Male circumcision remains a vital tool in the global fight against HIV, but its effectiveness in real-world settings appears lower than earlier clinical trials suggested. New research analyzing data from 29 African countries shows that while circumcision reduces HIV risk, the impact is more modest outside of controlled environments.
Between 2008 and 2019, close to two million Kenyan men and boys were circumcised in what became the world’s largest campaign to prevent HIV. This effort was launched based on findings from randomised controlled trials conducted in 2005 and 2006, which indicated that circumcised men were about 60 per cent less likely to acquire HIV from heterosexual intercourse compared to uncircumcised men.
However, controlled trials are conducted under ideal conditions, with carefully selected participants and strict monitoring. The real world is far less controlled, and many variables can affect outcomes. Until recently, there was limited data on how circumcision campaigns had influenced HIV rates at the population level across Africa.
A new study has addressed this gap by analyzing data from approximately 279,000 men aged 15 years and older across 29 countries in sub-Saharan Africa. The findings reveal that circumcised men had a 19 per cent lower risk of HIV infection. Though still significant, this reduction is far below the 60 per cent observed in controlled clinical trials.
The researchers confirmed the results through four different sensitivity analyses, each supporting the overall conclusion. They also found a lower HIV prevalence among circumcised men even within the same households. Among these men, the HIV prevalence was 3.5 per cent compared to 8.6 per cent among their uncircumcised counterparts.
The difference in real-world impact may be due to a variety of factors, including incomplete data on whether the circumcision was done medically or traditionally. Medical circumcision, which is safer and more consistent, typically offers better protection. In many countries, data on the method of circumcision were missing, making it difficult to draw firm conclusions about the full effect of voluntary medical male circumcision (VMMC) programmes.
Another reason for the more modest impact is the relatively recent implementation of circumcision campaigns and their focus on younger males, who may not yet represent the age group most affected by HIV. This could explain why some regions with high circumcision rates still report little or no change in overall HIV prevalence.
Despite these limitations, the study underscores the long-term potential of male circumcision in reducing HIV risk. Unlike interventions that depend on continuous use, such as condoms or antiretroviral drugs, circumcision provides lifelong partial protection after a one-time procedure. This makes it a valuable component in comprehensive HIV prevention strategies, especially in regions heavily burdened by the epidemic.
The researchers emphasized the need to continue and expand circumcision campaigns alongside other proven HIV prevention methods. They argue that combining approaches such as condom use, regular HIV testing, treatment as prevention, and education can amplify the benefits and offer broader protection to communities.
The study offers important real-world validation of earlier clinical findings and supports the integration of circumcision into public health policies aimed at curbing HIV infections across sub-Saharan Africa.
