HIVR4P 2016: Circumcision offers major contribution to ending HIV epidemic as a public health threat

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Science Speaks was in Chicago Oct.17-21 covering developments in HIV biomedical prevention research.

CHICAGO – Kenya’s medical circumcision program launched early with ambition, charting circumcisions performed for 1.3 million men by the end of 2015, leaving evaluators asking what is and what will be the impact of this HIV prevention intervention on the epidemic?

Through the lens of the clinical trials that showed that circumcision can reduce the risk of HIV infection by at least 60 percent, John Stover of Avenir Health, one of three modeling groups to explore the answers, shared the findings from this research on Thursday.

So far, Stover and the other modelers agree that from 21,000 to 33,000 HIV infections have been averted in Kenya, but this is just the beginning of the impact, since as Stover pointed out, this intervention carries “future benefits from current achievements.” Since about one-third of those who have been circumcised during Kenya’s campaign were under 15 years old, the impact on HIV incidence will accrue all the way to 2060, with 160,000 – 220,000 HIV infections prevented by 2030 – the year slated by UNAIDS for the achievements of 90 percent of infected individuals tested, 90 percent treated, and 90 percent with suppressed HIV virus. The impact of circumcision on Kenya’s epidemic in 2030 could contribute to a reduction of anticipated infections by one-third.

Looking at program costs, after 2026, the financial investment will be more than outweighed by the savings from not having to provide treatment to infected individuals. And, Stover noted, this analysis does not even totally capture the other benefits of circumcision programs from linking HIV-infected men to care, reducing other sexually-transmitted infections in both circumcised men and their female sexual partners, as well as building capacity for health care services in the community. While the model does not include direct effects on women, Stover said, it does acknowledge the critical secondary effect – fewer infected men in the community to infect women.

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