Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.

Three randomised controlled trials have clearly shown that circumcision of adult men reduces the chance that they acquire HIV infection. However, the potential impact of circumcision programmes--either alone or in combination with other established approaches--is not known and no further field trial...

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Main Authors: Timothy B Hallett, Kanwarjit Singh, Jennifer A Smith, Richard G White, Laith J Abu-Raddad, Geoff P Garnett
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2008-05-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC2387228?pdf=render
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spelling doaj-f19a3e3165714d0a94af6e5c8d3af37a2020-11-24T20:40:20ZengPublic Library of Science (PLoS)PLoS ONE1932-62032008-05-0135e221210.1371/journal.pone.0002212Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.Timothy B HallettKanwarjit SinghJennifer A SmithRichard G WhiteLaith J Abu-RaddadGeoff P GarnettThree randomised controlled trials have clearly shown that circumcision of adult men reduces the chance that they acquire HIV infection. However, the potential impact of circumcision programmes--either alone or in combination with other established approaches--is not known and no further field trials are planned. We have used a mathematical model, parameterised using existing trial findings, to understand and predict the impact of circumcision programmes at the population level.Our results indicate that circumcision will lead to reductions in incidence for women and uncircumcised men, as well as those circumcised, but that even the most effective intervention is unlikely to completely stem the spread of the virus. Without additional interventions, HIV incidence could eventually be reduced by 25-35%, depending on the level of coverage achieved and whether onward transmission from circumcised men is also reduced. However, circumcision interventions can act synergistically with other types of prevention programmes, and if efforts to change behaviour are increased in parallel with the scale-up of circumcision services, then dramatic reductions in HIV incidence could be achieved. In the long-term, this could lead to reduced AIDS deaths and less need for anti-retroviral therapy. Any increases in risk behaviours following circumcision, i.e. 'risk compensation', could offset some of the potential benefit of the intervention, especially for women, but only very large increases would lead to more infections overall.Circumcision will not be the silver bullet to prevent HIV transmission, but interventions could help to substantially protect men and women from infection, especially in combination with other approaches.http://europepmc.org/articles/PMC2387228?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Timothy B Hallett
Kanwarjit Singh
Jennifer A Smith
Richard G White
Laith J Abu-Raddad
Geoff P Garnett
spellingShingle Timothy B Hallett
Kanwarjit Singh
Jennifer A Smith
Richard G White
Laith J Abu-Raddad
Geoff P Garnett
Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.
PLoS ONE
author_facet Timothy B Hallett
Kanwarjit Singh
Jennifer A Smith
Richard G White
Laith J Abu-Raddad
Geoff P Garnett
author_sort Timothy B Hallett
title Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.
title_short Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.
title_full Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.
title_fullStr Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.
title_full_unstemmed Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa.
title_sort understanding the impact of male circumcision interventions on the spread of hiv in southern africa.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2008-05-01
description Three randomised controlled trials have clearly shown that circumcision of adult men reduces the chance that they acquire HIV infection. However, the potential impact of circumcision programmes--either alone or in combination with other established approaches--is not known and no further field trials are planned. We have used a mathematical model, parameterised using existing trial findings, to understand and predict the impact of circumcision programmes at the population level.Our results indicate that circumcision will lead to reductions in incidence for women and uncircumcised men, as well as those circumcised, but that even the most effective intervention is unlikely to completely stem the spread of the virus. Without additional interventions, HIV incidence could eventually be reduced by 25-35%, depending on the level of coverage achieved and whether onward transmission from circumcised men is also reduced. However, circumcision interventions can act synergistically with other types of prevention programmes, and if efforts to change behaviour are increased in parallel with the scale-up of circumcision services, then dramatic reductions in HIV incidence could be achieved. In the long-term, this could lead to reduced AIDS deaths and less need for anti-retroviral therapy. Any increases in risk behaviours following circumcision, i.e. 'risk compensation', could offset some of the potential benefit of the intervention, especially for women, but only very large increases would lead to more infections overall.Circumcision will not be the silver bullet to prevent HIV transmission, but interventions could help to substantially protect men and women from infection, especially in combination with other approaches.
url http://europepmc.org/articles/PMC2387228?pdf=render
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