Scaling Up Circumcision Programs in Southern Africa: The Potential Impact of Gender Disparities and Changes in Condom Use Behaviors on Heterosexual HIV Transmission
Identifieur interne : 001130 ( Pmc/Corpus ); précédent : 001129; suivant : 001131Scaling Up Circumcision Programs in Southern Africa: The Potential Impact of Gender Disparities and Changes in Condom Use Behaviors on Heterosexual HIV Transmission
Auteurs : Kyeen M. Andersson ; Douglas K. Owens ; A. David PaltielSource :
- AIDS and behavior [ 1090-7165 ] ; 2011.
Abstract
Circumcision significantly reduces female-to-male transmission of HIV infection, but changes in behavior may influence the overall impact on transmission. We sought to explore these effects, particularly for societies where women have less power to negotiate safe sex. We developed a compartmental epidemic model to simulate the population-level impact of various circumcision programs on heterosexual HIV transmission in Soweto. We incorporated gender-specific negotiation of condom use in sexual partnerships and explored post-circumcision changes in condom use. A 5-year prevention program in which only an additional 10% of uncircumcised males undergo circumcision each year, for example, would prevent 13% of the expected new HIV infections over 20 years. Outcomes were sensitive to potential changes in behavior and differed by gender. For Southern Africa, even modest programs offering circumcision would result in significant benefits. Because decreases in male condom use could diminish these benefits, particularly for women, circumcision programs should emphasize risk-reduction counseling.
Url:
DOI: 10.1007/s10461-010-9784-y
PubMed: 20924783
PubMed Central: 3112296
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PMC:3112296Le document en format XML
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<front><div type="abstract" xml:lang="en"><p id="P1">Circumcision significantly reduces female-to-male transmission of HIV infection, but changes in behavior may influence the overall impact on transmission. We sought to explore these effects, particularly for societies where women have less power to negotiate safe sex. We developed a compartmental epidemic model to simulate the population-level impact of various circumcision programs on heterosexual HIV transmission in Soweto. We incorporated gender-specific negotiation of condom use in sexual partnerships and explored post-circumcision changes in condom use. A 5-year prevention program in which only an additional 10% of uncircumcised males undergo circumcision each year, for example, would prevent 13% of the expected new HIV infections over 20 years. Outcomes were sensitive to potential changes in behavior and differed by gender. For Southern Africa, even modest programs offering circumcision would result in significant benefits. Because decreases in male condom use could diminish these benefits, particularly for women, circumcision programs should emphasize risk-reduction counseling.</p>
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<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Andersson</surname>
<given-names>Kyeen M.</given-names>
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<email>kyeen@aya.yale.edu</email>
<aff id="A1">Division of Health Policy & Administration, Department of Epidemiology & Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06510, USA</aff>
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<contrib contrib-type="author"><name><surname>Owens</surname>
<given-names>Douglas K.</given-names>
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<aff id="A2">VA Palo Alto Health Care System, Palo Alto, CA, USA</aff>
<aff id="A3">Center for Primary Care and Outcomes Research/Center for Health Policy, Stanford University, Stanford, CA, USA</aff>
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<contrib contrib-type="author"><name><surname>Paltiel</surname>
<given-names>A. David</given-names>
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<aff id="A4">Division of Health Policy & Administration, Department of Epidemiology & Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06510, USA</aff>
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<pub-date pub-type="nihms-submitted"><day>8</day>
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<volume>15</volume>
<issue>5</issue>
<fpage>938</fpage>
<lpage>948</lpage>
<permissions><copyright-statement>© Springer Science+Business Media, LLC 2010</copyright-statement>
<copyright-year>2010</copyright-year>
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<abstract><p id="P1">Circumcision significantly reduces female-to-male transmission of HIV infection, but changes in behavior may influence the overall impact on transmission. We sought to explore these effects, particularly for societies where women have less power to negotiate safe sex. We developed a compartmental epidemic model to simulate the population-level impact of various circumcision programs on heterosexual HIV transmission in Soweto. We incorporated gender-specific negotiation of condom use in sexual partnerships and explored post-circumcision changes in condom use. A 5-year prevention program in which only an additional 10% of uncircumcised males undergo circumcision each year, for example, would prevent 13% of the expected new HIV infections over 20 years. Outcomes were sensitive to potential changes in behavior and differed by gender. For Southern Africa, even modest programs offering circumcision would result in significant benefits. Because decreases in male condom use could diminish these benefits, particularly for women, circumcision programs should emphasize risk-reduction counseling.</p>
</abstract>
<kwd-group><kwd>Male circumcision</kwd>
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<contract-sponsor id="GM1">National Institute of General Medical Sciences : NIGMS</contract-sponsor>
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