Association of the ANRS-12126 Male Circumcision Project with HIV Levels Among Men in a South African Township: Evaluation of Effectiveness Using Cross-Sectional Surveys

Auvert, B., Taljaard, D., Rech, D., et al. PLOS Medicine (September 2013), 10(9): e1001509

This study evaluated the effectiveness of voluntary medical male circumcision (VMMC) in reducing the risk of HIV acquisition at a population level. VMMC was provided free as part of a community-based HIV prevention program in Orange Farm, a South African township that hosted one of the randomized controlled trials of VMMC for HIV prevention. Researchers conducted two cross-sectional surveys among random samples of men aged 15–49. Both surveys included questions, HIV testing and counseling, and circumcision status. The baseline Included 1,998 men, with 3,338 men in the follow-up three years later. The prevalence rate of adult male circumcision increased (from 12% to 53%). The researchers estimated that HIV incidence was reduced by between 57 percent and 61 percent among circumcised men compared with uncircumcised men, and found no association between circumcision status and reported risky sexual behavior. This study was not a randomized trial, so it could not show causality. However, the findings suggested that VMMC roll-out in this community was associated with a significant reduction in HIV incidence. Rapid uptake of VMMC was demonstrated in a setting where circumcision is not the norm. The authors recommended scaling up adult VMMC programs for HIV prevention as an international priority, and additional research to determine any effect on human papillomavirus and herpes simplex virus.