SynthesisJournal of the International AIDS Society2020
Impact of male circumcision on risk of HIV infection in men in a changing epidemic context - systematic review and meta-analysis.
Synthesis in Journal of the International AIDS Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 2 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- Traditional male circumcision and the risk for HIV transmission among men: a systematic review.BMJ open · 2023Pooled it
- Impact of male circumcision on risk of HIV infection in men in a changing epidemic context - systematic review and meta-analysis.Journal of the International AIDS Society · 2020Pooled it
- HIV Transmission and Immunology of the Male Reproductive Tract.American journal of reproductive immunology (New York, N.Y. : 1989) · 2026Review
- Reported Effectiveness of a Text-Based Post-Operative Care Intervention After Voluntary Medical Male Circumcision (VMMC) to Improve Quality of Care and Adverse Events Identification in Sub-Saharan Africa: A Scoping Review.Health science reports · 2026Review
- HIV incidence among sexually active young males and females in Kisumu County, Western Kenya.PloS one · 2026Article
- Men undergoing medical circumcision at a community health centre: Knowledge and attitudes.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2025Article
- Retrospective analysis of clinical outcomes and early complications of conventional circumcision techniques and thermocautery-assisted circumcision.Scientific reports · 2025Article
- Expanding two-way texting for post-operative follow-up: A cost analysis of the implementation and scale-up in routine voluntary medical male circumcision settings in South Africa.PLOS global public health · 2025Article
- Advances in the study of the correlation between balanoposthitis and skin microecology.Frontiers in microbiology · 2025Review
- Empathy in Action: Black Bioethics and the Role of Care Ethics in HPV Prevention and Education in Underserved Communities.Journal of healthcare, science and the humanities · 2025Article
- What does it cost to expand two-way texting for post-operative follow-up? A cost analysis in routine voluntary medical male circumcision settings in South Africa.medRxiv : the preprint server for health sciences · 2024Article
- Ethics of Mathematical Modeling in Public Health: The Case of Medical Male Circumcision for HIV Prevention in Africa.Public health ethics · 2024Article
- Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study.BMC public health · 2024Article
- Review
- HIV infection.Nature reviews. Disease primers · 2023Review
- What will it take for an injectable ARV to change the face of the HIV epidemic in high-prevalence countries? Considerations regarding drug costs and operations.Journal of the International AIDS Society · 2023Review
- Factors Beyond Compensation Associated with Uptake of Voluntary Medical Male Circumcision in Zambia.AIDS and behavior · 2023Article
- A review of public health, social and ethical implications of voluntary medical male circumcision programs for HIV prevention in sub-Saharan Africa.International journal of impotence research · 2023Review
- Voluntary Medical Male Circumcision to Reduce HIV Acquisition and Transmission.Current HIV/AIDS reports · 2022Review
- Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges.Current HIV/AIDS reports · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 3 countries.
Funding
Abstract
introductionWHO/UNAIDS recommended Voluntary Medical Male Circumcision in 2007 based on systematic review of observational studies prior to 1999 and three randomized controlled trials (RCTs). To inform updated WHO guidance, we conducted a systematic review and meta-analysis of impact of circumcision on the risk of HIV infection among heterosexual men.
methodsStudies in PubMed of HIV incidence and changes in prevalence in heterosexual men by circumcision status were identified. Pooled incidence rate ratios were computed using fixed- and random-effects meta-analysis and risk of bias was assessed using the ROBINS-I tool. RESULTS AND DISCUSSION: In three RCTs, the pooled incidence ratio was 0.41 (95% CI 0.30 to 0.56), with risk difference 10 (8 to 12) fewer infections per 1000 person-years (py). Pooled incidence ratios were 0.34 (0.24 to 0.49) in two post-RCT follow-up studies, 0.29 (0.19 to 0.43) in men at high HIV risk (five cohorts), 0.48 (0.33 to 0.70) in four community-based cohorts before circumcision scale-up, and 0.56 (0.49 to 0.64) (7 [6 to 8] fewer per 1000 py) in six community-based cohorts during circumcision and antiretroviral treatment scale-up. Heterogeneity between studies was low except in men at high HIV risk. We estimated 520,000 (425,000 to 605,000) fewer infections occurred in men by end of 2018 from 22.7 million circumcisions performed since 2008 and increasing by 155,000 (125,000 to 180,000) annually if epidemic conditions remain similar. After exclusion of studies with high risk of bias and those conducted outside Africa, pooled incidence ratios were similar. There was no evidence of confounding nor changes in risk behaviour following circumcision. In post-hoc exploratory analyses we observed a trend of decreasing effectiveness of circumcision in cohorts with lower HIV incidence.
conclusionsEfficacy of medical male circumcision on HIV incidence from randomized controlled trials was supported by effectiveness from observational studies in populations with diverse HIV risk and changing epidemic contexts. Voluntary Medical Male Circumcision remains an important evidence-based intervention for control of generalized HIV epidemics.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.