WORLDWIDE, OVER 35 CROSS-SECTIONAL and prospective studies,1-6 various ecologic analyses,5-8 and investigations of biologic plausibility,1,9,10 sexually transmitted infection (STI) epidemiology,1,2,11 and a longitudinal study of HIV-discordant heterosexual couples12 have identified lack of male circumcision as a significant risk factor for HIV acquisition. (However, some cross-sectional studies have found no correlation,2,6 and in a Rwandan study, women who reported that their current partners were circumcised had an increased risk of HIV.13,14) In the regions of east and southern Africa where heterosexually spread HIV epidemics are especially severe, large populations of men are uncircumcised, pointing to a possible prevention intervention.6,11,15 Previous studies in 6 sub-Saharan African countries have explored men's and women's awareness of the potential health benefits of male circumcision and men's willingness to undergo adult circumcision., Currently, pilot programs to introduce safe, affordable circumcision, as part of male reproductive health services, are being implemented or are planned in Botswana, Haiti, Kenya, South Africa, and Zambia.11,16,19
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