The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa

作者：Brian Gerard Williams, James O. Lloyd‐Smith, Eleanor Gouws, Catherine A Hankins, Wayne Marcus Getz, John W. Hargrove, Isabelle De Zoysa, Christopher Dye, Bertran Auvert · 发表于：PLoS Medicine · 年份：2006 · DOI：10.1371/journal.pmed.0030262 · 被引用次数：397 · 研究领域：Genital Health and Disease、Female Genital Mutilation/Cutting Issues、Cervical Cancer and HPV Research

BACKGROUND: 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 ...