In rural Uganda, an increase in the rate of male circumcision has worked in tandem with an increase in the number of HIV-positive women on antiretroviral therapy (ART) to significantly decrease the incidence of new HIV infections in men, according to researchers from Johns Hopkins Bloomberg School of Health, who have, for the first time, shown that these measures are effective in a real-world setting.
“The biology of these two prevention strategies has been proven, but the big question was whether these strategies could have an impact on the number of new HIV infections in communities still struggling to control the spread of the disease,” says lead author Xiangrong Kong, PhD, associate scientist, departments of Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Health, Baltimore, MD.
“Before our study, there was no empirical data to show the effects of scaling up these two interventions in real-world settings. It’s important to know whether prevention is working and this is evidence that strongly suggests that African nations should redouble their efforts to scale up these programs,” she added.
In sub-Sharan Africa, estimates from the Joint United Nations Program on HIV/AIDS (UNAIDS) hold that approximately 25.8 million individuals live with HIV, of whom approximately 41% were on ART in 2014. According to estimates from the World Health Organization, over 10 million men in 14 priority countries of the region had been circumcised between 2007 and 2015.
Results obtained in this study by Dr. Kong and colleagues, in a real-world setting, suggest that these circumcisions could dramatically impact the incidence of new HIV infections in the future.
Dr. Kong and colleagues gathered data from surveys from individuals in 45 communities in the rural Rakai District, Uganda, including community-level ART coverage, male circumcision coverage, sociodemographics, sexual behaviors, HIV prevalence, and the incidence of new HIV infection. They divided these data and analyzed them according to three separate periods:
- 1999-2004: pre-availability of ART and circumcision;
- Early ART availability; and
- 2007-2013: full program scale up of both ART and circumcision.
During the study, there was an increase in median community coverage of male circumcision, from 19% to 39%. In addition, there was an increase of median ART coverage, from 0% to 21% in men, and from 0% to 23% in women. New infections in men were reduced by a full 39% in those communities in which over 40% had been circumcised, and reduced by 23% where over 20% of HIV-infected women were taking ART as compared with communities where 20% or fewer were being treated.
Although no reductions in HIV incidence were seen in women, Dr. Kong is hopeful that this may change, as the use of male ART increases.
“We still have a long way to go in curbing the HIV epidemic in Africa. People need to adopt these strategies, and we need to have sustainable funding to support these efforts,” she concluded.
This study was supported by grants from the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (K25AI114461, U01AI000031 and U01AI075115) and National Institute of Child Health and Human Development (R01HD050180 and R01HD070769); the Bill and Melinda Gates Foundation; and the Johns Hopkins Center for AIDS Research (P20AI09189).