"The overall HIV rate at follow-up was 12% and the researchers estimated that without the circumcision procedures performed during the Bophelo Pele project, the rate of HIV among men living in this community would have been 15% in 2011".

"This effectiveness study has some limitations. Firstly, this study used a quasi-experimental design. It was not randomized and cannot prove a causal association. Secondly, HIV incidence was not measured in the context of a cohort study, which is the gold standard. We chose another design in order to be able to extrapolate HIV incidence among a random, cross sectional sample of men to the entire male population of the community. The possible selection bias associated with cohort studies followed up for many years may undermine extrapolating results from the sample analysis. Thirdly, we used an incidence assay to estimate IRRs, which has limitations, as described below. Lastly, the propensity score methods used can only reduce the selection bias associated with the observed covariates. We cannot exclude the possibility that there were also some unobserved confounding factors. However, the fact that those intending to become circumcised are not more aware of their HIV status [24] and not more infected with HIV, as found here, is reassuring. One additional limitation is that this study was conducted without the support of a national adult VMMC campaign. As a result, the VMMC uptake obtained may have been lower than what would have been observed if such campaign was in effect, since it would likely have reinforced our local communication campaign and encouraged VMMC uptake in the community."

"Competing interests: GP has received travel grants, consultancy fees, honoraria, or study grants from various pharmaceutical companies including Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, Roche, Splicos, and ViiV Healthcare. GP is a member of different committees of the French National Agency for Research on AIDS and Viral Hepatitis (HIV Pharmacology, HIV Resistance, Therapeutic Strategy on HIV and Viral Hepatitis). All other authors have declared that no competing interests exist."