Male circumcision for HIV prevention: the research evidence and some critical responses

Three randomised clinical trials, in South Africa, Uganda and Kenya, have shown a substantial reduction in female-to-male transmission of HIV to men who had been circumcised as compared to men who had not, during a follow-up period of up to 24 months. The question of what to do with this evidence is currently being debated around the world. WHO and UNAIDS took the lead by developing technical, policy and programmatic guidance following a series of consultations with a range of stakeholders in the field, using the research evidence as the basis. Consensus on many aspects of this matter is far from being achieved, however. Many questions and different points of view are emerging--clinical, public health, sociological, anthropological and cultural; in relation to priority setting in HIV prevention and delivery of health services; and in relation to sexuality, ethics, gender and rights. On 28 March 2007, WHO and UNAIDS published a set of conclusions and recommendations regarding the research implications for HIV policy and programming. The introduction and excerpts from these follow below. They are, in turn, followed by a roundtable of nine papers which contain a range of critical thinking and analysis of these issues. Male circumcision is generating debate across the globe. This can only be a good thing, as it is a complex matter and far more than a straightforward public health intervention. We hope these papers will help to inform that debate.