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Male circumcision and HIV.

Background There is an urgent need to intensify and expand HIV prevention strategies, with an estimated 33.4 million people living with HIV in 2008 and an estimated 2.7 million newly infected. New infections continue to outstrip advances made in numbers treated – for every 2 people put on antiretroviral therapy, another 5 become infected. Current strategies to reduce sexual transmission of HIV include behaviour change (delaying sexual debut, reducing the number of partners, consistent condom use) and biomedical approaches (vaginal microbicides, treatment of other STIs, pre-exposure prophylaxis, male circumcision). Sexual behaviour is influenced by many factors, making it difficult to achieve substantial, sustained changes. Of the biomedical approaches, only male circumcision has reduced the risk of HIV infection in multiple randomized controlled trials. Approximately 1 in 3 adult men are circumcised, with religion the main reason. Around 70% of circumcised men are Muslim. It is also practiced for non-religious reasons either neonatally (e.g. in the USA) or as a rite-of-passage to manhood (e.g. west Africa, parts of central and eastern Africa).