Circumcision Status and Risk of HIV Acquisition During Heterosexual Intercourse for Both Males and Females: A Meta-Analysis

Lei, J., Liu L., Wei Q., et al. PLOS ONE (May 2015), 10(5): e0125436, doi: 10.1371/journal.pone.0125436.

This article reported on a meta-analysis evaluating whether male circumcision was associated with lower HIV acquisition for heterosexual men and women. The analysis included 15 studies: four randomized controlled trials (RCTs), and 11 prospective cohort studies. Ten studies (3 RCTs and 7 cohort studies) assessed HIV transmission from females to males, and five studies (1 RCT and 4 cohort studies) assessed HIV transmission from males to females. The pooled analysis showed that circumcision provided 70 percent protection for men, consistent with an earlier meta-analysis from 2000. Another pooled analysis showed no difference in HIV acquisition between women with circumcised and uncircumcised partners. The studies in women differed in their design and measurement: in two cohort studies the partners’ HIV status was unknown, while three studies enrolled serodiscordant couples (SDCs). The only RCT was stopped due to futility. The authors noted that while the lower rate of HIV among men may benefit women, the meta-analysis showed no evidence of a direct benefit from HIV-positive men to HIV-negative women in SDCs. The analysis provided strong evidence that male circumcision reduces HIV acquisition in males, but there was no protective benefit for female sexual partners of circumcised men. The authors concluded that MMC should be considered as part of broader HIV prevention strategies to benefit both men and women.