Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta-analysis

BJU Int. 2018 Apr;121(4):515-526. doi: 10.1111/bju.14102. Epub 2018 Jan 29.


We aimed to assess male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition in heterosexual and homosexual men using all available data. A systematic literature review was conducted searching for studies that assessed male circumcision as a method to prevent HIV acquisition in homosexual and/or heterosexual men. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and were searched in March 2017. A random effects model was used to calculate a pooled risk ratio (RR) and its associated 95% confidence interval (CI). In total, 49 studies were included in this meta-analysis. The overall pooled RR for both homosexual and heterosexual men was 0.58 (95% CI 0.48-0.70), suggesting that circumcision was associated with a reduction in HIV risk. Circumcision was found to be protective for both homosexual and heterosexual men (RR: 0.80, 95% CI 0.69-0.92 and 0.28, 95% CI 0.14-0.59, respectively). Heterosexual men had a greater RR reduction (72% compared with 20% for homosexual men). There was significant heterogeneity among the studies (χ2 = 1378.34, df = 48; I2 = 97%). This meta-analysis shows that male circumcision was effective in reducing HIV risk for both heterosexual and homosexual men.

Keywords: circumcision; human immunodeficiency virus; prevention; voluntary medical male circumcision.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Circumcision, Male*
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control*
  • Heterosexuality
  • Humans
  • Male
  • Risk
  • Sexual and Gender Minorities
  • Treatment Outcome