Editorial review: male circumcision, gender and HIV prevention in sub-Saharan Africa: a (social science) research agenda

Abstract

Sub-Saharan Africa is the part of the world which is the most affected by the HIV and AIDS pandemic, with 24.5 million people infected by the virus that causes AIDS. Adult HIV prevalence in southern Africa is estimated at 16%, at 6% in East Africa and at 4.5% in West and Central Africa (UNAIDS, 2006). Ecological studies in sub-Saharan Africa have suggested a geographical association between areas of higher prevalence of HIV and lower prevalence of male circumcision (MC) (Drain, Halperin, Hughes, Klausner & Bailey, 2006). An initial short-term randomised controlled study on male circumcision led by the Agence nationale de recherche sur le sida (ANRS) at Orange Farm in South Africa revealed a reduction of 60%-75% in the risk of female to male transmission of HIV-1 in circumcised men (Auvert et al., 2005).These studies, which were supported by the National Institutes of Health (NIH), were conducted in Kisumu in Kenya (Bailey et al., 2007) and in Rakai in Uganda (Gray et al., 2007).They demonstrated a risk reduction of around 58% and 53% respectively.On the 28th of March 2007 based on these studies, the WHO and UNAIDS issued a statement endorsing male circumcision (MC) as an additional strategy in HIV prevention, particularly in high HIV prevalence and low male circumcision countries (WHO/UNAIDS, 2007).