Male circumcision and HIV infection: 10 years and counting

Abstract

A decade has passed since publication of Cameron and colleagues’ prospective study that showed a greater than eight-fold increased risk of HIV-1 infection for uncircumcised men. Today many observers of the AIDS pandemic are puzzled by the glaring discrepancies in HIV seroprevalence between different countries and regions despite the presence of what seem to be similar risk factors. For example the November 1998 UNAIDS/ WHO Report on the AIDS Epidemic concludes “It is not fully understood why HIV infection rates take off in some countries while remaining stable in neighbouring countries over many years.” We argue that since Cameron and colleagues’ landmark study the epidemiological and biological evidence that links lack of circumcision with HIV transmission has become compelling and that lack of male circumcision is one of the main causes of many regional discrepancies in rates of HIV infection. Furthermore as increasing numbers of men in some traditionally non-circumcising communities seek safe affordable circumcisions to avoid AIDS and other sexually transmitted diseases (STDs) it is time for the international health community to add male-circumcision services to the current limited armamentarium of AIDS prevention measures in countries with a high prevalence of heterosexually transmitted HIV and STDs. (excerpt)