title: Estimation of country-specific and global prevalence of male circumcision.
abstract: BACKGROUND
  Male circumcision (MC) status and genital infection risk are interlinked and MC is now part of HIV prevention programs worldwide. Current MC prevalence is not known for all countries globally. Our aim was to provide estimates for country-specific and global MC prevalence.
  
  
  METHODS
  MC prevalence data were obtained by searches in PubMed, Demographic and Health Surveys, AIDS Indicator Surveys, and Behavioural Surveillance Surveys. Male age was ≥15 years in most surveys. Where no data were available, the population proportion whose religious faith or culture requires MC was used. The total number of circumcised males in each country and territory was calculated using figures for total males from (i) 2015 US Central Intelligence Agency (CIA) data for sex ratio and total population in all 237 countries and territories globally and (ii) 2015 United Nations (UN) figures for males aged 15-64 years.
  
  
  RESULTS
  The estimated percentage of circumcised males in each country and territory varies considerably. Based on (i) and (ii) above, global MC prevalence was 38.7 % (95 % confidence interval [CI]: 33.4, 43.9) and 36.7 % (95 % CI: 31.4, 42.0). Approximately half of circumcisions were for religious and cultural reasons. For countries lacking data we assumed 99.9 % of Muslims and Jews were circumcised. If actual prevalence in religious groups was lower, then MC prevalence in those countries would be lower. On the other hand, we assumed a minimum prevalence of 0.1 % related to MC for medical reasons. This may be too low, thereby underestimating MC prevalence in some countries.
  
  
  CONCLUSIONS
  The present study provides the most accurate estimate to date of MC prevalence in each country and territory in the world. We estimate that 37-39 % of men globally are circumcised. Considering the health benefits of MC, these data may help guide efforts aimed at the use of voluntary, safe medical MC in disease prevention programs in various countries.
authors.affiliation: School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006 Australia.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Morris
authors.affiliation: Department of African-American Studies, Northeastern University, Boston, MA 02115 USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wamai
authors.affiliation: College of Science, Northeastern University, Boston, MA 02115 USA.
authors.forename: Esther B
authors.initials: EB
authors.lastname: Henebeng
authors.affiliation: Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287 USA.
authors.forename: Aaron Ar
authors.initials: AA
authors.lastname: Tobian
authors.affiliation: Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095 USA.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klausner
authors.affiliation: Jhpiego, an affiliate of Johns Hopkins University, Washington, DC 20009 USA.
authors.forename: Joya
authors.initials: J
authors.lastname: Banerjee
authors.affiliation: Department of Global Health, Academic Medical Centre and Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, 1105 AZ The Netherlands ; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Hankins
keywords: Country-specific prevalence; Global prevalence; Male circumcision; Population health