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December 3, 2008

Male Circumcision as an HIV Prevention Strategy in Sub-Saharan Africa: Sociolegal Barriers

Author Affiliations

Author Affiliations: O’Neill Institute for National and Global Health Law, Georgetown University, Washington, DC (Dr Gostin); and Department of Evidence, Monitoring, and Policy, Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland (Dr Hankins).

JAMA. 2008;300(21):2539-2541. doi:10.1001/jama.2008.752

The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) recommend safe, voluntary male circumcision as an additional, important strategy for the prevention of heterosexually acquired human immunodeficiency virus (HIV) infection in men in areas with high HIV prevalence and low levels of male circumcision.1 Comprehensive male circumcision services should include HIV testing and counseling, partner reduction, and male and female condom use.2 However, male circumcision can have deep symbolic meaning that could pose barriers to implementation. In some parts of the world, male circumcision is a traditional practice with religious or cultural significance; in others, it is a common hygiene intervention; and in yet others, it is unfamiliar or foreign. Consequently, the proportion of men who are circumcised varies by country from less than 5% to more than 80%, with an estimated 30% to 40% of adult men circumcised worldwide.3

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