Male circumcision programmes as part of combination HIV prevention are beneficial and cost effective

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Male circumcision programmes as part of combination HIV prevention are beneficial and cost effective

08 September 2009

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Male circumcision among heterosexual men in high HIV prevalence and low male circumcision settings is beneficial and cost effective, says a new article in the open access journal PLoS Medicine.

The report is based upon the findings of a series of meetings, convened by UNAIDS, the World Health Organization (WHO), and the South African Centre for Epidemiological Modelling and Analysis (SACEMA). These meetings reviewed published and unpublished modelling work to estimate the long-term population impact and cost-effectiveness of male circumcision programmes through mathematical modelling approaches.

Six models were considered by the expert group, which was led by Dr. Catherine Hankins, Chief Scientific Advisor at UNAIDS. The models predicted that, using a 10 year time horizon, one new HIV infection would be averted for every five to 15 men newly circumcised. For the most successful interventions, where almost all men are circumcised, HIV incidence could be reduced by 30% to 50% over the same period, with prevalence trends also following this decrease.

The estimated costs per adult male circumcision are between $30 and $60, depending on the programme setting, with neonatal circumcision costing about one-third this amount. The models estimate costs per infection averted of between $150 and $900 in high HIV prevalence settings over a 10-year time horizon.

All the models indirectly confirmed that the most favourable cost-effectiveness ratios will be seen where HIV incidence is highest. By comparison, estimates of discounted lifetime treatment costs typically exceed $7,000 per HIV infection if only first-line treatment is provided, and twice as much if second-line treatment is available. Thus, circumcising sexually active males of any age is likely to be cost saving.

While several studies have confirmed that male circumcision performed by well-trained medical professionals reduces the risk of men acquiring HIV through female-to-male transmission by approximately 60%, a major concern raised in discussions around male circumcision, is that it does not directly protect women from HIV. However, women do benefit indirectly from reduced HIV prevalence in circumcised male sexual partners as male circumcision programmes scale up.

Male circumcision does not replace other prevention measures. Because it provides partial protection, it should be combined with strategies such as delaying the onset of sexual relations, abstaining from penetrative sex, reducing the number of sexual partners, using male and female condoms correctly and consistently, learning your HIV status, and getting treatment for sexually transmitted disease.

Male circumcision may have minimal impact on reducing HIV transmission among men who have sex with men.

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Cosponsors:

WHO


Feature stories:

New clearinghouse on male circumcision for HIV prevention launched (23 February 2009)

Male circumcision: context, criteria and culture (part 1) (26 February 2007)

Male circumcision and HIV: the here and now (part 2) (28 February 2007)

Moving towards: UN policy and action on male circumcision (part 3) (02 March 2007)

International experts review male circumcision (part 4) (07 March 2007)


Multimedia:

View video of Dr. Catherine Hankins, Chief Scientific Advisor at UNAIDS talking about the findings of the study.


External links:

PLoS.org

PLoSmedicine.org

Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making?


Tools:

Clearinghouse on Male Circumcision for HIV Prevention


Publications:

Male Circumcision for HIV Prevention in High HIV Prevalence Settings: What Can Mathematical Modelling Contribute to Informed Decision Making? (pdf, 160 Kb)

Communications guidance - Male circumcision & HIV prevention in eastern and southern Africa (pdf, 150 Kb)

Safe, voluntary, informed male circumcision and comprehensive HIV prevention programming - Guidance for decision-makers on human rights, ethical & legal considerations (pdf, 382 Kb)

Recommendations from WHO/UNAIDS meeting on male circumcision and HIV prevention, Montreux, 28 March 2007 ( en | fr ) (pdf, 127 Kb | 148 Kb)