The Cost to Circumcise Africa

Abstract

Male circumcision employed as a prophylactic surgical intervention for HIV transmission reduction has been publicized in the media following recent results from observational trials conducted in Africa. Yet in all of the discussions concerning circumcision as a public health initiative, including a cost analysis performed on circumcision as a prophylactic for reducing HIV transmission in Africa, none estimates the endeavor’s scope or cost. Given the scale of the economics involved in and the number of competing strategies available for addressing the HIV epidemic, funding and cost effectiveness are vital concerns in the field. This raises the question of which treatments and methodologies to fund, or not. In this study, we use circumcision costs, census, and demographic data available from government agencies and other published sources to estimate the cost to circumcise all HIVnegative African adult males, including costs of complications. We compare that cost to another androcentric penile alteration: using condoms (including their purchase and distribution costs). Our findings suggest that behavior change programs are more efficient and cost effective than surgical procedures. Providing free condoms is estimated to be significantly less costly, more effective in comparison to circumcising, and at least 95 times more cost effective at stopping the spread of HIV in sub-Saharan Africa. In addition, condom usage provides protection for women as well as men. This is significant in an area where almost 61% of adults living with AIDS are women.