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The Cost to Circumcise Africa

RYAN G. MCALLISTERa JOHN W. TRAVISb
DAN BOLLINGERc CLAIRE RUTISERc VEERARAGHAVAN SUNDARc
a Georgetown University bWellness Associates c Independent Researchers


Male circumcision employed as a prophylactic surgical intervention for HIV transmission
reduction has been publicized in the media following recent results from
observational trials conducted in Africa. Yet in all of the discussions concerning
circumcision as a public health initiative, including a cost analysis performed on
circumcision as a prophylactic for reducing HIV transmission in Africa, none estimates
the endeavor’s scope or cost. Given the scale of the economics involved
in and the number of competing strategies available for addressing the HIV epidemic,
funding and cost effectiveness are vital concerns in the field. This raises the
question of which treatments and methodologies to fund, or not. In this study, we
use circumcision costs, census, and demographic data available from government
agencies and other published sources to estimate the cost to circumcise all HIVnegative
African adult males, including costs of complications. We compare that
cost to another androcentric penile alteration: using condoms (including their purchase
and distribution costs). Our findings suggest that behavior change programs
are more efficient and cost effective than surgical procedures. Providing free condoms
is estimated to be significantly less costly, more effective in comparison to
circumcising, and at least 95 times more cost effective at stopping the spread of
HIV in sub-Saharan Africa. In addition, condom usage provides protection for
women as well as men. This is significant in an area where almost 61% of adults
living with AIDS are women.

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