Male circumcision as an HIV prevention strategy

Research conducted by the School has demonstrated that circumcised men are at lower risk of HIV.

As a result of this research many countries in sub-Saharan Africa are now promoting voluntary medical male circumcision as an important HIV prevention method.

Approximately 34 million people worldwide live with HIV, two thirds of whom are in sub-Saharan Africa. Around 2.7 million people are newly infected with HIV every year, with 1.8m dying of AIDS-related causes and researchers and policy makers are constantly looking for ways to reduce the number of new infections.

In 1997 researchers from the School, including Helen Weiss and Richard Hayes, joined a team looking at HIV epidemics in African cities. The group carried out a series of large surveys in four cities, investigating why HIV had spread at very different rates in East and West Africa. The group found that herpes simplex virus type 2 and male circumcision were both risk factors for HIV.

Weiss and Hayes conducted a literature review of studies published up to April 1999 and found strong evidence that circumcised men were at lower risk of HIV. These findings led to the launch of three randomised controlled trials, conducted by French and US teams from 2002 to 2006, which showed that male circumcision reduces the risk of HIV infection by between 48% and 60%.

Later reviews, led by Weiss, Hayes, Natasha Larke and Sara Thomas from the School, showed that circumcised men are at lower risk of the sexually transmitted infections chancroid and syphilis. They also found that male circumcision reduces the incidence of penile cancer and human papillomavirus.

In March 2007, Weiss and Hayes presented their key findings on male circumcision to a joint meeting of the United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO). Following this, a document was produced which outlined male circumcision as an important HIV prevention strategy, alongside other methods such as condom promotion. This laid the foundations for subsequent guidelines and policy statements.

In 2008, Weiss and Richard White joined an expert group formed by partners including WHO and UNAIDS, which modelled the impact of a large-scale male circumcision programme on the HIV epidemic. It showed that for every five to 15 male circumcisions performed, one HIV infection would be averted.

This modelling work was used in a five-year action plan produced by WHO/UNAIDS in 2011 to accelerate the scale up of medical male circumcision. The plan set a goal of performing 20m circumcisions (covering 80% of men) in 14 priority countries by 2015.