• Circumcision

Circumcision

There is conclusive evidence from observational data and three randomised controlled trials that circumcised men have a significantly lower risk of becoming infected with the human immunodeficiency virus (HIV). This report from the World Health Organization reviews the determinants, prevalence, safety and acceptability of male circumcision, focusing on sub-Saharan Africa. The authors review the religious, cultural and social determinants of male circumcision and estimate the prevalence at global and regional levels. The report then summarises medical aspects of the procedure, including medical indications for circumcision, surgical methods used and the complications of circumcision carried out in clinical and non-clinical settings.

The public health implications of the fact that male circumcision reduces risk of HIV infection are then considered, including a summary of the acceptability of adult male circumcision in currently non-circumcising populations in sub-Saharan Africa with high incidence of HIV. The authors find that there is substantial evidence that male circumcision protects against several diseases, including urinary tract infections, syphilis, chancroid and invasive penile cancer, as well as HIV. However, as with any surgical procedure, there are risks involved. Recent studies of acceptability among non-circumcising communities with high prevalence of HIV in southern Africa were fairly consistent in finding that a majority of men would be willing to be circumcised if it were done safely and at minimal cost. The report concludes that there is increasing demand for male circumcision in southern Africa and future expansion of circumcision services must be embedded within comprehensive HIV prevention programming, including informed consent and risk-reduction counselling.

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