The Association between Male Circumcision and HIV Infection in Sub-Saharan Africa: A Systematic Review of the Literature

Results Thirty-six articles addressing the association between male circumcision and HIV transmission in sub-Saharan Africa were included in our assessment. Consistent evidence was found showing the protective effect of male circumcision on HIV infection for males at both individual and population level. In particular, evidence from three randomised control trials comparing the risk of HIV infection between circumcised and uncircumcised males in Sub-Sahara Africa suggest that male circumcision is significantly associated with risk reduction of HIV acquisition from female to male by approximately 50-60%. However, evidence of the protective effect of male circumcision for females shows mixed patterns and is inconclusive. Risky sexual behaviours post circumcision (ie., inconsistent condom use, having multiple sexual partnership); age at circumcision, surgical safety, type of circumcision (medical versus traditional), resuming sexual intercourse before the healing of the wound have been shown to modify the efficiency of male circumcision in protecting males against acquisition of HIV.