The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a posttrial follow-up study.
Open accessAbstract
BACKGROUND: The efficacy of male circumcision for HIV prevention over 2 years has been demonstrated in three randomized trials, but the longer-term effectiveness of male circumcision is unknown. METHODS: We conducted a randomized trial of male circumcision in 4996 HIV-negative men aged 15-49 in Rakai, Uganda. Following trial closure, we offered male circumcision to control participants and have maintained surveillance for up to 4.79 years. HIV incidence per 100 person-years was assessed in an as-treated analysis, and the effectiveness of male circumcision was estimated using Cox regression models, adjusted for sociodemographic and time-dependent sexual behaviors. For men uncircumcised at trial closure, sexual risk behaviors at the last trial and first posttrial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation. RESULTS: By 15 December 2010, 78.4% of uncircumcised trial participants accepted male circumcision following trial closure. During posttrial surveillance, overall HIV incidence was 0.50/100 person-years in circumcised men and 1.93/100 person-years in uncircumcised men {adjusted effectiveness 73% [95% confidence interval (CI) 55-84%]}. In control arm participants, posttrial HIV incidence was 0.54/100 person-years in circumcised and 1.71/100 person-years in uncircumcised men [adjusted effectiveness 67% (95% CI 38-83%)]. There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting male circumcision and those remaining uncircumcised. CONCLUSION: High effectiveness of male circumcision for HIV prevention was maintained for almost 5 years following trial closure. There was no self-selection or evidence of behavioral risk compensation associated with posttrial male circumcision acceptance.
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Follow-up studies have demonstrated sustained benefit of circumcision for HIV prevention.
“Follow-up studies have demonstrated sustained benefit of circumcision for HIV prevention (69) and that the effect is not mediated solely through a reduction in HSV-2 infection or genital ulcer disease (GUD) (70).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [69]
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Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.
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Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.
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Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda
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Self-citationMale circumcision and risk of HIV-1 and other sexually transmitted infections in India
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Sexually Transmitted Infections Treatment Guidelines, 2021
Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021) · MMWR. Recommendations and Reports · doi:10.15585/mmwr.rr7004a1 · Cited by 2,759 · see citing works
Mehta, S. D., Moses, S., Agot, K., Maclean, I., Odoyo-June, E., Li, H., & Bailey, R. C. (2013) · Journal of Infectious Diseases · doi:10.1093/infdis/jit371 · Cited by 26 · see citing works
- Authors
- Gray, R., Kigozi, G., Kong, X., Ssempiija, V., Makumbi, F., Wattya, S., Serwadda, D., Nalugoda, F., Sewenkambo, N. K., & Wawer, M. J.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Gray, Ron
- Venue
- AIDS
- Published
- 2012-03-13
- Volume
- 26
- Issue
- 5
- Pages
- 609-615
- ISSN
- 0269-9370 (ISSN-L)
- PMC
- PMC4296667
- OpenAlex
- W2037087763
- Cited by
- 209
- References
- 11
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 10 · 2020: 9 · 2019: 9 · 2018: 12 · 2017: 15 · 2016: 44 · 2015: 23 · 2014: 20 · 2013: 37 · 2012: 13
- FWCI
- 23.22
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- AIDS (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases (U1AI51171, U01AI051171, U01AI075115)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD042854)
- Topics
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Keywords
- male circumcision, HIV prevention, HIV incidence, long-term effectiveness, risk compensation, sexual risk behavior, Rakai, Uganda, HIV-negative men
- MeSH terms
- Adolescent, Adult, Circumcision, Male, Follow-Up Studies, Humans, Male, Middle Aged, Risk-Taking, Sexual Behavior, Uganda, HIV Infections, Incidence, Treatment Outcome, Young Adult
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