{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:04:17Z","timestamp":1790661857160,"version":"4.1.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>While voluntary medical male circumcision (VMMC) reduces the individual-level risk of HIV acquisition by approximately 60% in randomised-controlled trials, little is known about the \u2018real-world\u2019 long-term effect of medical and traditional male circumcision on the cumulative risk of HIV infection. We estimate the association between these for the first time using a quasi-experimental study design\u2014a household fixed-effects analysis\u2014for sub-Saharan Africa, the global region with the largest HIV burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We pooled individual-level cross-sectional data from the nationally-representative Demographic and Health Surveys and AIDS Indicator Surveys across all sub-Saharan African countries in which the surveys included data on both male circumcision and HIV status. We estimated the association between male circumcision and HIV status using modified Poisson regression models with household fixed-effects\u2014which control for unobserved and observed confounding shared by men living in the same household\u2014and included additional individual-level controls for demographic characteristics, socio-economic factors, and sexual behaviour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included individual data from 279,351 male participants in 48 nationally-representative surveys conducted in 29 countries between 2003 and 2018. The mean survey-level prevalence of male circumcision was 65.9% (median 84.5%, IQR 28.8\u201368.1%) and HIV was 5.6% (median 2.5%, IQR 1.2\u201310.2%). We estimated that male circumcision was associated with a significant nearly one-fifth reduction in the cumulative risk of HIV infection (adjusted risk ratio 0.81, 95% CI 0.73\u20130.89).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Male circumcision was associated with a significant reduction in the risk of HIV infection in sub-Saharan Africa over the past two decades. Increased political and financial commitment to VMMC could likely lead to further reductions in HIV prevalence, especially when rolled out as a HIV prevention option in combination with other interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1810573","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:50:54Z","timestamp":1790661054000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of male circumcision on risk of HIV infection in sub-Saharan Africa: a household fixed-effects analysis of 279,351 men from 29 countries"],"prefix":"10.3389","volume":"14","author":[{"given":"Caroline A.","family":"Bulstra","sequence":"first","affiliation":[{"name":"Heidelberg Institute of Global Health (HIGH), Heidelberg University Medical Center","place":["Heidelberg, Germany"]},{"name":"Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam","place":["Rotterdam, Netherlands"]},{"name":"Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochen","family":"Dai","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation (IHME), University of Washington","place":["Seattle, WA, United States"]},{"name":"Department of Health Metrics Sciences, School of Medicine, University of Washington","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Ngure","sequence":"additional","affiliation":[{"name":"School of Public Health, Jomo Kenyatta University of Agriculture and Technology","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly S.","family":"Rosenberg","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington","place":["Bloomington, IN, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice M.","family":"Wamuti","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington","place":["Seattle, WA, United States"]},{"name":"Harvard Center for Population and Development Studies","place":["Cambridge, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan A. C.","family":"Hontelez","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health (HIGH), Heidelberg University Medical Center","place":["Heidelberg, Germany"]},{"name":"Department of Public Health, Erasmus MC, Erasmus University Medical Center Rotterdam","place":["Rotterdam, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua A.","family":"Salomon","sequence":"additional","affiliation":[{"name":"Department of Health Policy, Stanford University","place":["Stanford, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina F.","family":"Ortblad","sequence":"additional","affiliation":[{"name":"Public Health Sciences Division, Fred Hutchinson Cancer Research Center","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"B\u00e4rnighausen","sequence":"additional","affiliation":[{"name":"Heidelberg Institute of Global Health (HIGH), Heidelberg University Medical Center","place":["Heidelberg, Germany"]},{"name":"Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University","place":["Boston, MA, United States"]},{"name":"Africa Health Research Institute","place":["KwaZulu-Natal, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0002212","article-title":"Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa","volume":"3","author":"Hallett","year":"2008","journal-title":"PLoS One"},{"key":"ref2","volume-title":"WHO Progress Brief: Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in Eastern and Southern Africa","year":"2017"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/s0140-6736(07)60312-2","article-title":"Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial","volume":"369","author":"Bailey","year":"2007","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/S0140-6736(07)60313-4","article-title":"Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial","volume":"369","author":"Gray","year":"2007","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e298","DOI":"10.1371\/journal.pmed.0020298","article-title":"Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial","volume":"2","author":"Auvert","year":"2005","journal-title":"PLoS Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/S0140-6736(07)60288-8","article-title":"Male circumcision to cut HIV risk in the general population","volume":"369","author":"Newell","year":"2007","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1097\/QAI.0b013e318095a3da","article-title":"The protective effect of circumcision on HIV incidence in rural low-risk men circumcised predominantly by traditional circumcisers in Kenya: two-year follow-up of the Kericho HIV cohort study","volume":"45","author":"Shaffer","year":"2007","journal-title":"J Acquir Immune Defic Syndr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0177076","DOI":"10.1371\/journal.pone.0177076","article-title":"Is traditional male circumcision effective as an HIV prevention strategy? 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