- Studies have shown a biological basis for the protective effect observed, as the inner foreskin has been shown to be poorly keratinized, contain a high proportion of HIV target cells such as Langerhans’ cells, and in vitro have a higher uptake rate of HIV than female cervical cells.4,5
- 2 other RCTs exist, showing similar evidence with 51% reduction in a Ugandan population3 and 60% in a South African population.2
- Simulation models based on assumption of 60% protective effect of circumcision estimate 2 million new HIV infections and 300,000 deaths can be prevented in Sub-Saharan Africa over the next 10 years if 100% of their population was circumcised.1 Models also predict it would be cost effective.1
- Concerns remain that belief that circumcision protects fully against HIV could lead to changes in sexual behaviors, as well as increased risk of infection in the 30 day post circumcision period.
- It is unclear what impact this would have in developed nations such as the US, where most circumcisions are done in the neonatal period, the HIV prevalence is much less, and most infections are attained via homosexual transmission or IV drug use as opposed to heterosexual transmission. The AAP is currently reevaluating their previous circumcision policy which states there is no medical necessity.
- Bailey RC, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007;369:643-56.
- Auvert B, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial, PLoS Med 2005: e298.
- Gray RH, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007;369:657-66.
- McCoombe SG, et al. Potential HIV-1 target cells in the human penis.AIDS 2006;20:1491-5.
- Patterson BK, et al. Susceptibility to human immunodeficiency virus-1 infection of human foreskin and cervical tissue grown in explant culture. Am J Pathol 2002;161:867-73.
- Seigfried N, et al. Male circumcision for prevention of heterosexual acquisition of HIV in men [Reviews]. The Cochrane Library