Department of African-American Studies, Northeastern University, Boston, MA, USA.
J Int AIDS Soc. 2011 Oct 20;14:49. doi: 10.1186/1758-2652-14-49.
Heterosexual exposure accounts for most HIV transmission in sub-Saharan Africa, and this mode, as a proportion of new infections, is escalating globally. The scientific evidence accumulated over more than 20 years shows that among the strategies advocated during this period for HIV prevention, male circumcision is one of, if not, the most efficacious epidemiologically, as well as cost-wise. Despite this, and recommendation of the procedure by global policy makers, national implementation has been slow. Additionally, some are not convinced of the protective effect of male circumcision and there are also reports, unsupported by evidence, that non-sex-related drivers play a major role in HIV transmission in sub-Saharan Africa. Here, we provide a critical evaluation of the state of the current evidence for male circumcision in reducing HIV infection in light of established transmission drivers, provide an update on programmes now in place in this region, and explain why policies based on established scientific evidence should be prioritized. We conclude that the evidence supports the need to accelerate the implementation of medical male circumcision programmes for HIV prevention in generalized heterosexual epidemics, as well as in countering the growing heterosexual transmission in countries where HIV prevalence is presently low.
异性性接触是撒哈拉以南非洲地区大多数 HIV 传播的原因，而这种传播方式在新感染病例中的比例正在全球范围内上升。20 多年来积累的科学证据表明，在这一时期倡导的 HIV 预防策略中，男性包皮环切术是最有效的策略之一，如果不是最有效的，那么在流行病学和成本效益方面也是如此。尽管如此，全球政策制定者还是推荐了这一程序，但国家的执行速度却很慢。此外，有些人对男性包皮环切术的保护作用持怀疑态度，也有一些没有证据支持的报告称，非性相关因素在撒哈拉以南非洲的 HIV 传播中起着重要作用。在这里，我们根据既定的传播驱动因素，对男性包皮环切术在减少 HIV 感染方面的现有证据进行了批判性评估，介绍了该地区目前正在实施的方案，并解释了为什么应该优先考虑基于既定科学证据的政策。我们的结论是，有证据表明需要加快实施针对异性传播普遍流行地区和 HIV 流行率目前较低国家的异性传播的男性包皮环切术预防 HIV 方案。
