THE ASSOCIATION BETWEEN LACK OF MALE CIRCUMCISION AND RISK FOR HIV-INFECTION - A REVIEW OF THE EPIDEMIOLOGIC DATA

Background and Objectives: Whether male circumcision reduces the risk of acquiring human immunodeficiency virus (HIV) infection remains cont roversial. Study Design: As there have now been a number of studies co nducted that have examined this issue, we undertook to review their fi ndings. Thirty epidemiological studies identified in the literature th at investigated the association between male circumcision status and r isk for HIV infection were reviewed. Results: Eighteen cross-sectional studies from six countries reported a statistically significant assoc iation, four studies from four countries found a trend toward an assoc iation. Four studies from two countries found no association. Two pros pective studies reported significant associations, as did two ecologic al studies. In studies in which significant associations were demonstr ated, measures of increased risk ranged from 1.5 to 8.4. The groups in which positive associations were found included sexually transmitted disease (STD) clinic and hospital patients, outpatient clinic and HIV screening clinic attenders, long-distance truck drivers, and general c ommunity members. Conclusion: Potential sources of error, assessment o f causality, implications of the findings, and future research needs a re discussed. Because a substantial body of evidence links noncircumci sion in men with risk for HIV infection, consideration should be given to male circumcision as an intervention to reduce HIV transmission.