[{"data":1,"prerenderedAt":1585},["ShallowReactive",2],{"cvu-tl-survey":3,"cvu-tl-country-rates":20},{"total":4,"circumcised":5,"uncircumcised":11,"ageRanges":16,"locationCounts":17,"satisfactionDistribution":18},49,{"total":6,"happy":7,"unhappy":8,"indecisive":9,"regretRate":10},32,16,14,2,44,{"total":12,"happy":8,"unhappy":13,"indecisive":14,"satisfactionRate":15},17,3,0,82,{},{},{"happy":19,"unhappy":12,"indecisive":9},30,{"count":21,"items":22,"query":1582},171,[23,41,51,63,78,88,100,110,122,135,145,155,165,176,189,202,212,224,236,246,258,270,280,298,314,324,335,347,357,368,378,387,407,417,429,440,450,460,470,482,494,505,515,531,542,546,562,566,578,588,599,607,618,630,647,658,674,689,696,703,719,732,742,752,763,768,781,791,801,812,823,827,831,846,857,870,874,879,892,907,918,932,947,962,976,987,1001,1013,1017,1021,1029,1034,1038,1042,1046,1057,1061,1073,1087,1099,1104,1114,1127,1131,1136,1140,1147,1152,1156,1169,1173,1188,1201,1205,1209,1222,1226,1230,1241,1256,1267,1271,1275,1286,1291,1302,1313,1317,1321,1325,1329,1333,1337,1349,1353,1357,1368,1373,1377,1381,1385,1389,1393,1403,1414,1424,1428,1432,1436,1440,1444,1448,1452,1456,1460,1464,1468,1478,1482,1486,1490,1501,1511,1515,1519,1523,1533,1543,1553,1563,1572],{"iso3":24,"isoNumeric":25,"name":26,"region":27,"circumcisionRatePct":28,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":35,"profileSources":36,"isFallback":40},"PSE","275","Palestine","Middle East & North Africa",99.9,0.1,null,"2023","UNAIDS","UNREGULATED","no","childhood",[37,38,39],"Morris et al. 2016 PMC4772313 — 99.9% is assumption-derived (not surveyed); ~97-98% of Palestinians are Muslim; the model assumes 99.9% of Muslim males circumcised","No DHS, MICS, or Palestinian health survey directly measuring male circumcision prevalence was found; 99.9% is reasonable as an assumption but should not be treated as a measured figure","Palestinian Christian minority (~1-2%) may also circumcise; Arab Christian circumcision is common in the Levant (culturally normative, not religiously mandated)",true,{"iso3":42,"isoNumeric":43,"name":44,"region":27,"circumcisionRatePct":45,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":46,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":35,"profileSources":47,"isFallback":40},"ESH","732","Western Sahara",99.6,"no data",[48,49,50],"Morris et al. 2016 PMC4772313 — modelled from Pew religious-demographic data; not surveyed (no survey infrastructure exists for this disputed non-UN-member territory)","Western Sahara: ~100% Muslim (Sahrawi Arab-Berber Sunni + Moroccan settler population); both groups Muslim and circumcising; near-universal assumption is robust","HIV: officially \"NA\" — no UNAIDS, WHO, or national health survey provides a quantified HIV figure for Western Sahara; Tindouf refugee camp data (~173,600 Sahrawi in Algeria) falls under Algerian/UNHCR tracking, not Western Sahara territorial surveillance",{"iso3":52,"isoNumeric":53,"name":54,"region":27,"circumcisionRatePct":55,"adultPrevalencePct":56,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":57,"profileSources":58,"isFallback":40},"MRT","478","Mauritania",99.2,0.3,"neonatal to early childhood",[59,60,61,62],"Morris et al. 2016 PMC4772313: 99.2% (primary, confirmed 3-0). NOTE: the Morris 2016 erratum (PMC4820865) as the source for the MRT 99.2% figure was REFUTED (1-2) — cite PMC4772313 primary. NOTE 2: Wikipedia as source for the 99.2% figure was REFUTED (0-3) — Wikipedia is not a primary source for this claim.","Mauritania ~100% Maliki Sunni Muslim; circumcision near-universal as religious obligation (sunnah/fard khilaf depending on madhab interpretation)","FGM: ~67% prevalence. STRICTLY SEPARATE from male circumcision — not conflated here","No circumcision statute found; practice is unregulated",{"iso3":64,"isoNumeric":65,"name":66,"region":67,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":72,"profileSources":73,"isFallback":40},"AFG","004","Afghanistan","South Asia",99,"2024","religious","not-necessary","Infancy/childhood — a common Muslim ritual (khatna/sunnat); often performed by local non-medical practitioners (barber/dallak), especially in rural areas; a Sunni (Hanafi) rite (the Shia Hazara minority also circumcise)",[74,75,76,77],"Prevalence: near-universal ~99.8% (Morris et al. 2016, Table 1), consistent with Afghanistan's ~99% Muslim (predominantly Sunni Hanafi) population. CAVEAT: 99.8% is a RELIGION-DERIVED modelled estimate (the model sums Jewish+Muslim males × 99.9%), NOT a measured Afghan survey — no Afghan circumcision survey (DHS/AIS) exists. A soft secondary belief-based figure (\"It is believed that more than 80% of the males in Afghanistan are circumcised\", Doyle 2005) is noted but not conflated with the 99.8% modelled figure. Khatna/sunnat is performed across the Pashtun, Tajik and Uzbek; the Shia Hazara minority also circumcise.","THE DISTINCTIVE ANGLE — a near-universal rite seen through WAR: circumcision (khatna/sunnat) of male infants and children is a common, religiously-grounded ritual (Sunni Hanafi-majority; \"regarded as a tradition originating from the Prophet\"), but it is performed often by local NON-MEDICAL practitioners \"with few safeguards, particularly in rural areas\" — a structural risk only deepened by decades of war and a fragile, post-2021 health system. SEPARATION GUARD: Afghanistan's documented \"bacha bazi\" child-abuse issue is an ENTIRELY SEPARATE matter and is NOT circumcision; it is never conflated with khatna and does not feature here.","PRACTICE / HARM (thin but real): the principal