Don't Get Stuck With HIV

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Circ’ing seems irrelevant to HIV epidemics outside Africa

[return to first circumcision page]

World: UNAIDS estimates 6.8 million HIV-positive men lived in countries outside Africa in 2016.[1] The population in the world outside Africa in 2016 was 6.2 billion, of which circa 2.4 billion were men aged 15 years and older.[1] Thus, outside Africa, on average 3 in 1,000 men (0.3% ≈ 6.8 million/2.4 billion) were HIV-positive. Because most men outside Africa got HIV from receptive anal sex with men or from injecting illegal drugs with unsterilized syringes and needles, less than 1 in 1,000 got it through their penis, whether circumcised or not.

Consider several countries:

United States: In the US, the latest estimate from the Centers for Disease Control (CDC) for 2015 identified <0.6% of men as HIV-positive, of which only 1/10th of this total (<0.06% or 6 in 10,000  men) are estimated to have been infected from women.[2] In other words, less than 0.06% of men in the US got HIV from a women through their penis. Even that may be an overestimate, since some men who report heterosexual risk may have not wanted to admit sex with men or injection drug use.

China: China’s population of 1.4 billion includes 560 million men aged 15 and older. China had 501,000 people living with HIV in 2014.[3] Even if all these infections were in men, less than 1 in 1,000 men would be infected. However: the 501,000 HIV-positive people in China includes women and men who got HIV from sex with men or injection drug use. Thus, far less than 1 in 1,000 men in China got HIV through their penis. The 14% of men circ’d in China is less than in almost all counties in Africa. Even though China’s population exceeds the population of Africa, Africa has more than 50 times as many HIV-positive people: 26.4 million in Africa vs. 501,000 China.

 

India: India’s population of 1.3 billion is similarly greater than Africa’s population. Approximately 35% (470 million) of India’s population is men aged 15 years and older. According to WHO, India in 2016 had 1.2 million men living with HIV[1], or less than 3 in 1,000 (= 1.2 million/470 million) men. Because many HIV-positive men got it through sex with men or injection drug use, the number of men who got HIV through their penis is much less. Only 13.5% of Indians are circumcised.

Outside Africa, circ’ing has little or no impact on men’s risk for HIV or on the percent of adults living with HIV. Why should anyone think circ’ing has a big impact on HIV  transmission in Africa but not elsewhere in the world?

References

1. UNAIDS. HIV estimates with uncertainty bounds 1990-2016. Geneva: UNAIDS, 2017. Available at: http://www.unaids.org/en/resources/documents/2017/HIV_estimates_with_uncertainty_bounds_1990-2016(accessed 12 October 2017).

2. Centers for Disease Control and Prevention. HIV Surveillance Report, 2016. Vol 28. 2017.  Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf(accessed 20 December 2018).

3. National Health and Family Planning Commission of the People’s Republic of China. 2015 China AIDS Response Progress Report. 2015. Available at: http://www.unaids.org/sites/default/files/country/documents/CHN_narrative_report_2015.pdf(accessed 20 February 2018).

 

A world map shows shows lower percentages of men circumcised in most countries outside Africa than in Africa. Countries and regions where circumcision is less common include China (0.1% of adults aged 15-49 are HIV-positive), India (o.3% of adults HIV-positive), Latin America and the Caribbean (0.4% of adults HIV-positive) and Europe (0.4% of adults HIV-positive [see annex 8 in this link]).

But even these data overstate the impact of an intact penis on men’s risk for HIV outside Africa. Only a small minority of HIV-positive men outside Africa got HIV through their penis. Most HIV-positive infected men outside Africa got HIV through their anus (from receptive anal sex with another man) or through their arm (from unsterile injections of illegal drugs).

Notably, the map (see above link) showing mostly intact men outside Africa (see above link) is on a pro-circumcision website — which is curious, because the obvious conclusion to draw from the map is that circumcision does not explain differences in HIV epidemics between countries.

[We’d like to add more data here. Do you have or know of a good on-line or published data set giving % of men circumcised vs % of adults HIV positive for African and non-African countries?]

Return to the first circumcision page.

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