Roll-out of community voluntary male circumcision is linked to reduced HIV infection levels

Roll-out of voluntary male circumcision services into the community of Orange Farm, South Africa is linked to substantial reductions in HIV infection levels, according to a study published in this week's PLOS Medicine. The study, (ANRS-12126), conducted by Bertran Auvert and colleagues from the University of Versailles (France), also reported that substantial uptake of voluntary male circumcision in one community was not linked to changes in sexual behavior that might affect HIV infection rates.

In this study, Bertran Auvert and colleagues estimated HIV infection levels in men associated with the implementation of the Bophelo Pele project, a community-based campaign against HIV that was initiated in 2008 and that includes free voluntary male circumcision services. Approximately 18,000 circumcision procedures on adult men were performed between 2008 and 2010.

Using information from surveys, the researchers observed that 12% of the men surveyed had been circumcised before the implementation of the Bophelo Pele project whereas in the follow-up survey, the overall rate of circumcision increased to 53% of the men surveyed. The overall HIV rate at follow-up was 12% and the researchers estimated that without the circumcision procedures performed during the Bophelo Pele project, the rate of HIV among men living in this community would have been 15% in 2011. The findings suggest that circumcision was also linked to a reduced number of new HIV infections but the methods used in this study cannot prove cause and effect. However, importantly, there was no evidence of a link between circumcision status and risky sexual behavior.

The authors say: "This study suggests that the roll-out of adult [voluntary medical male circumcision] is associated with a reduction in HIV in a sub-Saharan community where [male circumcision] is not a social norm."

They continue: " The main implication of this study is that the current roll-out of adult [voluntary medical male circumcision], endorsed by UNAIDS and WHO, and supported by international agencies such as PEPFAR, the Global Fund, and by donors like the Bill and Melinda gates Foundation, should be accelerated."