***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
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    Input: Objective : Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60 % . Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting , with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a r and omized trial suggesting no short-term benefit of circumcision . Design / methods : Data collected as part of a prospect i ve study among African HIV-1-serodiscordant couples were analyzed for the relationship between circumcision status of HIV-1-seropositive men and risk of HIV-1 acquisition among their female partners . Circumcision status was determined by physical examination . Cox proportional hazards analysis was used . Results : A total of 1096 HIV-1-serodiscordant couples in which the male partner was HIV-1-infected were followed for a median of 18 months ; 374 ( 34 % ) male partners were circumcised . Sixty-four female partners seroconverted to HIV-1 ( incidence 3.8 per 100 person-years ) . Circumcision of the male partner was associated with a nonstatistically significant approximately 40 % lower risk of HIV-1 acquisition by the female partner ( hazard ratio 0.62 , 95 % confidence interval 0.35–1.10 , P = 0.10 ) . The magnitude of this effect was similar when restricted to the subset of HIV-1 transmission events confirmed by viral sequencing to have occurred within the partnership ( n = 50 , hazard ratio 0.57 , P = 0.11 ) , after adjustment for male partner plasma HIV-1 concentrations ( hazard ratio 0.60 , P = 0.13 ) , and when excluding follow-up time for male partners who initiated antiretroviral therapy ( hazard ratio 0.53 , P = 0.07 ) . Conclusion : Among HIV-1-serodiscordant couples in which the HIV-1-seropositive partner was male , we observed no increased risk and potentially decreased risk from circumcision on male-to-female transmission of HIV-1 BACKGROUND Exp and ed access to combination antiretroviral therapy ( ART ) in re source -poor setting s is dependent on task shifting from doctors to other health-care providers . We compared outcomes of nurse versus doctor management of ART care for HIV-infected patients . METHODS This r and omised non-inferiority trial was undertaken at two South African primary -care clinics . HIV-positive individuals with a CD4 cell count of less than 350 cells per microL or WHO stage 3 or 4 disease were r and omly assigned to nurse-monitored or doctor-monitored ART care . Patients were r and omly assigned by stratified permuted block r and omisation , and neither the patients nor those analysing the data were masked to assignment . The primary objective was a composite endpoint of treatment-limiting events , incorporating mortality , viral failure , treatment-limiting toxic effects , and adherence to visit schedule . Analysis was by intention to treat . Non-inferiority of the nurse versus doctor group for cumulative treatment failure was prespecified as an upper 95 % CI for the hazard ratio that was less than 1.40 . This study is registered with Clinical Trials.gov , number NCT00255840 . FINDINGS 408 patients were assigned to doctor-monitored ART care and 404 to nurse-monitored ART care ;  all participants were analysed . 371 ( 46 % ) patients reached an endpoint of treatment failure : 192 ( 48 % ) in the nurse group and 179 ( 44 % ) in the doctor group . The hazard ratio for composite failure was 1.09 ( 95 % CI 0.89 - 1.33 ) , which was within the limits for non-inferiority . After a median follow-up of 120 weeks ( IQR 60 - 144 ) , deaths ( ten vs 11 ) , virological failures ( 44 vs 39 ) , toxicity failures ( 68 vs 66 ) , and programme losses ( 70 vs 63 ) were similar in nurse and doctor groups , respectively . INTERPRETATION Nurse-monitored ART is non-inferior to doctor-monitored therapy . Findings from this study lend support to task shifting to appropriately trained nurses for monitoring of ART . FUNDING National Institutes of Health ; United States Agency for International Development ; National Institute of Allergy and Infectious Diseases Background A r and omized controlled trial ( RCT ) has shown that male circumcision ( MC ) reduces sexual transmission of HIV from women to men by 60 % ( 32%−76 % ; 95 % CI ) offering an intervention of proven efficacy for reducing the sexual spread of HIV . We explore the implication s of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa . Methods and Findings Using dynamical simulation models we consider the impact of MC on the relative prevalence of HIV in men and women and in circumcised and uncircumcised men . Using country level data on HIV prevalence and MC  , we estimate the impact of increasing MC coverage on HIV incidence , HIV prevalence , and HIV-related deaths over the next ten , twenty , and thirty years in sub-Saharan Africa . Assuming that full coverage of MC is achieved over the next ten years , we consider three scenarios in which the reduction in transmission is given by the best estimate and the upper and lower 95 % confidence limits of the reduction in transmission observed in the RCT . MC could avert 2.0 ( 1.1−3.8 ) million new HIV infections and 0.3 ( 0.1−0.5 ) million deaths over the next ten years in sub-Saharan Africa . In the ten years after that , it could avert a further 3.7 ( 1.9−7.5 ) million new HIV infections and 2.7 ( 1.5−5.3 ) million deaths , with about one quarter of all the incident cases prevented and the deaths averted occurring in South Africa . We show that a ) MC will increase the proportion of infected people who are women from about 52 % to 58 % ; b ) where there is homogenous mixing but not all men are circumcised , the prevalence of infection in circumcised men is likely to be about 80 % of that in uncircumcised men ; c ) MC is equivalent to an intervention , such as a vaccine or increased condom use , that reduces transmission in both directions by 37 % . Conclusions This analysis is based on the result of just one RCT , but if the results of that trial are confirmed we suggest that MC could substantially reduce the burden of HIV in Africa , especially in southern Africa where the prevalence of MC is low and the prevalence of HIV is high . While the protective benefit to HIV-negative men will be immediate , the full impact of MC on HIV-related illness and death will only be apparent in ten to twenty years Background The objective of the study was to compare rates of adverse events ( AEs ) related to male circumcision ( MC ) in HIV-positive and HIV-negative men in order to provide guidance for MC programs that may provide services to HIV-infected and uninfected men . Methods and Findings A total of 2,326 HIV-negative and 420 HIV-positive men ( World Health Organization [ WHO ] stage I or II and CD4 counts > 350 cells/mm3 ) were circumcised  in two separate but procedurally identical trials of MC for HIV and /or sexually transmitted infection prevention in rural Rakai , Ug and a. Participants were followed at 1–2 d and 5–9 d , and at 4–6 wk , to assess surgery-related AEs , wound healing , and resumption of intercourse . AE risks and wound healing were compared in HIV-positive and HIV-negative men .  