The relationship between male circumcision and HIV infection in African populations.

The relationship between HIV seroprevalence and the proportion of uncircumcised males in African countries is examined to determine whether circumcision practices play a role in explaining the large existing variation in the sizes of African HIV epidemics. A review of the anthropological literature yielded estimates of circumcision practices for 409 African ethnic groups from which corresponding national estimates were derived. HIV seroprevalence rates in the capital cities were used as indicators of the relative level of HIV infection of countries. The correlation between these two variables in 37 African countries was high (R = 0.9; P less than 0.001). This finding is consistent with existing clinic-based studies that indicate a lower risk of HIV infection among circumcised males.