Article Text

Will circumcision provide even more protection from HIV to women and men? New estimates of the population impact of circumcision interventions
  1. Timothy B Hallett1,
  2. Ramzi A Alsallaq2,
  3. Jared M Baeten3,
  4. Helen Weiss4,
  5. Connie Celum3,
  6. Ron Gray5,
  7. Laith Abu-Raddad2,6,7
  1. 1Department of Infectious Disease Epidemiology, Imperial College London, London, UK
  2. 2Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  3. 3Departments of Global Health and Medicine, University of Washington, Seattle, Washington, USA
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  5. 5Department of Population, Family and Reproductive Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
  6. 6Weill Cornell Medical College - Qatar, Qatar Foundation - Education City, Doha, Qatar
  7. 7Department of Public Health, Weill Cornell Medical College, Cornell University, New York, New York, USA
  1. Correspondence to Dr Timothy B Hallett, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK; timothy.hallett{at}


Background Mathematical modelling has indicated that expansion of male circumcision services in high HIV prevalence settings can substantially reduce population-level HIV transmission. However, these projections need revision to incorporate new data on the effect of male circumcision on the risk of acquiring and transmitting HIV.

Methods Recent data on the effect of male circumcision during wound healing and the risk of HIV transmission to women were synthesised based on four trials of circumcision among adults and new observational data of HIV transmission rates in stable partnerships from men circumcised at younger ages. New estimates were generated for the impact of circumcision interventions in two mathematical models, representing the HIV epidemics in Zimbabwe and Kisumu, Kenya. The models did not capture the interaction between circumcision, HIV and other sexually transmitted infections.

Results An increase in the risk of HIV acquisition and transmission during wound healing is unlikely to have a major impact of circumcision interventions. However, it was estimated that circumcision confers a 46% reduction in the rate of male-to-female HIV transmission. If this reduction begins 2 years after the procedure, the impact of circumcision is substantially enhanced and accelerated compared with previous projections with no such effect—increasing by 40% the infections averted by the intervention overall and doubling the number of infections averted among women.

Conclusions Communities, and especially women, may benefit much more from circumcision interventions than had previously been predicted, and these results provide an even greater imperative to increase scale-up of safe male circumcision services.

  • HIV
  • mathematical model
  • circumcision
  • Epidemiology
  • Africa

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  • Funding Wellcome Trust + NIH.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.