Circumcision and HIV - Estimated Impact of Circumcision Programs

Estimated Impact of Circumcision Programs

Modelling of the population-level impact of circumcision has shown mixed results. Podder et al. found that although circumcision would not eliminate HIV, it would "significantly reduce" the HIV burden in a population, stating that reduction was more effective when circumcision was combined with anti-retroviral drugs than with condoms. Disease elimination was considered feasible when all interventions were combined. Hallet et al. predicted "dramatic" reductions in HIV if circumcision were scaled up alongside behaviour change programmes.

Studies of the cost-effectiveness of circumcision programmes have been similarly mixed. Kahn et al. studied sub-Saharan African settings with a high or moderate HIV prevalence, reporting that adult circumcision is "likely to be a cost-effective HIV prevention strategy" even when deployed among only a small fraction of the population. The authors concluded that circumcision "generates large net savings after adjustment for averted HIV medical costs". White et al. concluded that circumcision "is a cost-saving intervention in a wide range of scenarios of HIV and initial circumcision prevalence but the United Nations Joint Programme on HIV/AIDS/WHO recommended target age group should be widened to include older HIV-uninfected men and counselling should be targeted at both newly and already circumcised men to minimize risk compensation". The UNAIDS/WHO/SACEMA Expert Group on Modelling the Impact and Cost of Male Circumcision for HIV Prevention found "large benefits" of circumcision in settings with high HIV prevalence and low circumcision prevalence. The Group estimated "one HIV infection being averted for every five to 15 male circumcisions performed, and costs to avert one HIV infection ranging from US$150 to US$900 using a 10-y time horizon". McAllister et al. estimated that consistent condom use is 95 times more cost effective than circumcision at reducing the rate of HIV in sub-Saharan Africa; the World Health Organisation states that circumcision is "highly cost-effective" in comparison to other HIV interventions when data from the South African trial are used, but less cost-effective when data from the Ugandan trial are used.