Promoting male circumcision in China for preventing HIV infection and improving reproductive health

The incidence of heterosexually transmitted HIV infection is rapidly increasing in China,which reached 44.7% among the HIV-positive patients in 2007.With a view to the reduction of HIV transmission and improvement of reproductive health in the Chinese population,this paper introduces the latest evidence obtained from the international epidemiological studies and randomized controlled clinical trials on the preventive effect of male circumcision(MC)on HIV transmission,and elucidates the cellular and molecular mechanisms of HIV transmission through the foreskin.Four studies published during 1997-2007 demonstrated that the mean prevalences of redundant prepuce and phimosis in 15 109 Chinese males aged 3-23 years in 4 areas of China were 43.90 and 11.55%,respectively,while the rate of MC was only 2.66%.As MC is a simple,inexpensive and highly effective technique in HIV prevention,we appeal to the policy-makers in China to conduct a practical program for promoting MC and enhancing male productive health in combination with other approaches to the prevention of HIV infection.MC for neonates,children,adolescents and adults should be included in the health insurance program,and free and timely MC should be performed for the male adults with the high risk of HIV infection and the normal ones whose wives are HIV-positive.Further investigations should be carried out on the epidemiology of redundant prepuce and phimosis,the acceptance and socio-cultural context of MC and the development of simpler and safer methods for MC.