Male Circumcision for HIV Prevention: From Evidence to Action

Helen A. Weiss; Daniel Halperin; Robert C. Bailey; Richard J. Hayes; George Schmid; Catherine A. Hankins


AIDS. 2008;22(5):567-574. 

In This Article

Introduction and Male Circumcision Prevalence

An estimated 2.5 million people were newly infected with HIV in 2007, of whom two-thirds live in sub-Saharan Africa.[1] In the context of the urgent need for intensified and expanded HIV prevention efforts, the conclusive results of three randomized controlled trials (RCT) showing that male circumcision reduces the risk of HIV acquisition by approximately 60%[2,3,4] are both promising and challenging. Translation of these research findings into public health policy is complex and will be context specific. To guide this translation, we estimate the global prevalence and distribution of male circumcision, summarize the evidence of an impact on HIV incidence, and highlight the major public health opportunities and challenges raised by these findings.

Male circumcision, one of the oldest and most common surgical procedures, is practised for religious, social and medical reasons. By reviewing nationally representative data sources and assuming that all Muslim and Jewish men are circumcised, we estimate that 30-34% of adult men are circumcised worldwide.[5] Overall, an estimated 68% of circumcised men are Muslim and 1% are Jewish, with coverage almost universal in the Middle East, north Africa, Pakistan, Bangladesh and Indonesia (Fig. 1). Male circumcision is also practised for non-religious reasons either neonatally or as a rite-of-passage to manhood; and is very common in west Africa, parts of central and eastern Africa, the United States, Republic of Korea, and the Philippines.[5] Within countries, prevalence can vary widely with religion, ethnicity and socioeconomic status.[5,6]

Global map of male circumcision prevalence at country level, as of December 2006. Grey = No data; Yellow = <20% prevalence; Orange = 20-80% prevalence; Red = >80% prevalence. Source: World Health Organization. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.


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