Centre for International Health
Publication | HIV prevention

Circumcision as method for HIV prevention

PhD Candidate Simon P. Kibira has recently published the first article from his PhD project, concerning sexual risk and willingness to be circumcised in Uganda.

HIV and circumcision WHO infographics
World Health Organization (WHO)

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Reducing the risk by 60 %
There are now several interventions available to reduce the impact of the HIV epidemics in sub Saharan Africa. Voluntary medical male circumcision, also known as safe male circumcision (SMC), is one of the most recent. The foreskin is one of the prime sites for HIV entry and male circumcision reduces the risk of heterosexually acquired HIV infection by about 60 %. It also reduces the prevalence of high risk human papilloma virus and incidence of herpes simplex virus infection.

A national safe male circumcision programme
As a result of the beneficial evidence, WHO and UNAIDS in 2007 recommended safe male circumcision in 14 priority countries with high HIV prevalence and low male circumcision levels, including Uganda. Since the WHO recommendation, the Uganda Ministry of Health has implemented the SMC programme through activities aimed at educating leaders, health workers and the general public. In the first years these efforts included public debates, radio and television talk shows, educational materials for health workers and education and counselling through a national health hotline.

Until the WHO recommendation, male circumcision was mainly practised for cultural and religious reasons among a few ethnic groups. After 2007, demand and service provision have increased massively. By September 2013, more than thousand health facilities offered SMC services.

Early adopters and sexual risk behaviours
A study in Kenya found that early adopters of male circumcision perceived themselves to be at higher risk than later adopters. It is possible that early adopters have a different sexual risk profile than the later adopters, and those that do not get circumcised.  However, there were no published studies in Uganda that had looked at these associations. In a country with a severe HIV epidemic it is important to examine willingness to be circumcised among men with varied sexual behaviours. This will help to determine whether the National safe male circumcision programme is reaching those that have the highest need of increased protection from HIV infection.

In this study, Simon P. Kibira and his colleagues hypothesised that uncircumcised men who had higher sexual risk behaviours were more likely to be willing to be circumcised than their counterparts. They therefore set out to compare the sexual risk profile of men who were willing to be circumcised to those who were reluctant. In the study they conclude that early adopters of male circumcision may be those in the greatest need of such an added protective measure. Considering the high level of risk behaviour, sustained efforts are needed to sensitise men undergoing circumcision on continued use of condoms to avoid risk compensation.

SMC is only a partial protection
Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counseling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use.

Read the full study here:
Sexual Risk Behaviours and Willingness to Be Circumcised among Uncircumcised Adult Men in Uganda Kibira SP, Makumbi F, Daniel M, Atuyambe LM, Sandøy IF.
PLoS One. 2015 Dec