The Potential Impact of Male Circumcision on HIV in Sub-Saharan Africa

Background: A randomized controlled trial (RCT) has shown that male circumcision (MC) reduces sexual transmission of HIV from women to men by 60(32?76; 95CI) offering an intervention of proven efficacy for reducing the sexual spread of HIV. We explore the implications of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa. Methods and Findings :Using dynamical simulation models we consider the impact of MC on the relative prevalence of HIV in men and women and in circumcised and uncircumcised men. Using country level data on HIV prevalence and MC; we estimate the impact of increasing MC coverage on HIV incidence; HIV prevalence; and HIV-related deaths over the next ten; twenty; and thirty years in sub-Saharan Africa. Assuming that full coverage of MC is achieved over the next ten years; we consider three scenarios in which the reduction in transmission is given by the best estimate and the upper and lower 95confidence limits of the reduction in transmission observed in the RCT. MC could avert 2.0 (1.1?3.8) million new HIV infections and 0.3 (0.1?0.5) million deaths over the next ten years in sub-Saharan Africa. In the ten years after that; it could avert a further 3.7 (1.9?7.5) million new HIV infections and 2.7 (1.5?5.3) million deaths; with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa. We show that a) MC will increase the proportion of infected people who are women from about 52to 58; b) where there is homogenous mixing but not all men are circumcised; the prevalence of infection in circumcised men is likely to be about 80of that in uncircumcised men; c) MC is equivalent to an intervention; such as a vaccine or increased condom use; that reduces transmission in both directions by 37. Conclusions: This analysis is based on the result of just one RCT; but if the results of that trial are confirmed we suggest that MC could substantially reduce the burden of HIV in Africa; especially in southern Africa where the prevalence of MC is low and the prevalence of HIV is high. While the protective benefit to HIV-negative men will be immediate; the full impact of MC on HIV-related illness and death will only be apparent in ten to twenty years

Experiencias Canadienses con el SIDA y la infeccion por el VIH / Canadian experiences with AIDS and HIV infection

Since Canada's first AIDS case was reported in 1978, a total of 1 775 cases have been recorded. Most of these (90 percent) have occurred in three provinces (Ontario, Quebec, and British Columbia); most (89 percent) have occurred among adults 24 to 49 years old; and most (95 percent) of these adult cases have occurred in males. Nationwide, 82 percent of those afflicted have been homosexual of bisexual men, 5 percent have been immigrants from endemic regions, and 4.6 percent have been recipients of blood or blood products. However, the distribution differs in the different provinces-especially in Quebec, where a substantial share of all cases (17 percent) have occurred among immingrants from endemic regions. Regarding levels of HIV infection, information is limited. The authors estimate that roughly 30 000 Canadians were probably infected as of early 1988, but the true number could be as low as 10 000 or as high as 50 000. HIV tests are available free of charge to any Canadian who requests them. At present, a system of voluntary testing of individuals for personal or clinical reasons, combined with anonymous screening of populations for epidemiologic purposes, comprises the HIV testing program in Canada. In seven of Canada's 10 provinces, HIV seropositivity is reportable to public health authorities. One of these provinces conducts a contact tracing programs based on traditional sexually