A program that includes male circumcision and antiviral drug treatment led to a sharp drop in HIV infection rates in a high-risk region of Uganda, researchers report.
Their study of a U.S.-funded HIV prevention program in the rural Rakai District on the shore of Lake Victoria followed 34,000 people. The program provides a number of free services, including anti-HIV drugs for people who are infected, voluntary male circumcision, condoms and promotion of safe sex.
While it’s known that such measures reduce HIV risk at an individual level, their long-term population-wide impact has been less clear.
The study, by Johns Hopkins researchers, found a 42 percent drop in new HIV infections in the Rakai District between the start of the program in the early 2000s and 2016.
The decrease was greater among men (50 percent) than among women (30 percent).
“This difference may have been due to the direct risk-lowering effect of circumcision for men, plus the fact that infected women were more likely than men to use antiretroviral therapy and thus were less likely to transmit the virus to male partners,” said study author Mary Kate Grabowski. She is an assistant professor in the pathology department at Hopkins.
“Increasing antiretroviral therapy use among men may help close this gap,” she said in a Hopkins news release.
The findings were published Nov. 30 in the New England Journal of Medicine.
“When I started doing research at Rakai in the late 1980s, about a third of people in the trading centers were HIV-positive and there was little we could do to prevent a further spread of the virus,” said senior study author Dr. Maria Wawer. She is a professor in the departments of epidemiology and population, family and reproductive health at Hopkins’ School of Public Health.
“But now there’s so much more that we can do, and with this study we’re finally seeing the beneficial results of these combined interventions,” Wawer added.
The U.S. Centers for Disease Control and Prevention has more on HIV prevention.