International

Report on Male Circumcision: an Arguable Method of Reducing the Risks of HIV Transmission

Published 15 May 2007

Members of the Working Committee on circumcision:
- Willy Rozenbaum, President;
- François Bourdillon, Vice President;
- Jean-Pierre Dozon;
- Samir Hamamah;
- William Lowenstein;
- Danielle Quantinet;
- Muriel Vray

Report produced by: Marc Dixneuf; Anthony Poncier.

An initial short-term study on male circumcision led by the Agence nationale de recherche sur le sida (ANRS) at Orange Farm in South Africa revealed a reduction of 60% in the risk of HIV transmission among circumcised men who have heterosexual sex [1]. Thereafter, two further studies carried out by the National Institutes of Health (NIH), one in Kisumu in Kenya [2], the other in Rakai in Uganda, [3] demonstrated a reduction of around 50% in the risk of HIV infection within the context of heterosexual sex practiced by men who had been circumcised. Following on from these results, the WHO and UNAIDS quickly organised a congress of experts whose conclusions envisage «considering male circumcision as a significant supplementary means of reducing the risk of heterosexual HIV transmission in men.» [4]. Male circumcision therefore appears to be a possible method of reducing risk in specific situations. However, in parallel to the interpretation of the results, studies are generating debate among the scientific community and are also raising a number of questions with regard to its implementation and role in terms of public health strategy. The heavy media coverage of the recent results of this research and the confusion that this has caused in terms of understanding of the messages of prevention has prompted the Conseil national du sida (CNS) to take steps to clarify the situation.

Footnotes

[1]Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction in HIV infection risk: the ANRS Trial. Plos Med 2005; 2(11): e298.

[2]Bailey RC, Moses S, Parker C, Agot K, Maclean I, Krieger JN, Williams CFM, Campbell RT, Ndinya-Achola JO. Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. The Lancet 2007; 369: 643-56.

[3]Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ, Sewankambo NK, Wabwire-Mangen F, Bacon MC, Williams CFM, Opendi P, Reynolds SJ, Laeyendecker O, Quinn TC, Wawer MJ. Male circumcision for HIV prevention in young men in Rakai, Uganda: A randomised controlled trial. The Lancet 2007; 369: 657-66.

[4]Joint press release between WHO / UNAIDS issued on 28 March: WHO and UNAIDS announce recommendations from expert consultation on male circumcision HIV prevention. http://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html

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