Male circumcision for HIV prevention in high HIV prevalence settings: what can mathematical modelling contribute to informed decision making?

Abstract

Experts from UNAIDS, WHO, and the South African Centre for Epidemiological Modelling report their review of mathematical models estimating the impact of male circumcision on HIV incidence in high HIV prevalence settings.

Figure 1. Reductions in HIV incidence by coverage level.

This figure shows model estimates for the reduction in HIV incidence 10 y after the programme begins, among circumcised men, women, uncircumcised men, and the population overall, at varying levels of circumcision uptake (from a baseline of 0%). The model is a deterministic compartmental simulation of the heterosexual spread of HIV in a sex- and sexual-activity stratified population, parameterised for Southern and Eastern African populations. The model assumes that there is a 60% reduction in female-to-male transmission for circumcised men, that there is no direct reduction in male-to-female transmission from circumcised men, and that 5%, 20%, 35%, 50%, 70%, and 90% of men are circumcised within 10 y of the intervention being scaled-up. Note: Since the fraction of men circumcised increases over time, the weighted-average of reductions in incidence in these demographic groups at year 10 is not expected to equal the reduction in incidence in the whole population over the first 10 y of the intervention.