Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices

Richard T Gray; Andrew Vallely; David P Wilson; John Kaldor; David MacLaren; Angela Kelly-Hanku; Peter Siba; John M Murray; Male Circumcision Acceptability and Impact Study (MCAIS) team

doi:10.1371/journal.pone.0104531

Impact of male circumcision on the HIV epidemic in Papua New Guinea: a country with extensive foreskin cutting practices

PLoS One. 2014 Aug 11;9(8):e104531. doi: 10.1371/journal.pone.0104531. eCollection 2014.

Authors

Richard T Gray¹, Andrew Vallely², David P Wilson¹, John Kaldor¹, David MacLaren³, Angela Kelly-Hanku⁴, Peter Siba⁵, John M Murray⁶; Male Circumcision Acceptability and Impact Study (MCAIS) team

Affiliations

¹ The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
² The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia; Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea.
³ School of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
⁴ Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea; International HIV Research Group, School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea.
⁶ School of Mathematics and Statistics, University of New South Wales, Sydney, New South Wales, Australia.

Abstract

The degree to which adult medical male circumcision (MC) programs can reduce new HIV infections in a moderate HIV prevalence country like Papua New Guinea (PNG) are uncertain especially given the widespread prevalence of longitudinal foreskin cuts among adult males. We estimated the likely impact of a medical MC intervention in PNG using a mathematical model of HIV transmission. The model was age-structured and incorporated separate components for sex, rural/urban, men who have sex with men and female sex workers. Country-specific data of the prevalence of foreskin cuts, sexually transmitted infections, condom usage, and the acceptability of MC were obtained by our group through related studies. If longitudinal foreskin cutting has a protective efficacy of 20% compared to 60% for MC, then providing MC to 20% of uncut males from 2012 would require 376,000 procedures, avert 7,900 HIV infections by 2032, and require 143 MC per averted infection. Targeting uncut urban youths would achieve the most cost effective returns of 54 MC per HIV infection averted. These numbers of MC required to avert an HIV infection change little even with coverage up to 80% of men. The greater the protective efficacy of longitudinal foreskin cuts against HIV acquisition, the less impact MC interventions will have. Dependent on this efficacy, increasing condom use could have a much greater impact with a 10 percentage point increase averting 18,400 infections over this same period. MC programs could be effective in reducing HIV infections in PNG, particularly in high prevalence populations. However the overall impact is highly dependent on the protective efficacy of existing longitudinal foreskin cutting in preventing HIV.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child
Child, Preschool
Circumcision, Male / ethnology*
Circumcision, Male / statistics & numerical data*
Condoms / statistics & numerical data
Epidemics / prevention & control*
Female
Foreskin*
HIV Infections / epidemiology*
HIV Infections / prevention & control
HIV Infections / transmission
Humans
Infant
Infant, Newborn
Male
Middle Aged
Models, Statistical*
Papua New Guinea / epidemiology
Papua New Guinea / ethnology
Risk
Young Adult

Grants and funding

The Male Circumcision Acceptability and Impact Study (MCAIS) was funded by an Australian Agency for International Development (AusAID) Australian Development Research Award (ADRA 44743). RTG and DPW received funding from a National Health and Medical Research Council Project Grant (630495). The Kirby Institute is funded by the Australian Government, Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.