Incremental role of male circumcision on a generalised HIV epidemic through its protective effect against other sexually transmitted infections: From efficacy to effectiveness to population-level impact

M. C. Boily, K. Desai, B. Masse, Abba Gumel

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Male circumcision (MC) can reduce HIV acquisition. However, a better understanding of the indirect protective effect of MC on sexually transmitted infections (STIs) is required. Objective: To assess the incremental benefits conferred by MC on HIV infection at the individual level in circumcision trials (no herd immunity effect) and at the population level (with herd immunity effect) owing to its protective effect against other STIs. Methods: A dynamic stochastic model of HIV and STI infections in a Kenyan population was used to simulate the impact of MC offered to a few trial participants or to a large proportion of men in order to study the protective role of MC on HIV infection at the individual and population levels. Results: Fewer than 20% of the HIV infections prevented in the circumcised arm of the circumcision trials (individual level) could be attributable to the efficacy of MC against STIs rather than against HIV. At the population level, MC can significantly reduce the prevalence of HIV, especially among men and women in the longer term. However, even at the population level, the long-term incremental impact of MC on HIV due to the protection against STI is modest (even if MC efficacy against the STI and STI prevalence was high). Conclusions: The protection of MC against STI contributes little to the overall effect of MC on HIV. Additional work is needed to determine whether, and under what conditions, the protective effect of MC efficacy against STIs can have a significant incremental benefit on the HIV epidemic.

Original languageEnglish (US)
JournalSexually Transmitted Infections
Volume84
Issue numberSUPPL. 2
DOIs
StatePublished - Oct 2008
Externally publishedYes

Fingerprint

Male Circumcision
Sexually Transmitted Diseases
HIV
Population
Herd Immunity
HIV Infections

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

@article{faabf4c586534fc497fa14fa9aef2218,
title = "Incremental role of male circumcision on a generalised HIV epidemic through its protective effect against other sexually transmitted infections: From efficacy to effectiveness to population-level impact",
abstract = "Background: Male circumcision (MC) can reduce HIV acquisition. However, a better understanding of the indirect protective effect of MC on sexually transmitted infections (STIs) is required. Objective: To assess the incremental benefits conferred by MC on HIV infection at the individual level in circumcision trials (no herd immunity effect) and at the population level (with herd immunity effect) owing to its protective effect against other STIs. Methods: A dynamic stochastic model of HIV and STI infections in a Kenyan population was used to simulate the impact of MC offered to a few trial participants or to a large proportion of men in order to study the protective role of MC on HIV infection at the individual and population levels. Results: Fewer than 20{\%} of the HIV infections prevented in the circumcised arm of the circumcision trials (individual level) could be attributable to the efficacy of MC against STIs rather than against HIV. At the population level, MC can significantly reduce the prevalence of HIV, especially among men and women in the longer term. However, even at the population level, the long-term incremental impact of MC on HIV due to the protection against STI is modest (even if MC efficacy against the STI and STI prevalence was high). Conclusions: The protection of MC against STI contributes little to the overall effect of MC on HIV. Additional work is needed to determine whether, and under what conditions, the protective effect of MC efficacy against STIs can have a significant incremental benefit on the HIV epidemic.",
author = "Boily, {M. C.} and K. Desai and B. Masse and Abba Gumel",
year = "2008",
month = "10",
doi = "10.1136/sti.2008.030346",
language = "English (US)",
volume = "84",
journal = "Sexually Transmitted Infections",
issn = "1368-4973",
publisher = "BMJ Publishing Group",
number = "SUPPL. 2",

}

TY - JOUR

T1 - Incremental role of male circumcision on a generalised HIV epidemic through its protective effect against other sexually transmitted infections

T2 - From efficacy to effectiveness to population-level impact

AU - Boily, M. C.

AU - Desai, K.

AU - Masse, B.

AU - Gumel, Abba

PY - 2008/10

Y1 - 2008/10

N2 - Background: Male circumcision (MC) can reduce HIV acquisition. However, a better understanding of the indirect protective effect of MC on sexually transmitted infections (STIs) is required. Objective: To assess the incremental benefits conferred by MC on HIV infection at the individual level in circumcision trials (no herd immunity effect) and at the population level (with herd immunity effect) owing to its protective effect against other STIs. Methods: A dynamic stochastic model of HIV and STI infections in a Kenyan population was used to simulate the impact of MC offered to a few trial participants or to a large proportion of men in order to study the protective role of MC on HIV infection at the individual and population levels. Results: Fewer than 20% of the HIV infections prevented in the circumcised arm of the circumcision trials (individual level) could be attributable to the efficacy of MC against STIs rather than against HIV. At the population level, MC can significantly reduce the prevalence of HIV, especially among men and women in the longer term. However, even at the population level, the long-term incremental impact of MC on HIV due to the protection against STI is modest (even if MC efficacy against the STI and STI prevalence was high). Conclusions: The protection of MC against STI contributes little to the overall effect of MC on HIV. Additional work is needed to determine whether, and under what conditions, the protective effect of MC efficacy against STIs can have a significant incremental benefit on the HIV epidemic.

AB - Background: Male circumcision (MC) can reduce HIV acquisition. However, a better understanding of the indirect protective effect of MC on sexually transmitted infections (STIs) is required. Objective: To assess the incremental benefits conferred by MC on HIV infection at the individual level in circumcision trials (no herd immunity effect) and at the population level (with herd immunity effect) owing to its protective effect against other STIs. Methods: A dynamic stochastic model of HIV and STI infections in a Kenyan population was used to simulate the impact of MC offered to a few trial participants or to a large proportion of men in order to study the protective role of MC on HIV infection at the individual and population levels. Results: Fewer than 20% of the HIV infections prevented in the circumcised arm of the circumcision trials (individual level) could be attributable to the efficacy of MC against STIs rather than against HIV. At the population level, MC can significantly reduce the prevalence of HIV, especially among men and women in the longer term. However, even at the population level, the long-term incremental impact of MC on HIV due to the protection against STI is modest (even if MC efficacy against the STI and STI prevalence was high). Conclusions: The protection of MC against STI contributes little to the overall effect of MC on HIV. Additional work is needed to determine whether, and under what conditions, the protective effect of MC efficacy against STIs can have a significant incremental benefit on the HIV epidemic.

UR - http://www.scopus.com/inward/record.url?scp=53549086161&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=53549086161&partnerID=8YFLogxK

U2 - 10.1136/sti.2008.030346

DO - 10.1136/sti.2008.030346

M3 - Article

C2 - 18799489

AN - SCOPUS:53549086161

VL - 84

JO - Sexually Transmitted Infections

JF - Sexually Transmitted Infections

SN - 1368-4973

IS - SUPPL. 2

ER -