Gazimbi MM, Magadi MA, Kruger C (2019) The Association between Male Circumcision and HIV Infection in Sub-Saharan Africa: A Systematic Review of the Literature. Int Arch Public Health Community Med 3:022.


© 2019 Gazimbi MM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESS DOI: 10.23937/2643-4512/1710022

The Association between Male Circumcision and HIV Infection in Sub-Saharan Africa: A Systematic Review of the Literature

Gazimbi MM1*, Magadi MA2 and Kruger C3

1Global Development Institute, University of Manchester, UK

2School of Education and Social Sciences, University of Hull, UK

3Centre for Sexualities, AIDS and Gender, University of Pretoria, South Africa



Although both traditional and medical male circumcision are now being promoted as part of strategies for HIV prevention in Africa, particularly in countries with low circumcision prevalence, there are debates on the efficacy of male circumcision in the prevention of HIV at both individual and population levels.

Methods and objective

In light of debates on the validity of male circumcision as the panacea for HIV prevention, the objective of this paper is to systematically review evidence on the association between male circumcision and acquisition of HIV infection in sub-Saharan Africa.


Thirty-six articles addressing the association between male circumcision and HIV transmission in sub-Saharan Africa were included in our assessment. Consistent evidence was found showing the protective effect of male circumcision on HIV infection for males at both individual and population level. In particular, evidence from three randomised control trials comparing the risk of HIV infection between circumcised and uncircumcised males in Sub-Sahara Africa suggest that male circumcision is significantly associated with risk reduction of HIV acquisition from female to male by approximately 50-60%. However, evidence of the protective effect of male circumcision for females shows mixed patterns and is inconclusive. Risky sexual behaviours post circumcision (ie., inconsistent condom use, having multiple sexual partnership); age at circumcision, surgical safety, type of circumcision (medical versus traditional), resuming sexual intercourse before the healing of the wound have been shown to modify the efficiency of male circumcision in protecting males against acquisition of HIV.


Although evidence from existing research supports promotion and scaled up of male circumcision in countries where the practice is not common, the concern that male circumcision might substitute other efforts such as condom use and behavioural modification interventions must be addressed alongside ethical concerns such as conflict with traditional values. A purely biomedical approach to the HIV/AIDS epidemic is unlikely to be sufficient in addressing the continued spread of HIV in sub-Saharan Africa.