The achievement of the UNAIDS 90-90-90 targets would reduce levels of viral suppression amongst HIV+ people to 73% by 2020. The target is set at this ambitious level because, modelers suggest, it would bring about the elimination of HIV by 2030. In sub-Saharan Africa the challenge seems so great – especially in regard to the […]
Category: Circumcision
Boys’ BV?
Recent studies in STIs have drawn attention to the impact of the state of the microbiome of the female genital tract (FGT) and susceptibility to STIs – and, in particular, the protective effect of the hydrogen peroxide-releasing microbe Lactobacillus crispatus (L.c.) (Antonio & Hillier/STIs) (A&H). Such STIs include, not only BV (53% less likely with […]
Location of HIV-2 emergence determined by distribution of indigenous cultural practices of male circumcision
Sousa & Vandamme demonstrate a robust correlation between HIV-2 prevalence at the time of the 1980s surveys and the absence of indigenous practices of male circumcision earlier in the century. This is a complex and interdisciplinary study, involving some of the earliest large-scale, West African serological surveys of HIV-2 (1980s) and extensive ethnography of the […]
Feasibility of infant circumcision as an HIV prevention tool
Recent trials have shown male circumcision (MC) to be associated with a reduced HIV incidence of up to 60%. For this reason UNAIDS has included ambitious goals for circumcision (20 millions MCs) as a major component of its HIV prevention strategies for 14 priority countries in sub-Saharan Africa (STI/blogs/Roll-out of UNAIDS voluntary male circumcision). The […]
First study of population-level preventative impact of Medical Male Circumcision and ART on HIV incidence in a country of sub-Saharan Africa
Clinical studies have demonstrated the potential effectiveness of ART (HPTN 052) and Voluntary Medical Male Circumcision (VMMC) (Gray & Kigozi/STIs) as preventative measures against HIV. This led WHO/UNAIDS to launch a Joint Strategic Action Framework (JSAF) setting a target in 14 priority sub-Saharan countries of 80% VMMC by 2016. What, then, are the potential gains of ART and VMMC interventions in […]
Does risk compensation behaviour neutralize the benefits of voluntary medical male circumcision?
The effectiveness and feasibility of voluntary medical male circumcision (VMMC) as a preventative intervention against HIV has been demonstrated in a variety of non-circumcising African communities. The WHO has designated 14 countries in southern and eastern Africa as priority areas for VMMC scale-up. Attempts to model the progress of the epidemic have long sought to […]
Cultural constraints on the uptake of voluntary medical male circumcision in Eastern and Southern Africa
My previous blog spoke of the recent PLoS-Medicine Collection on the progress of a UNAIDS initiative for a five-year scale-up of Voluntary Male Medical Circumcision (VMMC) for HIV prevention in 14 high priority Eastern and Southern African countries. Among the papers, Ashengo & Njeuhmeli (A&N) and Macintyre & Bertrand (M&B) deal with what the authors […]
The roll-out of UNAIDS voluntary medical male circumcision programmes in sub-Saharan Africa: Is it working?
Voluntary medical male circumcision (VMMC) has been demonstrated to reduce HIV acquisition by 60% or more. WHO and UNAIDS have recommended that VMMC form a part of comprehensive HIV prevention programming in regions of high prevalence, such as sub-Saharan Africa. Mathematical modelling suggests that the achievement of 80% VMMC coverage within 5 years in 14 […]
To circumcise or not to circumcise? Continued US debate on the benefits of infant male circumcision as an STI prevention tool
Last month saw two further developments in the ongoing US debate over infant male circumcision (MC). European readers may be surprised to discover that infant MC has traditionally been widely practised in the US – for complex historical reasons (https://blogs.bmj.com/sti/2011/10/15/to-circumcise-or-not-to-circumcise/?preview=true&preview_id=509&preview_nonce=9ecb80c216 ). MC has shown a sharp decline in the US from around 79% some twenty […]
Bloodless circumcision procedure opens the way to HIV prevention in Rwanda
As three recent randomized control trials undertaken in Africa have shown, male circumcision can reduce risk of HIV transmission by 53-60%. But sub-Saharan African countries will need to scale up voluntary male medical circumcision (VMMC) hugely if they are to achieve these preventative benefits. (See our earlier blog: Costing the Scale-Up of Voluntary Male Medical […]