Abstract
Impact of male circumcision on the female-to-male transmission
of HIV
Introduction: Observational studies suggest that male circumcision
could protect against HIV-1 acquisition. A randomized control
intervention trial to test this hypothesis was performed in sub-Saharan
Africa with a high prevalence of HIV and where the mode of transmission
is through sexual contact.
Methods: 3273 uncircumcised men, aged 18-24 and wishing to be
circumcised, were randomized in a control and intervention group.
Men were followed for 21 months with an inclusion visit and follow-up
visits at month 3, 12 and 21. Male circumcision was offered to
the intervention group just after randomization and to the control
group at the end of 21 month follow-up visit. Male circumcisions
were performed by medical doctors. At each visit, sexual behavior
was assessed by a questionnaire and a blood sample was taken for
HIV serology. These grouped censored data were analyzed in an
“intention to prevent” univariate and multivariate
analysis using the piecewise survival model, and relative risk
(RR) of HIV infection with 95% confidence interval (95% CI) was
determined.
Results: Loss to follow-up was 11%; 1% of the intervention group
were not circumcised and 2% of the control group were circumcised
during the follow-up. We observed 45 HIV infections in the control
group and 15 in the intervention group, RR=2.77 (95% CI: 1.56
– 4.91; p=0.0005). When controlling for sexual behavior,
including condom use and health seeking behavior, the RR was unchanged:
RR=2.93 (p=0.0003).
Conclusions: Male circumcision provides a high degree of protection
against HIV infection acquisition. Male circumcision is equivalent
to a vaccine with a 63% efficacy. The promotion of male circumcision
in uncircumcised males will reduce HIV incidence among men and
indirectly will protect females and children from HIV infection.
Male circumcision must be recognized as an important means to
fight the spread of HIV infection and the international community
must mobilize to promote it.
Kaisernetwork has the webcast from the session and press conference
as well as the slideset up at: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1460
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