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Three randomized trials have
demonstrated the efficacy of male circumcision for HIV prevention over two
years, the authors wrote, “but the longer-term effectiveness of male
circumcision is unknown.”
In Rakai, the researchers conducted
a randomized trial of male circumcision in 4,996 HIV-negative men ages 15-49.
After the trial, male circumcision was offered to control participants, and
surveillance was maintained for up to 4.79 years. An as-treated analysis
assessed HIV incidence per 100 person-years; Cox regression models, adjusted
for sociodemographic and time-dependent sexual behaviors, were used to estimate
the effectiveness of male circumcision. “For men uncircumcised at trial
closure, sexual risk behaviors at the last trial and first posttrial visits
were assessed by subsequent circumcision acceptance to detect behavioral risk
compensation,” the authors wrote.
As of Dec. 15, 2010, 78.4 percent of
the uncircumcised participants accepted male circumcision after the trial
closed. During the posttrial surveillance period, overall HIV incidence was
0.50/100 person-years among the men who were circumcised and 1.93/100
person-years among the men who were not (adjusted effectiveness 73 percent [95
percent confidence interval 55 percent-84 percent]). Among participants of the
control arm, posttrial HIV incidence was 0.54/100 person-years in circumcised
men and 1.71/100 person-years in the uncircumcised men (adjusted effectiveness
67 percent [95 percent CI 38 percent-83 percent]). No significant differences
were noted in sociodemographic characteristics and sexual behaviors between
controls who accepted circumcision and those who did not.
“High effectiveness of male
circumcision for HIV prevention was maintained for almost five years following
trial closure,” the authors concluded. “There was no self-selection or evidence
of behavioral risk compensation associated with posttrial male circumcision
acceptance.”
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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