WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention

In response to the urgent need to reduce the number of new HIV infections globally, the World Health Organization (WHO) and the UNAIDS Secretariat convened an international expert consultation to determine whether male circumcision should be recommended for the prevention of HIV infection.

Based on the evidence presented, which was considered to be compelling, experts attending the consultation recommended that male circumcision now be recognized as an additional important intervention to reduce the risk of heterosexually acquired HIV infection in men. The international consultation, which was held from 6-8 March 2007 in Montreux, Switzerland, was attended by participants representing a wide range of stakeholders, including governments, civil society, researchers, human rights and women's health advocates, young people, funding agencies and implementing partners.

"The recommendations represent a significant step forward in HIV prevention", said Dr Kevin De Cock, Director, HIV/AIDS Department, World Health Organization. "Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment."

There is now strong evidence from three randomized controlled trials undertaken in Kisumu, Kenya, Rakai District, Uganda (funded by the US National Institutes of Health) and Orange Farm, South Africa (funded by the French National Agency for Research on AIDS) that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. This evidence supports the findings of numerous observational studies that have also suggested that the geographical correlation long described between lower HIV prevalence and high rates of male circumcision in some countries in Africa, and more recently elsewhere, is, at least in part, a causal association. Currently, an estimated 665 million men, or 30 % of men worldwide, are estimated to be circumcised.

Male circumcision should be part of a comprehensive HIV prevention package

Male circumcision should always be considered as part of a comprehensive HIV prevention package, which includes the provision of HIV testing and counselling services; treatment for sexually transmitted infections; the promotion of safer sex practices; and the provision of male and female condoms and promotion of their correct and consistent use.

Counselling of men and their sexual partners is necessary to prevent them from developing a false sense of security and engaging in high-risk behaviours that could undermine the partial protection provided by male circumcision. Furthermore, male circumcision service provision was seen as a major opportunity to address the frequently neglected sexual health needs of men.