advanced search

<< Back To Home

CSU 68/2009: MALE CIRCUMCISION FOR HIV PREVENTION IN HIGH PREVALENCE SETTINGS

Friday, 30th of October 2009

CSU 68/2009: MALE CIRCUMCISION FOR HIV PREVENTION  IN HIGH PREVALENCE SETTINGS
 
 How many surgical procedures are necessary to prevent one case of HIV?  Using mathematical models, these authors try to answer that question with  special reference to high prevalence countries in southern Africa, where  heterosexual transmission is the main vehicle of infection.
 
 Full text is at  http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000109
 
 
 Good reading.
 
 BD
 
 Summary Points
 
 Mathematical models can estimate the population-level impact of male
 circumcision on HIV incidence in high HIV prevalence settings, but
 different methods, assumptions, and input variables can produce conflicting
 results.
 
 UNAIDS/WHO/SACEMA recently convened experts to review the outcomes of six
 simulation models on key policy and programmatic decision-making questions.
 
 Large benefits of male circumcision among heterosexual men in low male
 circumcision, high HIV prevalence settings were found: one HIV infection
 being averted for every five to 15 male circumcisions performed, and costs
 to avert one HIV infection ranging from US$150 to US$900 using a 10-y time
 horizon.
 
 The models predicted that both premature postoperative resumption of sexual
 intercourse and behavioural risk compensation, if confined to newly or
 already circumcised men and their partners, have only small population
 level effects on the anticipated impact of male circumcision service
 scale-up on HIV incidence.
 
 Women benefit indirectly from reduced HIV prevalence in circumcised male
 partners and male circumcision service scale-up acts synergistically with
 other strategies to reduce HIV disease burden.
 
 The modelling results have informed development of a pragmatic
 decision-makers' programme planning tool.