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

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 ClinicalTrials.gov 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 (χ 2 = 1378.34, df = 48; I 2 = 97%). This meta‐analysis shows that male circumcision was effective in reducing HIV risk for both heterosexual and homosexual men.