Circumcision and AIDS

This guy standing outside the entrance to the 2012 AIDS Conference is just wrong:

He’s not wrong in a “I disagree with you” sort of way. His contention that circumcision does not prevent HIV is demonstrably, empirically wrong.  There have been several studies showing that male circumcision can reduce the heterosexual transmission of HIV by as much as 60%. 

Circumcision is relatively inexpensive, too — far less expensive than treating people with ARVs. It targeted investment that is just one part of a larger global strategy to defeat HIV/AIDS.

In a special issue of the academic journal JAIDS several authors use mathematical modeling to demonstrate the value of voluntary medical male circumcision:

As the science demonstrating strong evidence for voluntary medical male circumcision (VMMC) for HIV prevention has evolved, the President’s Emergency Plan for AIDS Relief (PEPFAR) has collaborated with international agencies, donors, and partner country governments supporting VMMC programming. Mathematical models forecast that quickly reaching a large number of uncircumcised men with VMMC in strategically chosen popula- tions may dramatically reduce community-level HIV incidence and save billions of dollars in HIV care and treatment costs. Because VMMC is a 1-time procedure that confers life-long partial protection against HIV, programs for adult men are vital short-term investments with long-term benefits. VMMC also provides a unique opportunity to reach boys and men with HIV testing and counseling services and referrals for other HIV services, including treatment. After formal recommendations by WHO in 2007, priority countries have pursued expansion of VMMC. More than 1 million males have received VMMC thus far, with the most notable successes coming from Kenya’s Nyanza Province. However, a myriad of necessary cultural, political, and ethical considerations have moderated the pace of overall success.

Because many millions more uncircumcised men would benefit from VMMC services now, US President Barack Obama committed PEPFAR to provide 4.7 million males with VMMC by 2014. Innovative circumcision methods—such as medical devices that remove the foreskin without injected anesthesia and/or sutures—are being rigorously evaluated. Incorporation of safe innovations into surgical VMMC programs may provide the opportunity to reach more men more quickly with services and dramatically reduce HIV incidence for all.

The study shows how investments in these campaigns over time could significantly reduce HIV transmission rates in high-risk populations.  If 80% of the male adult population between the ages of 15-49 in 13 high risk countries were circumcised, nearly 400,000 new cases of HIV could be averted by 2025.

No one advocates replacing condoms with large-scale voluntary male circumcision drives. This is not an either/or proposition. But circumcision does have the comparative advantage of being a one-time intervention that does not require long-term behavior change. It is a one time intervention that offers lifelong risk-reduction, which makes male circumcision an important part of the HIV prevention mix.