***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Male circumcision could provide substantial protection against acquisition of HIV-1 infection . Our aim was to determine whether male circumcision had a protective effect against HIV infection , and to assess safety and changes in sexual behaviour related to this intervention . METHODS We did a r and omised controlled trial of 2784 men aged 18 - 24 years in Kisumu , Kenya . Men were r and omly assigned to an intervention group ( circumcision ; n=1391 ) or a control group ( delayed circumcision , 1393 ) , and assessed by  HIV testing , medical examinations , and behavioural interviews during follow-ups at 1 , 3 , 6 , 12 , 18 , and 24 months . HIV seroincidence was estimated in an intention-to-treat analysis . This trial is registered with Clinical Trials.gov , with the number NCT00059371 . FINDINGS The trial was stopped early on December 12 , 2006 , after a third interim analysis review ed by the data and safety monitoring board . The median length of follow-up was 24 months . Follow-up for HIV status was incomplete for 240 ( 8.6 % ) participants . 22 men in the intervention group and 47 in the control group had tested positive for HIV when the study was stopped . The 2-year HIV incidence was 2.1 % ( 95 % CI 1.2 - 3.0 ) in the circumcision group and 4.2 % ( 3.0 - 5.4 ) in the control group ( p=0.0065 ) ; the relative risk of HIV infection in circumcised men was 0.47 ( 0.28 - 0.78 ) , which corresponds to a reduction in the risk of acquiring an HIV infection of 53 % ( 22 - 72 ) . Adjusting for non-adherence to treatment and excluding four men found to be seropositive at enrollment , the protective effect of circumcision was 60 % ( 32 - 77 ) . Adverse events related to the intervention ( 21 events in 1.5 % of those circumcised ) resolved quickly . No behavioural risk compensation after circumcision was observed . INTERPRETATION Male circumcision significantly reduces the risk of HIV acquisition in young men in Africa . Where appropriate , voluntary , safe , and affordable circumcision services should be integrated with other HIV preventive interventions and provided as expeditiously as possible In the last decade , three r and omized controlled trials in Kenya , South Africa , and Ug and a have shown that medical male circumcision ( MMC ) reduces the sexual transmission of HIV from women to men . Objectives of this assessment were to measure acceptability of  adult MMC  and circumcision of children to inform policies regarding whether and how to promote MMC as an HIV prevention strategy . This mixed- method study , conducted across four Ug and an districts , included a two-stage household survey of 833 adult males and 842 adult females , focus group discussion s , and a health provider survey . Respondents ’ acceptability of MMC  was positive and substantial after being informed about the results of recent r and omized trials . In uncircumcised men , between 40 % and 62 % across the districts would consider getting circumcised . Across the four districts between 60 % and 86 % of fathers and 49 % and 95 % of mothers were supportive of MMC for sons . Widespread support exists among men and women in this study for promoting MMC as part of Ug and a 's current ‘ ABC + ’ HIV prevention strategy Background Observational studies suggest that male circumcision may provide protection against HIV-1 infection .  A r and omized , controlled intervention trial was conducted in a general population of South Africa to test this hypothesis . Methods and Findings A total of 3,274 uncircumcised men , aged 18–24 y , were r and omized to a control or an intervention group with follow-up visits at months 3 , 12 , and 21 . Male circumcision was offered to the intervention group immediately after r and omization and to the control group at the end of the follow-up . The grouped censored data were analyzed in intention-to-treat , univariate and multivariate , analyses , using piecewise exponential , proportional hazards models . Rate ratios ( RR ) of HIV incidence were determined with 95 % CI . Protection against HIV infection was calculated as 1 − RR . The trial was stopped at the interim analysis , and the mean ( interquartile range ) follow-up was 18.1 mo ( 13.0–21.0 ) when the data were analyzed . There were 20 HIV infections ( incidence rate = 0.85 per 100 person-years ) in the intervention group and 49 ( 2.1 per 100 person-years ) in the control group , corresponding to an RR of 0.40 ( 95 % CI : 0.24%–0.68 % ; p < 0.001 ) . This RR corresponds to a protection of 60 % ( 95 % CI : 32%–76 % ) . When controlling for behavioural factors , including sexual behaviour that increased slightly in the intervention group , condom use , and health-seeking behaviour , the protection was of 61 % ( 95 % CI : 34%–77 % ) . Conclusion Male circumcision provides a degree of protection against acquiring HIV infection , equivalent to what a vaccine of high efficacy would have achieved . Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa . ( Preliminary and partial results were presented at the International AIDS Society 2005 Conference , on 26 July 2005 , in Rio de Janeiro , Brazil . BACKGROUND Ecological and observational studies suggest that male circumcision reduces the risk of HIV acquisition in men . Our aim was to investigate the effect of male circumcision on  HIV incidence in men . METHODS 4996 uncircumcised , HIV-negative men aged 15 - 49 years who agreed to HIV testing and counselling were enrolled in this r and omised trial in rural Rakai district , Ug and a. Men were r and omly assigned to receive immediate circumcision ( n=2474 ) or circumcision delayed for 24 months ( 2522 ) .  HIV testing , physical examination , and interviews  were repeated at 6 , 12 , and 24 month follow-up visits . The primary outcome was HIV incidence . Analyses were done on a modified intention-to-treat basis . This trial is registered with Clinical Trials.gov , with the number NCT00425984 . FINDINGS Baseline characteristics of the men in the intervention and control groups were much the same at enrollment . Retention rates were much the same in the two groups , with 90 - 92 % of participants retained at all time points . In the modified intention-to-treat analysis , HIV incidence over 24 months was 0.66 cases per 100 person-years in the intervention group and 1.33 cases per 100 person-years in the control group ( estimated efficacy of intervention 51 % , 95 % CI 16 - 72 ; p=0.006 ) . The as-treated efficacy was 55 % ( 95 % CI 22 - 75 ; p=0.002 ) ; efficacy from the Kaplan-Meier time-to-HIV-detection as-treated analysis was 60 % ( 30 - 77 ; p=0.003 ) . HIV incidence was lower in the intervention group than it was in the control group in all sociodemographic , behavioural , and sexually transmitted disease symptom subgroups . Moderate or severe adverse events occurred in 84 ( 3.6 % ) circumcisions ; all resolved with treatment . Behaviours were much the same in both groups during follow-up . INTERPRETATION Male circumcision reduced HIV incidence in men without behavioural disinhibition . Circumcision can be recommended for HIV prevention in men Background In recent r and omized controlled trials , male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men . Consequently , Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission . However , there is a need to investigate the perceptions of male circumcision in Tanzania using specific population s. The purpose of the present study was to assess the perceptions of male circumcision  in a cohort of police officers that also served as a source of volunteers for a phase I/II HIV vaccine ( HIVIS-03 ) trial in Dar es Salaam , Tanzania . Methods In-depth interviews with 24 men and 10 women were conducted . Content analysis informed by the socio-ecological model was used to analyze the data . Results Informants perceived male circumcision as a health-promoting practice that may prevent HIV transmission and other sexually transmitted infections . They reported male circumcision promotes sexual pleasure , confidence and hygiene or sexual cleanliness . They added that it is a religious ritual and a cultural practice that enhances the recognition of manhood in the community . However , informants were concerned about the cost involved in male circumcision and cleanliness of instruments used in medical and traditional male circumcision . They also expressed confusion about the shame of undergoing circumcision at an advanced age and pain that could emanate after circumcision . The participants advocated for health policies that promote medical male circumcision at childhood , specifically along with the vaccination program . Conclusions The perceived benefit of male circumcision as a preventive strategy to HIV and other sexually transmitted infections is important . However , there is a need to ensure that male circumcision is conducted under hygienic conditions . Integrating male circumcision service in the routine childhood vaccination program may increase its coverage at early childhood . The findings from this investigation provide context ual underst and ing that may assist in scaling-up male circumcision in Tanzania Background :  Male circumcision  can reduce the risk of heterosexually acquired HIV-1 infection in men .  