The potential impact of male circumcision on HIV in Sub-Saharan Africa

Simple item page
dc.contributor.authorWilliams, Brian G.en_ZA
dc.contributor.authorLloyd-Smith, James O.en_ZA
dc.contributor.authorGouws, Eleanoren_ZA
dc.contributor.authorHankins, Catherineen_ZA
dc.contributor.authorGetz, Wayne M.en_ZA
dc.contributor.authorHargrove, Johnen_ZA
dc.contributor.authorDe Zoysa, Isabelleen_ZA
dc.contributor.authorDye, Christopheren_ZA
dc.contributor.authorAuvert, Bertranen_ZA
dc.date.accessioned2012-07-25T13:42:50Z
dc.date.available2012-07-25T13:42:50Z
dc.date.issued2006-07
dc.descriptionThe original publication is available at http://www.plosmedicine.orgen_ZA
dc.description.abstractBackground A randomized controlled trial (RCT) has shown that male circumcision (MC) reduces sexual transmission of HIV from women to men by 60% (32% 76%; 95% CI) offering an intervention of proven efficacy for reducing the sexual spread of HIV. We explore the implications of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa. Methods and Findings Using dynamical simulation models we consider the impact of MC on the relative prevalence of HIV in men and women and in circumcised and uncircumcised men. Using country level data on HIV prevalence and MC, we estimate the impact of increasing MC coverage on HIV incidence, HIV prevalence, and HIV-related deaths over the next ten, twenty, and thirty years in sub-Saharan Africa. Assuming that full coverage of MC is achieved over the next ten years, we consider three scenarios in which the reduction in transmission is given by the best estimate and the upper and lower 95% confidence limits of the reduction in transmission observed in the RCT. MC could avert 2.0 (1.1 3.8) million new HIV infections and 0.3 (0.1 0.5) million deaths over the next ten years in sub-Saharan Africa. In the ten years after that, it could avert a further 3.7 (1.9 7.5) million new HIV infections and 2.7 (1.5 5.3) million deaths, with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa. We show that a) MC will increase the proportion of infected people who are women from about 52% to 58%; b) where there is homogenous mixing but not all men are circumcised, the prevalence of infection in circumcised men is likely to be about 80% of that in uncircumcised men; c) MC is equivalent to an intervention, such as a vaccine or increased condom use, that reduces transmission in both directions by 37%. Conclusions This analysis is based on the result of just one RCT, but if the results of that trial are confirmed we suggest that MC could substantially reduce the burden of HIV in Africa, especially in southern Africa where the prevalence of MC is low and the prevalence of HIV is high. While the protective benefit to HIV-negative men will be immediate, the full impact of MC on HIV-related illness and death will only be apparent in ten to twenty years.en_ZA
dc.description.versionPublishers' Versionen_ZA
dc.format.extentp. 1032 - 1040 : ill., maps
dc.identifier.citationWilliams, B.G. et al. 2006. The potential impact of male circumcision on HIV in Sub-Saharan Africa. PLoS Med, 3(7), e262, 1032-1040, doi:10.1371/journal.pmed.0030262.en_ZA
dc.identifier.issn1549-1676 (online)
dc.identifier.issn1549-1277 (print)
dc.identifier.otherdoi:10.1371/journal.pmed.0030262
dc.identifier.urihttp://hdl.handle.net/10019.1/21805
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science -- PLoSen_ZA
dc.rights.holderAuthors retain the copyrighten_ZA
dc.subjectHIV infections -- Africa, Sub-Saharan -- Preventionen_ZA
dc.subjectAIDS (Diseases) -- Africa, Sub-Saharan -- Preventionen_ZA
dc.subjectCircumcision -- Africa, Sub-Saharanen_ZA
dc.titleThe potential impact of male circumcision on HIV in Sub-Saharan Africaen_ZA
dc.typeArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
williams_potential_2006.pdf
Size:
223.38 KB
Format:
Adobe Portable Document Format
Description:
Publishers' Version
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.95 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Research Articles ((SACEMA) South African Centre for Epidemiological Modelling and Analysis )