For the first time, researchers have shown a link between voluntary medical male circumcision (VMMC) as well as antiretroviral (ARV) treatment and a reduction in HIV infection rates. Publishing their findings in the Journal of the American Medical Association, researchers analyzed one or more sexual health surveys from 44,688 people in 45 communities in Rakai District, Uganda, covering 1999 through 2013.
The study examined three periods: 1999 to 2004, before ARVs and VMMC became available; 2004 to 2007, during the early availability of these interventions; and 2007 to 2013, during their significant scale-up.
Research has suggested that those who have an undetectable viral load thanks to successful ARV treatment have a very small, perhaps nonexistent, chance of transmitting HIV. A collection of advanced trials published during the mid-2000s found that VMMC is associated with about a 60 percent reduced risk of female-to-male transmission of the virus.
During this new paper’s study period, the annual rate of HIV infection declined from 1.25 percent to 0.84 percent among males and from 1.25 percent to 0.99 percent among females. The median community coverage of VMMC increased from 19 percent to 39 percent while the median HIV treatment rate increased from zero percent to 21 percent in males and from zero percent to 23 percent in females.
Those communities that had a greater than 40 percent VMMC coverage had an average annual male HIV infection rate of 1.03 percent, compared with 1.69 percent in those communities with VMMC coverage of 10 percent or less. After adjusting for various factors, the researchers found that 40-plus percent coverage, compared with coverage up to 10 percent, was associated with a 39 percent reduction in the HIV rate among males.
Comparing communities with HIV treatment rates among females of greater than 20 percent (in which the average male HIV incidence rate was 0.87 percent) with those with female treatment rates of 20 percent or less (in which the average male incidence rate was 1.17 percent), the researchers found that, after adjusting for various factors, 20-plus percent treatment coverage in females was associated with a 23 percent reduced HIV rate among males.
The researchers did not see any reduction in HIV infection rates among females but speculate that such rates may drop as use of ARVs increases among men.
To read a press release about the study, click here.
To read the study abstract, click here.