Study shows circumcision reduces HIV in “real-life” conditions

Michael Rautenbach

5 September 2013

A South African study demonstrates for the “first time the effectiveness of male circumcision, in real-life conditions in curbing the spread of HIV”, says its lead researcher, Bertran Auvert.

The study was published in this week’s PLoS Medicine. It found that “the roll-out of adult [voluntary medical male circumcision] is associated with a reduction in HIV in a sub-Saharan community where [male circumcision] is not a social norm.”

Three randomised controlled clinical trials have previously shown that voluntary male medical circumcision in adults reduces the risk of heterosexual men contracting HIV. One of them was conducted in Orange Farm by the same research group that published this study.

The study (ANRS-12126) conducted by Auvert and colleagues from the University of Versailles (France) used information from surveys conducted in the community of Orange Farm in Gauteng.

On any day of the week scores of young men can be found queuing outside Orange Farm’s Bophelo Pele Centre on the dusty and forlorn veld near Vereeniging in the Vaal Triangle. Since 2008 the Bophelo Pele Project has been offering free medical circumcision to the men in the communities around Orange Farm. By 2010, within two years, 18,000 men had filed through the project’s surgeries to be circumcised.

The researchers observed that 12% of the men surveyed had been circumcised before the implementation of the Bophelo Pele project whereas in the follow-up survey, the overall rate of circumcision increased to 53% of the men surveyed.

The overall HIV rate at follow-up was 12% and the researchers estimated that without the circumcision procedures performed by the Bophelo Pele project, the rate of HIV among men living in this community would have been 15% in 2011.

Significantly, the study also reported that there was “no evidence of a link between circumcision status and risky sexual behavior”. In other words, there was no evidence that circumcised men were less likely to use condoms.

The reseachers conclude, ” The main implication of this study is that the current roll-out of adult [voluntary medical male circumcision], endorsed by UNAIDS and WHO, and supported by international agencies such as PEPFAR, the Global Fund, and by donors like the Bill and Melinda gates Foundation, should be accelerated.”

Declaration of conflict of interests: Nathan Geffen, the editor of GroundUp, has been, for several years, a member of the scientific committee that conducted this study. He has received no remuneration for this except reimbursement of expenses incurred directly from his work on the committee (such as a plane ticket to a meeting). His membership of the scientific committee ends this month.