Voluntary Medical Male Circumcision for HIV Prevention: a Global Overview.

IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES
Chen Zhang, Sten H Vermund
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引用次数: 2

Abstract

Purpose of review: With the promise of HIV prevention, there has been a scale-up of voluntary medical male circumcision (VMMC) in high HIV incidence/low circumcision prevalence nations worldwide. Nonetheless, debates over the implementation and the effectiveness and safety of the VMMC in real-world settings persist. We revisit the role of VMMC in HIV prevention to inform health professionals, policymakers, and advocates or opponents in this new era.

Recent findings: There has been substantial progress on VMMC scale-up to date, but this has varied considerably by region. The evidence of solid and direct protection of VMMC is available for heterosexual men and older adolescent boys in sub-Saharan Africa. The protective effect in men who have sex with men is suggested by systematic reviews but is not confirmed by clinical trials. Sexual partners, including women, likely benefit indirectly from the increased VMMC coverage through a decreased risk of exposure to infected male partners. Fortunately, the preponderance of studies does not suggest higher sexual risk behaviors among circumcised men, so-called risk compensation. VMMC requires health systems strengthening and continued promulgation of other evidence-based HIV prevention strategies to be successful. Health authorities in high HIV incidence areas that have low circumcision coverage should implement VMMC within a context of complementary biomedical and behavioral prevention strategies.

Abstract Image

自愿医疗男性包皮环切预防艾滋病毒:全球概况。
综述目的:随着艾滋病毒预防的前景,在全球艾滋病毒高发/包皮环切率低的国家,自愿医学男性包皮环切(VMMC)的规模不断扩大。尽管如此,关于VMMC在现实环境中的实施及其有效性和安全性的争论仍然存在。我们重新审视VMMC在艾滋病毒预防中的作用,以告知卫生专业人员、政策制定者、倡导者或反对者在这个新时代。最近的发现:迄今为止,在VMMC规模扩大方面取得了实质性进展,但不同地区的情况差异很大。撒哈拉以南非洲地区的异性恋男性和年龄较大的青少年男孩可获得阴道阴道阴道炎的可靠和直接保护的证据。系统综述表明,它对男男性行为者有保护作用,但尚未得到临床试验的证实。包括妇女在内的性伴侣可能通过降低接触受感染的男性伴侣的风险,间接受益于自愿生殖保健服务覆盖面的扩大。幸运的是,多数研究并没有表明包皮环切手术的男性有更高的性风险行为,即所谓的风险补偿。VMMC需要加强卫生系统并继续颁布其他以证据为基础的艾滋病毒预防战略才能取得成功。在包皮环切覆盖率低的艾滋病毒高发地区,卫生当局应在补充生物医学和行为预防战略的背景下实施包皮环切手术。
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来源期刊
Current HIV/AIDS Reports
Current HIV/AIDS Reports INFECTIOUS DISEASES-
CiteScore
8.10
自引率
2.20%
发文量
45
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of HIV/AIDS. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antiretroviral therapies, behavioral aspects of management, and metabolic complications and comorbidity. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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