Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai,Uganda

Abstract

Randomized trials have shown that medical male circumcision( MMC)reduces maleHIVacquisition by50% to 60%,1-3 and that early initiation of antiretroviral therapy (ART) reduces HIV transmission by more than90%in HIV-discordant couples.4Mathematical modeling suggests that these interventions could mitigate the HIV epidemic in subSaharan Africa,5-7 but there is limited empirical evidence for the population-level effects of these interventions on HIV incidence in real-world programs. MMC provides direct protection against male HIV acquisition by removing the foreskin, which is rich in HIV target cells.8-10 The potential effect ofMMCon population-level HIV incidence depends on this biological effect, the level ofMMC coverage, risk profiles ofmenacceptingMMC,and whether behavioral disinhibition occurs following circumcision.