Male circumcision curbs spread of HIV over time, risky behavior does not increase

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Dr. Bertran Auvert (center), principal investigator of the ANRS 12126 male circumcision (MC) trial in Orange Farm South Africa, discusses results after three years of MC scale up Wednesday. (Photo: Meredith Mazzotta/Science Speaks)

Three years after the voluntary medical male circumcision (MC) campaign rolled out in the Orange Farm Township in South Africa, the first “real world” results are available showing a marked reduction of HIV acquisition among circumcised adult men with a 55 percent lower HIV prevalence (proportion of HIV-infected people) among circumcised men compared to their uncircumcised counterparts and overall reduction in HIV incidence (the number of new cases) among men 15 to 34 years old of 76 percent.

Earlier randomized controlled studies have shown medical male circumcision to reduce the risk of men acquiring HIV through vaginal sex by up to 60 percent. It is rare indeed for on-the-ground implementation of an intervention to yield even greater efficacy than was measured in a randomized clinical trial.

The ANRS 12126 trial involved 110,000 adults and shows MC roll-out is effective at the community level in curbing the spread of HIV. The free service was offered to all willing male residents 16 years of age and older.

“After three years of this project, people are still coming to us to get circumcised,” said Dr. Betran Auvert of the University of Versailles, principal investigator of the ANRS trial. When the trial started, circumcision prevalence among men in Orange Farm was at 10 percent; now it is 50 percent, and even higher among young people, he said at a press conference Wednesday afternoon at the 2011 International AIDS Conference in Rome.

A slide from Dr. Auvert showing what would have happened without MC intervention on all adult men in the Orange Farm community in South Africa.

“We calculated that without MC in this community HIV prevalence would have been 25 percent higher and without MC in this community HIV incidence among all men would have been 58 percent higher,” Auvert said at the late-breaker session

Also crucially important, men are not changing their sexual risk behavior after having been circumcised, Auvert said. Circumcised men were found to be younger, more educated, less likely to be married and more aware of their HIV status than those who were not circumcised.

Another MC study with results reported at the conference revealed that of 316 men interviewed one year after having been voluntarily circumcised, 92.3 percent said they experienced more sexual pleasure after the operation and 87.7 percent found it easier to reach an orgasm. The researchers at the University of Makerere in Uganda also revealed that nine out of 10 men said they were happy with the look of their penis after having the operation, and 95.4% said their partner was also pleased.

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