Neonatal male circumcision ( NMC ) has many potential advantages over circumcision at older ages , but little is known about its feasibility and safety in re source -limited setting s. Methods : We performed a r and omized trial in southeastern Botswana of Mogen clamp and Plastibell , 2 commonly used devices for NMC . Follow-up visits occurred at 6 weeks and 4 months postpartum . Adverse events , parental satisfaction , and staff impressions were recorded . Results : Of 302 male neonates r and omized , 300 ( 99 % ) underwent circumcision , 153 ( 51 % ) with Mogen clamp , and 147 ( 49 % ) with Plastibell .  There were no major adverse events in the Mogen clamp arm , but there were 2 major adverse events in the Plastibell arm ( both were a proximally migrated ring that had to be removed by study staff ) . Minor adverse events were more common with the Mogen clamp compared with the Plastibell , specifically removal of too little skin and formation of skin bridges or adhesions ( 12 versus 1 and 11 versus 3 , respectively , all P < 0.05 ) . Five ( 3 % ) infants in the Mogen clamp arm and none in the Plastibell arm had minor bleeding ( P = 0.03 ) . More than 94 % of mothers reported being highly or completely satisfied with the procedure . Conclusions : NMC can be performed in Botswana with a low rate of adverse events and high parental satisfaction . Although the risk of migration and retention of the Plastibell is small , the Mogen clamp may be safer for NMC in regions where immediate emergent medical attention is not available Background : The efficacy of male circumcision for HIV prevention over 2 years has been demonstrated in three r and omized trials , but the longer-term effectiveness of male circumcision is unknown . Methods : We conducted a r and omized trial of male circumcision in 4996 HIV-negative men aged 15–49 in Rakai , Ug and a. Following trial closure , we offered male circumcision to control participants and have maintained surveillance for up to 4.79 years . HIV incidence per 100 person-years was assessed in an as-treated analysis , and the effectiveness of male circumcision was estimated using Cox regression models , adjusted for sociodemographic and time-dependent sexual behaviors . For men uncircumcised at trial closure , sexual risk behaviors at the last trial and first posttrial visits were assessed by subsequent circumcision acceptance to detect behavioral risk compensation . Results : By 15 December 2010 , 78.4 % of uncircumcised trial participants accepted male circumcision following trial closure . During posttrial surveillance , overall HIV incidence was 0.50/100 person-years in circumcised men and 1.93/100 person-years in uncircumcised men { adjusted effectiveness 73 % [ 95 % confidence interval ( CI ) 55–84%]}. In control arm participants , posttrial HIV incidence was 0.54/100 person-years in circumcised and 1.71/100 person-years in uncircumcised men [ adjusted effectiveness 67 % ( 95 % CI 38–83 % ) ] . There were no significant differences in sociodemographic characteristics and sexual behaviors between controls accepting male circumcision and those remaining uncircumcised . Conclusion : High effectiveness of male circumcision for HIV prevention was maintained for almost 5 years following trial closure . There was no self- selection or evidence of behavioral risk compensation associated with posttrial male circumcision acceptance Background : Resumption of sex before complete wound healing after male circumcision may increase risk of postoperative surgical complications , and HIV acquisition and transmission . We aim ed to determine the effect of text messaging to d 
    Output:
    
Mientras que las barreras y motivadores son poco grado de context o específico , esta revisión sugiere que existen temas comunes que deben abordarse en toda la región si la absorción de IMC para la prevención del VIH va a ser ampliamente adoptado .
Result ados del estudio por lo tanto , son propensos a tener amplias implicaciones para despliegue IMC