Male Circumcision as an HIV Prevention Strategy in Sub-Saharan Africa: Socio-Legal Barriers

Abstract

UNAIDS and WHO recommend safe, voluntary male circumcision as an additional, important strategy for the prevention of heterosexually-acquired HIV in men in areas with high HIV prevalence and low levels of male circumcision. Comprehensive male circumcision services should include HIV testing and counseling, partner reduction, and male and female condom use. Yet, male circumcision can have deep symbolic meaning that could pose barriers to implementation. In some parts of the world, it is a traditional practice with religious or cultural significance, in others it is a common hygiene intervention, and in yet others it is unfamiliar or foreign. Consequently, the proportion of men who are circumcised varies from <5% to >80%, with an estimated 30-40% of adult men circumcised worldwide.

Confirming a number of observational studies, three randomized controlled trials in Africa have shown that circumcision reduces the likelihood of female-to-male HIV transmission by 50-60%, leading WHO/UNAIDS to conclude that the evidence is "compelling." Male circumcision is a relatively simple, inexpensive one-time surgical procedure that is cost-effective, but raises a host of ethical, legal, and human rights challenges.

Keywords: health policy, HIV/AIDS, circumcision