The association between lack of male circumcision and risk for HIV infection: a review of the epidemiological data.
OBJECTIVE
Whether male circumcision reduces the risk of acquiring human immunodeficiency virus (HIV) infection remains controversial.


METHODS
As there have now been a number of studies conducted that have examined this issue, we undertook to review their findings. Thirty epidemiological studies identified in the literature that investigated the association between male circumcision status and risk for HIV infection were reviewed.


RESULTS
Eighteen cross-sectional studies from six countries reported a statistically significant association, four studies from four countries found a trend toward an association. Four studies from two countries found no association. Two prospective studies reported significant associations, as did two ecological studies. In studies in which significant associations were demonstrated, measures of increased risk ranged from 1.5 to 8.4. The groups in which positive associations were found included sexually transmitted disease (STD) clinic and hospital patients, outpatient clinic and HIV screening clinic attenders, long-distance truck drivers, and general community members.


CONCLUSIONS
Potential sources of error, assessment of causality, implications of the findings, and future research needs are discussed. Because a substantial body of evidence links noncircumcision in men with risk for HIV infection, consideration should be given to male circumcision as an intervention to reduce HIV transmission.
Department of Community Health, University of Nairobi, Kenya.
S
S
Moses
F A
FA
Plummer
J E
JE
Bradley
J O
JO
Ndinya-Achola
N J
NJ
Nagelkerke
A R
AR
Ronald
D015982:Bias; D002944:Circumcision, Male; D015986:Confounding Factors, Epidemiologic; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1; D015498:HIV-2; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D012106:Research; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000209:etiology