The roll out of voluntary medical male circumcision (VMMC) programs in highly affected areas not only reduces HIV/AIDS acquisition among heterosexual men, but also significantly reduces HIV levels in the community, according to a study by researchers from the University of Versailles published in PLOS Medicine this week. The study also found that VMMC is not associated with changes in sexual behavior that may affect HIV infection rates.
In 2007 and 2008 in Orange Farm, South Africa, – the site of one of three randomized controlled trials that proved that VMMC can reduce the heterosexual acquisition of HIV in men by 50-60 percent – researchers conducted a baseline biomedical survey of nearly 2,000 men aged 15 to 49 about their sexual behavior and their intention to become circumcised. At baseline, 12 percent of men had been circumcised.
A follow up survey was conducted in 2010-2011, in which more than 3,000 men were invited to participate, and it was found that 53 percent of those surveyed had been circumcised, thanks to the roll out of the Bophelo Pele Project, a community-based campaign against HIV launched in 2008, which included free VMMC. Due to the uptake in VMMC, researchers found a reduction of HIV incidence rate ranging from 57-61 percent among circumcised men, compared to uncircumcised men.
The overall HIV prevalence rate in the community at the time of follow up was 12 percent, and researchers estimated that without the circumcisions performed during the Bophelo Pele project and the preceding randomized control trial, the prevalence of HIV among men would have been 15 percent in 2011, and 19 percent in the community at large.
Researchers also found no evidence of an association between circumcision status and risky sexual behavior.
Study writers conclude that the roll-out of VMMC among adults in sub-Saharan Africa should be an international priority and needs to be accelerated to combat the spread of HIV, and further studies need to be done to show if VMMC roll-out also reduces HIV infections among women and uncircumcised men.