The following is a guest blog post by HIV Medicine Association Executive Director Andrea Weddle, who is live blogging from the 19th Conference on Retroviruses and Opportunistic Infections in Seattle.
HIV incidence among non-Muslim men has decreased with greater uptake of voluntary medical male circumcision (MMC) in Uganda, according to data presented Tuesday at CROI. Dr. Ronald Grey and colleagues conducted an observational “time period” study among a Rakai cohort of 14,000 individuals in 50 communities. The study compared data from three time periods: 1999 to 2003 when MMC was not available among non-Muslim men; 2004 to 2006 when MMC became available through a randomized controlled trial; and the post-trial era when MMC was made available on a larger scale, especially with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program beginning in 2008. Throughout the period when MMC was available, MMC among non-Muslim men increased from 5.6 to 25.3 percent while HIV incidence decreased by 37.1 percent during the same period among non-Muslim men. No effect on HIV incidence was seen among females in the cohort. The study focused on non-Muslim men because it is the practice in the Muslim community to circumcise young boys.
Gray noted that there is no data supporting concerns that the benefits of MMC are compromised by increases in risky behaviors, such as less frequent use of condoms. “We don’t see any changes in risk behavior that might explain that change in incidence over time,” Grey said at a press conference at the 19th Conference on Retroviruses and Opportunistic Infections in Seattle Monday. “We do detailed risk behavior assessments.”
He also highlighted the challenge of increasing demand for MCC. In 2011, 65 percent of non-Muslim men remain uncircumcised in the cohort despite widespread availability and large-scale educational efforts.
Dr. Bertran Auvert reported on a trial on MMC in the Orange Farm Township in South Africa among 110,000 adults – the first study to investigate the effect of the roll-ou tof MMC in the real world spread of HIV and herpes simplex virus (HSV-2). MMC roll out started in 2008 – at that time MMC prevalence was around 11 percent among males aged 15 to 49. Prevalence of MMC has grown now to 59 percent. Auvert and colleagues conducted a cross-sectional survey among 3,000 plus men to assess the impact of this MMC roll out on HIV and HSV-2. HIV prevalence would have been 25 percent higher among all men, and when comparing circumcised men with uncircumcised men they found that HIV prevalence was 50 percent lower among circumcised men. They also found a reduction of 23 percent of HSV-2 prevalence among circumcised men as compared with uncircumcised men – similar to what was found in Rakai.
“We hope that some communication from the government of South Africa that may come some day might boost prevalence of MC to 50 or 80 percent,” Auvert said at a press conference Monday. The question is can you get MMC incidence high enough to get a population level impact on HIV, he said, adding he is optimistic they can get the very high MMC coverage rates needed.