...what the new data mean for HIV prevention in the United States
Author(s): Sullivan PS, Kilmarx PH, Peterman TA, et al.
Reference: PLoS Med. 2007 Jul 24;4(7):e223.
Published Abstract:
Three randomized, controlled clinical trials in South Africa, Kenya, and Uganda were recently unblinded early because interim analyses concluded that circumcision of HIV-negative adult males reduced their risk for acquiring HIV infection through penile-vaginal sex [1-3]. In each trial, men who had been randomly assigned to an intervention group receiving circumcision had a lower incidence of HIV infection in up to two years of follow up, compared to men who were assigned to a control group not receiving circumcision. The estimated reduction in the risk of HIV infection ranged from 51% to 60%; per-protocol estimates of risk reduction ranged from 55% to 76%. It is now clear that male circumcision can be efficacious for men in reducing their risk of HIV acquisition through sex with women [4]. Some experts predict that the impact of male circumcision as a biomedical intervention for HIV prevention in Africa could be large [5,6], and preparatory work has been done to establish male circumcision programs in Africa. The implications of African trials on circumcision for HIV prevention programs in the United States are less clear-despite the interest of the popular press in the idea [7]. Here, we consider the differences between the HIV epidemics in Africa and the US, the current status of male circumcision in the US, and the knowledge gaps that will need to be addressed as we consider whether male circumcision should be evaluated or implemented as a biomedical intervention to reduce sexually acquired HIV infections domestically.
The full paper is available here.
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