Male circumcision among heterosexual men in low male circumcision, high
HIV prevalence settings is beneficial and cost effective, says a new
article
in the open access journal PLoS Medicine. Male circumcision should be
considered as part of a combination HIV prevention package and not as an
isolated measure. One HIV infection can be averted for every five to 15
male circumcisions performed, and the costs to avert one HIV infection
ranging
from US$150 to $900 using a 10-y time horizon, say the authors. The report
is based upon a series of meetings of experts convened by UNAIDS, the
World
Health Organization (WHO), and the South African Centre for
Epidemiological Modelling and Analysis (SACEMA) that reviewed the outcomes
of six
simulation models on key policy and programmatic decision-making questions
related to male circumcision.

The models predicted that both premature postoperative resumption of
sexual intercourse and behavioural risk compensation, if confined to newly
or
already circumcised men and their partners, have only small population
level effects on the anticipated impact of male circumcision service
scale-up
on HIV incidence. Women benefit indirectly from reduced HIV prevalence in
circumcised male partners and male circumcision service scale-up acts
synergistically with other strategies to reduce HIV disease burden, says
the group. Male circumcision has minimal impact on reducing HIV
transmission
among men who have sex with men.

The group, called UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact
and Cost of Male Circumcision for HIV Prevention, was led by Dr. Catherine
Hankins, Chief Scientific Advisor at UNAIDS.

Funding:
The three UNAIDS/WHO/SACEMA modelling meetings were funded
through the First UN Work Plan on Male Circumcision and HIV, which was
supported
by the Bill & Melinda Gates Foundation, the United States National
Institutes of Health, the French Agence nationale de recherches sur le
sida, and
the Joint United Nations Programme on HIV/AIDS. The funders had no role in
study design, data collection and analysis, decision to publish, or
preparation of the manuscript.

Citation:
“Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making?”
UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Male Circumcision for HIV Prevention (2009)
PLoS Med 6(9): e1000109. doi:10.1371/journal.pmed.1000109

Source
PLoS Medicine