title: Male circumcision and HIV infection risk.
abstract: BACKGROUND
  Male circumcision is being promoted to reduce human immunodeficiency virus type 1 (HIV) infection rates. This review evaluates the scientific evidence suggesting that male circumcision reduces HIV infection risk in high-risk heterosexual populations.
  
  
  METHODS
  We followed the updated International Consultation on Urological Diseases evidence-based medicine recommendations to critically review the scientific evidence on male circumcision and HIV infection risk.
  
  
  RESULTS
  Level 1 evidence supports the concept that male circumcision substantially reduces the risk of HIV infection. Three major lines of evidence support this conclusion: biological data suggesting that this concept is plausible, data from observational studies supported by high-quality meta-analyses, and three randomized clinical trials supported by high-quality meta-analyses.
  
  
  CONCLUSIONS
  The evidence from these biological studies, observational studies, randomized controlled clinical trials, meta-analyses, and cost-effectiveness studies is conclusive. The challenges to implementation of male circumcision as a public health measure in high-risk populations must now be faced.
authors: Department of Urology, School of Medicine, University of Washington, Seattle, WA 98195, USA. jkrieger@u.washington.edu
authors: John N
authors: JN
authors: Krieger
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