title: Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices.
abstract: The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV.
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Gray
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea.
authors.forename: Andrew
authors.initials: A
authors.lastname: Vallely
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Wilson
authors.affiliation: The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kaldor
authors.affiliation: School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
authors.forename: David
authors.initials: D
authors.lastname: MacLaren
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea; International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly-Hanku
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea.
authors.forename: Peter
authors.initials: P
authors.lastname: Siba
authors.affiliation: School of Mathematics and Statistics, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male / Q000208:ethnology* / Q000706:statistics & numerical data*; D017280:Condoms / Q000706:statistics & numerical data; D058872:Epidemics / Q000517:prevention & control*; D005260:Female; D052816:Foreskin; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010219:Papua New Guinea / Q000453:epidemiology / Q000208:ethnology; D012306:Risk; D055815:Young Adult
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