in South Africa suggests that the roll-out of circumcision is reducing the
prevalence and incidence of HIV among men. Published in PLOS Medicine, the study also showed circumcision does not lead to
the adoption of riskier sexual behaviour that could potentially cancel its
researchers who conducted the study believe its findings support the
accelerated roll-out of circumcision programmes for men living in settings with high
The results of
three randomised controlled trials published between 2005 and 2007 showed that circumcision reduced men’s risk of infection with HIV by between 50 and
60%. As a result, since 2007 both UNAIDS and WHO have recommended that voluntary
medical male circumcision (VMMC) programmes should be incorporated into
prevention initiatives in settings with a high HIV prevalence.
However, little is
known about the impact of circumcision roll-out programmes on the spread of HIV
investigators from the Bophelo Pele project designed a cross-sectional study involving
men in the Orange Farm township in South Africa. The first
randomised controlled trial to test the effectiveness of VMMC on HIV acquisition was conducted in the township between 2002 and
Roll-out of VMMC started in Orange Farm in 2008 and between 2007 and 2008 the French
investigators recruited 1998 men between the ages of 15 and 49 years to a
baseline survey. The men were tested for HIV, their circumcision status was
determined and demographic data were collected. The men were also asked about
their sexual risk behaviour, including condom use and number of non-spousal
A follow-up survey
was conducted in 2010 and 2011 and involved 3388 men.
calculated the prevalence of circumcision, compared HIV prevalence rates
and sexual risk behaviour between circumcised and uncircumcised men and
calculated the impact of circumcision roll-out on HIV incidence.
prevalence increased from 17% in the baseline survey to 53% in the 2010-2011
“This study has
shown that the roll-out of free VMMC can lead to a substantial uptake in just a
few years,” comment the authors.
There were no
significant differences in the sexual behaviour of circumcised and
uncircumcised men. The proportion of circumcised and uncircumcised men
reporting consistent condom use in the previous twelve months was 44 vs 45%.
The proportion reporting two or more non-spousal partners was 50 vs 44%.
The HIV prevalence
rate among uncircumcised men was 19% compared to 7% among circumcised men with
an overall prevalence rate of 12%. The investigators calculated that it would
have been 15%, almost a fifth higher, if the circumcision programme had not
been rolled out.
authors also calculated that the roll-out of VMMC reduced
the incidence of new HIV infections by between 57 and 61%.
“The roll-out of
VMMC in this community was associated with a reduction in the prevalence and
incidence of HIV among circumcised men in comparison with uncircumcised men,
and we estimate that without this project, HIV prevalence averaged on all adult
men would have been significantly higher,” write the authors.
that their study has limitations, chief among these its cross-sectional design.
As the study was not randomised, it could not prove a causal relationship
between circumcision status and the risk of HIV infection.
authors believe their research shows the value of circumcision and conclude:
“the main implication of this study is that the current roll-out of adult
VMMC…should be accelerated.”