Modeling the Impact of Male Circumcision HIV Intervention Strategies

Jeff Eaton, University of Washington

Recent randomized clinical trial in South Africa, Kenya and Uganda have found that circumcised males are 50-60% less likely to acquire HIV compared to uncircumcised males. However such an individual level effect does not guarantee the efficacy of male circumcision as an intervention method at the population level. We use the Structured Population Event History Simulator (SPEHS), a stochastic simulation model of an HIV epidemic in a sub-Saharan African population, to investigate the impact of different male circumcision-based intervention strategies on population level HIV prevalence. In particular we seek to (i) define the subpopulation of males in which a circumcision-based intervention is most effective, (ii) identify the threshold number of circumcisions in order produce a substantial decrease in HIV prevalence, and (iii) assess the indirect effect of a male circumcision intervention on HIV incidence and prevalence in women and children.