Bloodborne HIV: Don't Get Stuck!

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Circumcision and HIV in the world

Except for parts of Africa, countries with majority Muslim populations, and a handful of other countries (the US, South Korea), most men in the world are intact (uncircumcised).[1] Even so, adults in Africa are much more likely to be HIV-positive than adults in other parts of the world.

Outside Africa, UNAIDS estimates 6.8 million HIV-positive men,[2] which was 0.3% of roughly 2.4 billion adult men. Because most infected 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.

Circumcision and HIV in selected 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 1/10^th of this total (<0.06% or 6 in 10,000  men) are estimated to have been infected from women.[3] 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.[4] 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[2], or less than 3 in 1,000 (= 1.2 million/470 million) men. Many of these men got HIV from receptive anal sex with men or injection drug use. Only 13.5% of Indians are circumcised.

References

1. Indy100. The map of the world by circumcision popularity. No date. Available at: https://www.indy100.com/article/circumcision-map-world-reddit-medical-surgery-penis-foreskin-removal-8101976 (accessed 22 October 2018).

2. 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).

3. 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).

4. 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).