Abstract
This paper reviews the demographic evidence for the relationship between male circumcision and HIV infection in national or sub-national African populations. A meta-analysis based on 18 countries, representing more than half of the population of sub-Saharan Africa, shows no relationship [standardized odds ratio = 1.00; 95% CI: 0.96–1.05]. There were even more countries in which HIV prevalence was higher among circumcised persons than countries where it was lower. In only five countries, the odds ratio of HIV prevalence (circumcised/intact) was significantly different from 1.0; three countries where it was higher, and two countries where it was lower. The contrast between lack of demographic impact and results from clinical trial is striking, and can probably be explained by the low clinical efficacy in situations of intense and repeated exposure, and by the interactions with the many other determinants of HIV spread. This paper also addresses some ethical and political issues, and in particular raises the question of power abuse, which may lie in the practice of genital mutilations and relevant international recommendations.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Aggleton P. (2007) Just a snip? A social history of male circumcision. Reprod Health Matters. 15(29):15–21.
Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLOS Med. 2(11):e298, 1–111.
Bailey RC, Moses S, Parker CB, Agot K, MacLean I, Krieger JN, Willams CFM, Campbell RT, Nidnya-Achola JO. (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: A randomised controlled trial. Lancet. 369:643–656.
Bongaarts J, Reining P, Way P, Conant F. (1989) The relationship between male circumcision and HIV infection in African populations. AIDS. 3(6):373–377.
Brown T, Sittitrai W, Vanichseni S, Thisyakorn U. (1994) The recent epidemiology of HIV and AIDS in Thailand. AIDS. 8(Suppl 2):S131–S141.
Clark PA. (2006) To circumcise or not to circumcise? Health Prog. 87(5):1–9.
Connolly C, Simbayi LC, Shanmugam R, Nqeketo A. (2008) Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002. S Afr Med J. 98(10):789–794.
Darby R. (2005) A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain. Chicago, IL: University of Chicago Press.
Demographic and Health Surveys. Web site: http://www.measuredhs.com
Doctors opposing male circumcision. (2006) Medical Ethics and the Circumcision of Children. Report, 2006. Available on web site: http://www.doctorsopposingcircumcision.org/pdf/A4-MedicalEthicsReport.pdf
Edwards K, Decker M. (2008) Cholera vaccine. In: Plotkin SA, Orenstein WA. (eds.) Vaccines. Philadelphia, PA: Elsevier-Saunders.
Garenne M. (2006) Male circumcision and HIV control in Africa. PLoS Med. 3(1):e78.[Letter]
Garenne M. (2008) Long-term population effect of male circumcision in generalized HIV epidemics in sub-Saharan Africa. Afr J AIDS Res. 7(1):1–8.
Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ, Sewankambo NK, Wabwire-Mangen F, Bacon MC, Williams CFM, Opendi P, Reynolds SJ, Laeyendecker O, Quinn TC, Waver MJ. (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised controlled trial. Lancet. 369:657–666.
Labbok MH, Queenan JT. (1989) The use of periodic abstinence for family planning. Clin Obstet Gynecol. 32(2):387–402.
Lesotho – Ministry of Health and Social Welfare (MOHSW), Bureau of Statistics (BOS), and ORC Macro. (2005) Lesotho Demographic and Health Survey 2004. Calverton, NY: MOH, BOS, and ORC Macro.
Low-Beer D. (2002) HIV incidence and prevalence trends in Uganda. Lancet. 360(9347):1788.
Low-Beer D, Stoneburner RL. (2003) Behaviour and communication change in reducing HIV: Is Uganda unique? Afr J AIDS Res. 1(2):9–21.
Malawi – National Statistical Office (NSO), and ORC Macro. (2005) Malawi Demographic and Health Survey 2004. Calverton, NY: NSO and ORC Macro.
Mead M. (1949) Male and Female: A Study of the Sexes in a Changing World. New York, NY: [Reprinted by Harper-Collins, 2002].
Moses S, Bradley JE et al. (1990) Geographical patterns of male circumcision practices in Africa. Int J Epidemiol. 19(3):693–697.
Pollard R. (1980) Relation between vaccination and notification rates for whooping cough in England and Wales. Lancet. 1(8179):1180–1182.
Redd SC, Markowitz LE, Katz SL. (1999) Measles vaccine. In: Plotkin SA, Orenstein WA. (eds.) Vaccines. Philadelphia, PA: W.B. Saunders, pp 222–266.
Tacket C, Sack D. (2008) Cholera vaccine. In: Plotkin SA, Orenstein WA. (eds.) Vaccines. Philadelphia, PA: Elsevier-Saunders.
Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, Weiss H, Wlaker S, Williamson P. (2007) Male circumcision for prevention of heterosexual acquisition of HIV in men (Review). The Cochrane Library.
South Africa. (2002) The Nelson Mandela/HSRC study of HIV/AIDS, 2002. Human Science Research Council, Cape Town, South Africa. [available on web site: http://www.hsrcpress.ac.za]
Tanzania – Commission for AIDS (TACAIDS), National Bureau of Statistics (NBS), and ORC Macro. (2005) Tanzania HIV/AIDS Indicator Survey 2003–2004. Calverton, NY: TACAIDS, NBS, and ORC Macro.
Van Howe RS. (1999a) Does circumcision influence sexually transmitted diseases? A literature review. BJU Int. 83(Supp 1):52–62.
Van Howe RS. (1999b) Circumcision and HIV infection: Review of the literature and meta-analysis. Int J STD AIDS. 10:8–16.
Weiss HA, Quigley MA, Hayes RK. (2000) Male circumcision and risk of HIV infection in sub-Saharan Africa: A systematic review and meta-analysis. AIDS. 174:2361–2370.
Wood DL, Brunell PA. (1995) Measles control in the United States: Problems of the past and challenges for the future. Clin Microbiol Rev. 8(2):260–267.
WHO/UNAIDS. (2007) Recommendations from expert consultation on male circumcision for HIV prevention. Available at: http://www.who.int/hiv/mediacentre/news68/en/index.html
Zwang J, Garenne M. (2008) Premarital fertility and HIV/AIDS in Africa. Afr J Reprod Health. 12(1):64–74.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer Netherlands
About this chapter
Cite this chapter
Garenne, M. (2010). Mass Campaigns of Male Circumcision for HIV Control in Africa: Clinical Efficacy, Population Effectiveness, Political Issues. In: Denniston, G., Hodges, F., Milos, M. (eds) Genital Autonomy:. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-9446-9_4
Download citation
DOI: https://doi.org/10.1007/978-90-481-9446-9_4
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-90-481-9445-2
Online ISBN: 978-90-481-9446-9
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)