To Cut or Not to Cut: A Modeling Approach for Assessing the Role of Male Circumcision in HIV Control
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
A recent randomized controlled trial shows a significant reduction in women-to-men transmission of HIV due to male circumcision. Such development calls for a rigorous mathematical study to ascertain the full impact of male circumcision in reducing HIV burden, especially in resource-poor nations where access to anti-retroviral drugs is limited. First of all, this paper presents a compartmental model for the transmission dynamics of HIV in a community where male circumcision is practiced. In addition to having a disease-free equilibrium, which is locally-asymptotically stable whenever a certain epidemiological threshold is less than unity, the model exhibits the phenomenon of backward bifurcation, where the disease-free equilibrium coexists with a stable endemic equilibrium when the threshold is less than unity. The implication of this result is that HIV may persist in the population even when the reproduction threshold is less than unity. Using partial data from South Africa, the study shows that male circumcision at 60% efficacy level can prevent up to 220,000 cases and 8,200 deaths in the country within a year. Further, it is shown that male circumcision can significantly reduce, but not eliminate, HIV burden in a community. However, disease elimination is feasible if male circumcision is combined with other interventions such as ARVs and condom use. It is shown that the combined use of male circumcision and ARVs is more effective in reducing disease burden than the combined use of male circumcision and condoms for a moderate condom compliance rate.
- Aubert, B., Taljaard, D., Lagrade, E., Sobngwi-Tambekou, J., Sitta, R. et al., 2005. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med. 2, e298. CrossRef
- Bailey, R., Neema, S., Otheno, R., 1999. Sexual behaviors and other HIV risk factors in circumcised and uncircumcised men in Uganda. J. Acquir Immune Defic. Syndr. 22, 294–301.
- Blower, S., Koelle, K., Mills, J., 2002. Health policy modeling: epidemic control, HIV vaccines, and risky behavior. In: Kaplan, Brookmeyer (Eds.) Qualitative Evaluation of HIV Prevention Programs, pp. 260–289. Yale University Press.
- Brian, G. Williams, Lioyd-Smith, J.O., Gouws, E., Hankins, C., Getz, W.M., Hargrove, J., de Zoysa, I., Dye, C., Auvert, B., 2006. The potential impact of male circumcision on HIV in sub-Saharan Africa. PLoS Med. 3(7), e262. CrossRef
- David, K.R., Weller, S.C., 1999. The effectiveness of condoms in reducing heterosexual transmision of HIV. Fam. Plann. Perspect 31(6), 272–279. CrossRef
- Elbasha, E.H., Gumel, A.B., 2006. Theoretical assessment of public health impact of imperfect prophylactic HIV-1 vaccines with therapeutic benefits. Bull. Math. Biol. 68, 577–614. CrossRef
- Fink, A., 1986. A possible explanation for heterosexual male infection with AIDS. N. Engl. J. Med. 314, 1167.
- Gumel, A.B., McCluskey, C.C. et al., 2006. Mathematical study of a staged-progression HIV model with imperfect vaccine. Bull. Math. Biol. 68(8), 2105–2128. CrossRef
- Hutchinson, J., 1885. On the influence of circumcision in preventing syphilis. Med. Times Gazette 1, 542–543.
- Lansky, A., Nakashima, A., Jones, J., 2000. Risk behaviors related to heterosexual transmission from HIV-infected persons. Sex. Transm. Dis. 27, 483–489. CrossRef
- Moses, S., Bailey, R.C., Ronald, A.R., 1998. Male circumcision: assessment of health benefits and risks. Sex. Transm. Infect. 74, 368–373. CrossRef
- Perelson, A.S., Nelson, P.W., 1999. Mathematical analysis of HIV-1 dynamics in vivo. SIAM Rev. 41(1), 3–44. CrossRef
- Robert, C.B., Francis, A.P., Stephen, M., 2001. Male circumcision and HIV prevention: current knowledge and future research directions. Lancet Infect. Dis. 1, 223–231. CrossRef
- Report on the global AIDS epidemic: Executive summary, 2006. A UNAIDS 10th anniversary special edition.
- Siegfried, N., Muller, M., Deeks, J., Volmink, J., Egger, M. et al., 2005. HIV and male circumcision—a systematic review with assessment of the quality of studies. Lancer Infect. Dis. 5, 165–173.
- USAID 2004. The President’s emergency plan for AIDS relief: US five-year Global HIV/AIDS strategy. Available: http://www.usaid.gov/our_work/global_health/aids/pepfar.html, accessed 25 May 2006.
- van den Driessche, P., Watmough, J., 2002. Reproduction numbers and sub-threshold endemic equilibria for compartmental models of disease transmission. Math. Biosci. 180, 29–48. CrossRef
- Weiss, H.A., Quigley, M.A., Hayes, R.J., 2000. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 14, 2361–2370. CrossRef
- WHO, UNAIDS, 2005. Progress on access to anti-retroviral therapy: an update on “3 by 5”, p. 34 World Health Organization, Geneva.
- Wilson, P.A., Binagwaho, A., Ruxin, J., 2005. Combating AIDS in the developing world, p. 276 Earthscan, London.
- To Cut or Not to Cut: A Modeling Approach for Assessing the Role of Male Circumcision in HIV Control
Bulletin of Mathematical Biology
Volume 69, Issue 8 , pp 2447-2466
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Male circumcision
- Reproduction number
- Backward bifurcation