What is Adult Male Circumcision for HIV Prevention? Medical male circumcision refers to the surgical removal of some or all the foreskin of the penis by a trained health professional. The research that has been done to date also shows that medical male circumcision reduces men’s risk of HIV infection and genital ulcer disease. It is believed that removing the foreskin with the vulnerable cells and the resulting toughening of the skin covering the penis decreases a man’s risk of acquiring HIV during sexual intercourse.
Three trials of male circumcision for HIV negative men have been completed and are currently continuing long-term follow up of volunteers, along with expanding male circumcision services to the broader community. These trials took place in South Africa, Kenya and Uganda. Some countries in sub-Saharan Africa can be considered priority countries for support for male circumcision programme scale-up because of their low prevalence of male circumcision and high prevalence of HIV. These include Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. A number of countries, such as Botswana, Kenya, South Africa, and Swaziland are in the early stages of preparing to scale up male circumcision services, though the pace and the stage of these efforts varies by country. The WHO/UNAIDS, in 2007, based on the clinical trial evidence recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men.
Adult Male Circumcision Investment . Global public-sector and philanthropic investment in R&D and operations research related to adult male circumcision has totaled US$51.6 million over the last eight years. Investment in circumcision research slowed after completion of the NIH-funded trials in Rakai, Uganda and Kisumu, Kenya, both in 2006. These trials, along with the ANRS-funded study in Orange Farm, South Africa, provided sufficient rationale for investment in introduction of male circumcision as an HIV prevention strategy. As scale-up has proceeded; there has been increased investment by the ANRS, BMGF, and NIH in follow-up studies. The BMGF funded a trial looking at the prevention effect of circumcision on the HIV-negative female partners of HIV-positive men. The trial found that circumcision of HIV-positive men did not reduce HIV transmission to female partners over 24 months. The NIH has supported follow-up of this trial which is scheduled to end September 2009. ANRS funded follow-up research in Orange Farm to determine if circumcision roll-out could increase use of existing means of HIV prevention and decrease the spread of HIV and HSV-2. In addition, PEPFAR began funding roll-out of adult male circumcision programs. WHO and UNAIDS, with support from the BMGF, also invested resources in materials, technical assistance, and policy development to translate the research findings into potential public-health impact.
