Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis

  title={Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis},
  author={Helen Anne Weiss and Maria A. Quigley and Richard J. Hayes},
ObjectiveTo systematically review studies of male circumcision and the risk of HIV-1 infection in men in sub-Saharan Africa, and to summarize the findings in a meta-analysis. DesignA meta-analysis of observational studies. MethodsA systematic literature review was carried out of studies published up to April 1999 that included circumcision as a risk factor for HIV-1 infection among men in sub-Saharan Africa. A random effects meta-analysis was used to calculate a pooled relative risk (RR) and 95… 

The Association between Male Circumcision and HIV Infection in Sub-Saharan Africa: A Systematic Review of the Literature

Evidence from existing research supports promotion and scaled up of male circumcision in countries where the practice is not common, but the concern that male circumcision might substitute other efforts such as condom use and behavioural modification interventions must be addressed alongside ethical concerns such as conflict with traditional values.

Male circumcision for HIV prevention in sub-Saharan Africa: who, what and when?

Circumcision is a cost-saving intervention in a wide range of scenarios of HIV and initial circumcision prevalence but the United Nations Joint Programme on HIV/AIDS/WHO recommended target age group should be widened to include older HIV-uninfected men and counselling should be targeted at both newly and already circumcised men to minimize risk compensation.

Public health initiative : male circumcision for prevention of HIV in sub-Saharan African countries

All three RCTs reviewed that examined the effect(s) male circumcision has on HIV acquisition through heterosexual intercourse overwhelmingly support male circumcision as a means to prevent HIV transmission in sub-Saharan Africa.

Male circumcision and its association with HIV infection and sexually transmitted diseases: evidence from 18 demographic and health surveys in sub-Saharan Africa

  • Samson Gebremedhin
  • Medicine
    SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance
  • 2011
There is a strong association between uncircumcised status and HIV infection and male circumcision can be considered as a possible way of reducing the spread of HIV infection in areas where the practice is rare.

Circumcision Status and Risk of HIV Acquisition during Heterosexual Intercourse for Both Males and Females: A Meta-Analysis

Male circumcision may serve as an additional approach toward HIV control, in conjunction with other strategies such as HIV counseling and testing, condom promotion, and so on, to protect males but not females from HIV acquisition at the population level.

Economic Evaluations of Adult Male Circumcision for Prevention of Heterosexual Acquisition of HIV in Men in Sub-Saharan Africa: A Systematic Review

Economic evaluations on adult male circumcision (AMC) offered the same conclusion that AMC is cost-effective and potentially cost-saving for prevention of heterosexual acquisition of HIV in men, and should be implemented in conjunction with other evidence-based prevention methods.

The Protective Effect of Circumcision on HIV Incidence in Rural Low-Risk Men Circumcised Predominantly by Traditional Circumcisers in Kenya: Two-Year Follow-Up of the Kericho HIV Cohort Study

Data from well-designed prospective cohort studies in populations with unique cultural characteristics can supplement RCT data in recommending public health policy and offers protection from HIV infection in adult men in rural Kenya.

The when and how of male circumcision and the risk of HIV: a retrospective cross-sectional analysis of two HIV surveys from Guinea-Bissau

It is observed that post-pubertal circumcision provided the highest level of HIV risk reduction in both cohorts compared to non-circumcised, and the findings suggest that sexual risk behaviour and traditional circumcision may increases HIV risk.

Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002.

Circumcision had no protective effect in the prevention of HIV transmission, and has implications for the possible adoption of the mass male circumcision strategy both as a public health policy and an HIV prevention strategy.



Circumcision in men and the prevention of HIV infection: a 'meta-analysis' revisited

The results from this re-analysis support the contention that male circumcision may offer protection against HIV infection, particularly in high-risk groups where genital ulcers and other STDs 'drive' the HIV epidemic.

Circumcision and HIV infection: review of the literature and meta-analysis.

Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.

Circumcision and HIV Infection: Review of the Literature and Meta-Analysis

Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.

Male circumcision and susceptibility to HIV infection among men in Tanzania

Male circumcision has a protective effect against HIV infection in this population of men in north-western Tanzania, which may be stronger in urban areas and roadside settlements than in the rural areas.

Analysis of the scientific literature on male circumcision and risk for HIV infection.

It was argued that the most important risk factor for male-to-male sexual transmission of HIV is receptive anal intercourse which is not related to the circumcision status of the receptive partner.

The Association Between Lack of Male Circumcision and Risk for HIV Infection: A Review of the Epidemiological Data

Because a substantial body of evidence links noncir-cumcision in men with risk for HIV infection, consideration should be given to male circumcision as an intervention to reduce HIV transmission.

Age of male circumcision and risk of prevalent HIV infection in rural Uganda.

Prepubertal circumcision is associated with reduced HIV risk, whereas circumcision after age 20 years is not significantly protective against HIV-1 infection.

Sexual behaviors and other HIV risk factors in circumcised and uncircumcised men in Uganda.

It is suggested that differences between circumcised and uncircumcised men in their sex practices and hygienic behaviors do not account for the higher risk of HIV infection found among uncircUMcised men.

Increased risk of infection with human immunodeficiency virus type 1 among uncircumcised men presenting with genital ulcer disease in Kenya.

  • M. TyndallA. Ronald F. Plummer
  • Medicine
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 1996
A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised and with a history of urethral discharge among men with genital ulcer disease, and should be considered as an intervention strategy for AIDS control.

Male circumcision: a role in HIV prevention?

It is ultimately concluded that more studies are needed to quantify the relative risk associated with the lack of male circumcision, and Observational designs could be employed to that end along with laboratory and primate research.