Understanding the Impact of Male Circumcision Interventions on the Spread of HIV in Southern Africa

BACKGROUND: Three randomised controlled trials have clearly shown that circumcision of adult men reduces the chance that they acquire HIV infection. However, the potential impact of circumcision programmes--either alone or in combination with other established approaches--is not known and no further field trials are planned. We have used a mathematical model, parameterised using existing trial findings, to understand and predict the impact of circumcision programmes at the population level. FINDINGS: Our results indicate that circumcision will lead to reductions in incidence for women and uncircumcised men, as well as those circumcised, but that even the most effective intervention is unlikely to completely stem the spread of the virus. Without additional interventions, HIV incidence could eventually be reduced by 25-35%, depending on the level of coverage achieved and whether onward transmission from circumcised men is also reduced. However, circumcision interventions can act synergistically with other types of prevention programmes, and if efforts to change behaviour are increased in parallel with the scale-up of circumcision services, then dramatic reductions in HIV incidence could be achieved. In the long-term, this could lead to reduced AIDS deaths and less need for anti-retroviral therapy. Any increases in risk behaviours following circumcision, i.e. 'risk compensation', could offset some of the potential benefit of the intervention, especially for women, but only very large increases would lead to more infections overall. CONCLUSIONS: Circumcision will not be the silver bullet to prevent HIV transmission, but interventions could help to substantially protect men and women from infection, especially in combination with other approaches

Protecting investments in polio eradication: the past, present and future of surveillance for acute flaccid paralysis.

In September 2003 a WHO consultation group on vaccine-derived polioviruses (VDPV) concluded that in order to prevent future generations of paralytic polio after interruption of transmission of wild poliovirus, the use of trivalent oral polio vaccine (OPV) must be stopped [1]. Another important global policy decision along the road to polio eradication thus became possible – cessation of OPV use at some time after eradication. The question now is not whether OPV must be stopped, but rather when.</jats:p