In South Africa, mean yearly HIV incidence and an estimate of Ro were computed from antenatal clinics data and compared by province, according to level of circumcision. In thirteen other countries where Demographic and Health Surveys (DHS) were conducted, male HIV prevalence was compared between circumcising and non circumcising groups.

In South Africa, mean yearly incidences and net reproduction rates between 1994 and 2004 were not lower in provinces with high rates of male circumcision than in others. A meta analysis of thirteen countries contrasting HIV seroprevalence according to circumcision status showed no difference between the two groups (RR= 0.99, 95%CI= 0.92 1.03). Eight countries showed no significant differences, two showed lower prevalence among the circumcised groups (Kenya and Uganda), and three showed higher prevalence (Cameroon, Lesotho, Malawi). In most countries with complex ethnic fabric, the relationship between circumcision status and HIV seroprevalence was not straightforward, with the exception of the Luo in Kenya and a few groups in Uganda.

These observations question the potential long-term effect of voluntary circumcision programs in countries with generalized epidemics.

Michel Garenne PhD (demography) is Director of Research at the French Institute for Research and Development and is currently working at the Pasteur Institute, Emerging Diseases Unit, in Paris. He is also honorary Associate Professor at the University of Witwatersrand, Johannesburg. He directed the Niakhar Demographic Surveillance System in Senegal in the 1980s and has collaborated with the Agincourt Health and Demographic Surveillance System in South Africa since 1992. He is the author of numerous publications on population and health issues in Africa, and has taught demography at several universities in Europe (Paris, Clermont-Ferrand, Heidelberg, Antwerp), and in the United States (Harvard). Paris, France.