Kenya and Uganda (all duly published in peer reviewed journals such as The Lancet). These findings were reinforced by the results of a second trial in South Africa led by Auvert et al that were presented at the International AIDS Society conference in Rome in 2011 that provided the basis for the UNAIDS recommendation. The new analysis by Auvert et al involved 1,198 South African men, aged 15 to 49, randomly sampled, interviewed and tested for HIV in 2007, before the circumcision programme began, and 1,178 men of the same age studied in late 2010, three years into the circumcision programme. Among men 15 to 49 years old, adjusted HIV prevalence was 55% lower in the 2010 group than in the 2007 group (adjusted prevalence ratio 0.45, 95% confidence interval [CI ] 0.30 to 0.63). Among men 15 to 34 years old, adjusted HIV incidence was 76% lower in the 2010 group (adjusted incidence ratio 0.24, 95% CI 0.00 to 0.66). The investigators calculated that without the intervention (if no men were circumcised), HIV prevalence among 15- to 49-year-old men would have been 25.1% higher than with the intervention (95% CI 13.1% to 39.1%), and HIV incidence among 15- to 34-year-old men would have been 57.9% higher (95% CI 17.0% to 131%). The report of the 2011 IAS conference is at: http://www.iasociety.org/Web/WebContent/File/IAS2011_Conference_Report.pdf Auvert B, Taljaard D, Rech D, et al. Effect of the Orange Farm (South Africa) male circumcision roll-out (ANRS) on the spread of HIV. IAS 2011 Rome (Italy), Abstract number WELBC02 There are other benefits from male circumcision as well. As published in the NEJM (see below), in addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure. (ClinicalTrials.gov numbers, NCT00425984 and NCT00124878.) Auvert B, Sobngwi-Tambekou J, Cutler E, et al. Eff ect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Tobian AA, Serwadda D, Quinn TC, et al. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med 2009; 360: 1298–309 Other references of interest: Weiss HA, Hankins CA, Dickson K. Male circumcision and risk of HIV infection in women: a systematic review and meta-analysis. Lancet Infect Dis 2009; 9: 669–77 Orange Farm, South Africa. J Infect Dis 2009; 199: 14–19. Hallett TB, Alsallaq RA, Baeten JM, Weiss H, Celum C, Gray R, Abu-Raddad L. Will circumcision provide even more protection from HIV to women and men? New estimates of the population impact of circumcision interventions. Sex Transm Infect 2011, 87:88-93.