Adjusted odds ratios ( AdjORs ) were estimated by multiple logistic regression , adjusting for baseline characteristics and postoperative resumption of sex . At enrollment , HIV-positive men were older , more likely to be married , reported more sexual partners , less condom use , and higher rates of sexually transmitted disease symptoms than HIV-negative men . Risks of moderate or severe AEs were 3.1/100 and 3.5/100 in HIV-positive and HIV-negative participants , respectively ( AdjOR 0.91 , 95 % confidence interval [ CI ] 0.47–1.74 ) . Infections were the most common AEs ( 2.6/100 in HIV-positive versus 3.0/100 in HIV-negative men ) . Risks of other complications were similar in the two groups . The proportion with completed healing by 6 wk postsurgery was 92.7 % in HIV-positive men and 95.8 % in HIV-negative men ( p = 0.007 ) . AEs were more common in men who resumed intercourse before wound healing compared to those who waited ( AdjOR 1.56 , 95 % CI 1.05–2.33 ) . Conclusions Overall , the safety of MC was comparable in asymptomatic HIV-positive and HIV-negative men , although healing was somewhat slower among the HIV infected . All men should be strongly counseled to refrain from intercourse until full wound healing is achieved . Trial registration : http://www . Clinical Trials.gov ; for HIV-negative men , # NCT00047073 and for HIV-positive men , # NCT00047073 We prospect ively review ed 3824 boys circumcised during two circumcision festivities . The boys were circumcised in their respective houses under aseptic conditions by teams of nurses , midwives and surgical aids locally trained for that purpose . Complications were seen in 2.3 % of the boys , the commonest being infection that was easily controlled by local wound care OBJECTIVE To present and evaluate circumcision practice s in Nigerian and Kenyan Africans . DESIGN Continuous prospect i ve study involving:- two hundred and forty-nine consecutive circumcisions performed from 1981 to 1998 and ; fifty patients with post circumcision complications referred for further management during the same period . SETTING Lagos University Teaching Hospital , Duro-Soleye Hospital and First Foundation Medical Centre in Lagos , Nigeria ; and Kenyatta National Hospital , Mater Misericordiae and Nairobi Hospital in Nairobi , Kenya . SUBJECTS Males of all ages presenting for circumcision and males of all ages referred with post circumcision complications . RESULTS One hundred and fifty-two ( 61.04 % ) of circumcisions performed were in adolescents and young adults for cultural initiation into ' manhood ' . The remaining seventy-nine ( 31.73 % ) neonates were circumcised for religious , parental , cultural and medical reasons . Eighty per cent of the patients referred with circumcision complications were initially circumcised by unqualified traditional " surgeons " . One patient ( 2 % ) died from septicaemia ; two patients ( 4 % ) lost their penis from gangrene and five other patients ( 10 % ) remained with permanent disability from complete or partial amputation of the penis or glans . CONCLUSION This study shows that circumcision is a commonly performed operation but can have serious , life shattering and prolonged complications sometimes result ing in death . It should therefore be performed only in medical institutions under sterile conditions and by suitably trained surgeons for specific medical indications . Ritual circumcision whether mass or single for cultural or religious reasons remains controversial without medical benefit and should be discouraged Background : Three r and omized controlled trials ( RCTs ) have demonstrated that male circumcision prevents female-to-male HIV transmission in sub-Saharan Africa . Data from prospect i ve cohort studies are helpful in considering generalizability of RCT results to population s with unique epidemiologic/cultural characteristics . Methods : Prospect i ve observational cohort sub- analysis . A total of 1378 men were evaluated after 2 years of follow-up . Baseline sociodemographic and behavioral/HIV risk characteristics were compared between  270 uncircumcised and 1108 circumcised men .  HIV incidence rates ( per 100 person-years ) were calculated , and Cox proportional hazards regression analyses estimated hazard rate ratios ( HRs ) . Results : Of the men included in this study , 80.4 % were circumcised ; 73.9 % were circumcised by traditional circumcisers . Circumcision was associated with tribal affiliation , high school education , fewer marriages , and smaller age difference between spouses ( P < 0.05 ) . After 2 years of follow-up , there were 30 HIV incident cases ( 17 in circumcised and 13 in uncircumcised men ) . Two-year HIV incidence rates were 0.79 ( 95 % confidence interval [ CI ] : 0.46 to 1.25 ) for circumcised men and 2.48 ( 95 % CI : 1.33 to 4.21 ) for uncircumcised men corresponding to a HR = 0.31 ( 95 % CI : 0.15 to 0.64 ) . In one model controlling for sociodemographic factors , the HR increased and became non-significant ( HR = 0.55 ; 95 % CI : 0.20 to 1.49 ) . Conclusions : Circumcision by traditional circumcisers offers protection from HIV infection in adult men in rural Kenya . Data from well- design ed prospect i ve cohort studies in population s with unique cultural characteristics can supplement RCT data in recommending public health policy In a combined study from the USA and Kenya , the safety of adult male circumcision  in the latter country was review ed , particularly with the purported association between this procedure and a lower incidence 
    Output:
    
CONCLUSION Task-shifting of male medical circumcision  to non-physician clinicians can be done safely , with reported rates of adverse events similar to doctors and specialists