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Could male circumcision reduce HIV incidence in the UK?

B D Rice1, V C Delpech, B G Evans

  • 1Department of HIV and STIs, Health Protection Agency Centre for Infections, Colindale, London, UK. brian.rice@hpa.org.uk

HIV Medicine
|August 19, 2008
PubMed

Insights

Male circumcision (MC) shows public health relevance in reducing female-to-male HIV transmission in Africa. However, its effectiveness among men who have sex with men (MSM) in the UK remains unknown and should not compromise existing HIV prevention strategies.

Area of Science:

  • Public Health
  • Infectious Diseases
  • Epidemiology

Background:

  • Recent African clinical trials demonstrate male circumcision (MC) efficacy in reducing heterosexual HIV transmission.
  • Heterosexually acquired HIV infections are the majority of new UK diagnoses, but often acquired abroad.
  • Men who have sex with men (MSM) represent a key population at risk for acquiring HIV within the UK.

Purpose of the Study:

  • To assess the public health relevance of male circumcision (MC) for HIV prevention in the UK.
  • To highlight the unknown efficacy of MC in preventing HIV transmission among MSM, particularly during unprotected anal intercourse.
  • To emphasize that any consideration of MC should not undermine established HIV prevention interventions.

Main Methods:

  • Review and consideration of existing clinical trial data on male circumcision (MC) from African studies.
  • Analysis of HIV transmission dynamics in the UK, differentiating between abroad-acquired and domestically-acquired infections.
  • Evaluation of the specific risk factors and transmission routes relevant to men who have sex with men (MSM).

Main Results:

  • Male circumcision (MC) has demonstrated effectiveness in reducing female-to-male HIV transmission in African clinical trials.
  • A significant proportion of HIV infections in the UK are acquired abroad, necessitating context-specific prevention strategies.
  • The protective role of MC in the context of unprotected anal intercourse among MSM in the UK is currently unknown.

Conclusions:

  • While MC shows promise for HIV prevention, its direct applicability and effectiveness for MSM in the UK require further investigation.
  • Existing, proven HIV prevention interventions must be maintained and not jeopardized by the potential introduction of MC.
  • Public health strategies for HIV prevention in the UK need to consider the specific transmission routes and populations at highest risk.

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