New data on male circumcision and HIV prevention: policy and programme implications

WHO/UNAIDS technical consultation on male circumcision and HIV prevention: Research implications for policy and programming, Montreux, 6 – 8 March 2007 Conclusions and recommendations

At the end of 2006, an estimated 39.5 million people were living with HIV and 4.3 million became newly infected with the virus that year . Prevention must be greatly prioritized in the response to AIDS and efforts are being made to find new prevention technologies to bolster the package of already known effective prevention methods. Male circumcision is one of these new potential methods, along with vaginal microbicides, pre-exposure prophylaxis with antiretroviral medication, herpes suppressive therapy, cervical barrier methods and HIV vaccines.

A number of observational studies indicate that circumcised men have lower levels of HIV infection than uncircumcised men iii. On 13 December 2006, the United States of America National Institutes of Health announced that two trials assessing the impact of male circumcision on HIV risk would be stopped on the recommendation of the Data Safety and Monitoring Board. The trials being carried out in Kisumu, Kenya, and Rakai District, Uganda revealed at least a 53% and 51% reduction in risk of acquiring HIV infection, respectively iv, . These results support findings published in 2005 from the South Africa Orange Farm Intervention Trial, sponsored by the French National Agency for Research on AIDS, which demonstrated at least a 60% reduction in HIV infection among men who were circumcised.

WHO and UNAIDS convened an international consultation to review the results of the three randomised controlled trials and other evidence on male circumcision and HIV prevention, to discuss the policy and programme implications, and to make recommendations regarding public health issues. This document summarizes the principal conclusions and recommendations of the meeting.