verified Afghan harm evidence is a single small (n=2) 2013 US Army Medical Department Journal case series (Gurney et al.) of complications treated at a US combat support hospital in rural Afghanistan — Case 1 a ~4-year-old with excessive foreskin removal (≈1.5 cm of penile shaft exposed) and persistent bleeding (ash applied to the wound) after a local practitioner cut him ~10 days prior; Case 2 a male infant whose attempted circumcision caused partial glans amputation and a transected urethra. This is a weak single source for the SCALE of harm (n=2, a non-MEDLINE military journal) and must NOT be generalised; it does, however, document the traditional-sector, low-safeguard pattern directly.","HIV: a low-level, concentrated epidemic — general-population prevalence \u003C0.1% (~11,000–13,000 people living with HIV, on a rising trajectory) driven by people who inject drugs (~57,000 PWID at ~4.4% HIV prevalence, far above other key groups). Because circumcision is already near-universal, VMMC (for low-circumcision, high-prevalence generalised settings) is irrelevant and no circumcision-HIV protective claim applies. (Data carry severe uncertainty given the war/health-system situation.) Sex-ed/other composite scores omitted.",{"iso3":79,"isoNumeric":80,"name":81,"region":27,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":82,"profileSources":83,"isFallback":40},"IRQ","368","Iraq","No fixed age — boys, through childhood (Baghdad study: 18% circumcised by 6 months rising to 92% by age 6); khitan as a shared Islamic identity rite across the Shia-Arab majority + Sunni-Arab/Sunni-Kurd",[84,85,86,87],"Prevalence: ~98.9% national (Morris et al. 2016, Table 1 — near-universal). Male circumcision (khitan / الختان) is a near-universal Islamic identity rite that crosses Iraq's sectarian and ethnic lines uniformly — the Shia-Arab majority of the south/centre, the Sunni-Arab west, and the Sunni-Kurd north all practise it. It is confined to the Muslim majority; the Christian, Yazidi and Mandaean minorities do not ritually circumcise. (The notion that Shia tradition frames it as a distinctly more-stringent \"ritual-purity\" rite was checked and not sustained — it is presented simply as a shared Islamic rite.)","THE DISTINCTIVE ANGLE — a UNIFYING rite across a divided country: in a society defined by the Shia/Sunni split and Arab/Kurd ethnicity, khitan is one near-universal constant. A real Iraqi field study anchors the profile: Naji & Mustafa (Frontiers of Medicine 2013) surveyed 4,000 preschool boys at Baghdad's Central Teaching Hospital for Children (data April 2003–October 2004); 61% were already circumcised, the rate rising from 18% at 6 months to 92% by age 6, and only 7.4% were circumcised for a medical reason (the rest religious). In that hospital sample the operator was a doctor for 30%, a nurse for 52% and a traditional circumciser for 18%.","PRACTICE / MEDICALISATION (honestly bounded): the Baghdad sample shows a strong medical/para-medical presence (doctor + nurse ~82% in that sample), but this is a single 2003–04 hospital-based study and must NOT be read as a national \"shift to medical providers\" — that over-reaching framing was refused in verification. Traditional circumcisers persist; Iraq's prolonged war and health-system disruption are a documented context for safety risk, though no specific national operator split or complication rate is asserted here.","HIV: very low and poorly surveilled — the Middle East & North Africa region runs ~0.1% adult prevalence (among the lowest globally) and Iraq specifically has no sufficient reported HIV-prevalence data and does not meet the \"generalized epidemic\" definition. Because circumcision is already near-universal AND Iraq is not a generalized-epidemic setting, VMMC is irrelevant — no circ↔HIV protective claim applies. Sex-ed/other composite scores omitted.",{"iso3":89,"isoNumeric":90,"name":91,"region":92,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":93,"medicalNecessity":71,"avgAge":94,"profileSources":95,"isFallback":40},"AZE","031","Azerbaijan","Eastern Europe & Central Asia","near-universal","Pre-adolescent, typically ages 3–7 (kiçik toy ceremony before school age common); no fixed universal age",[96,97,98,99],"Prevalence: ~98.5% modelled (Morris et al. 2016, derived from Pew Research Center Muslim population proportion data; not a direct DHS measurement). Azerbaijan is ~97% Muslim; the 99.9% assumed circumcision rate among Muslim males yields the ~98.5% overall estimate. Near-universality is not contested; the exact figure carries model uncertainty. No country-specific DHS male circumcision survey exists for Azerbaijan.","Cultural practice: sünnət (circumcision) is one of Azerbaijan's most important cultural rites, celebrated with the kiçik toy ('small wedding') — a feast gathering up to 250+ guests with traditional Azerbaijani music, dancing, multi-course cuisine, and gender-separated seating. Circumcision is observed across secular and non-observant households alike as a fundamental ethnic identity marker, not only a religious one. Contrary to common assumptions, classical Shia jurisprudence (including rulings attributed to the 6th Imam Ja'far al-Sadiq and Ali ibn Abi Talib) frames male circumcision as among the most stringent requirements — not merely recommended. Health policy shift: from 2024, Azerbaijan added male circumcision to its Compulsory Medical Insurance (İMİA) scheme, with over 15,000 procedures performed under that coverage in the first six months.","Harm: three verified incidents spanning 2011–2020 — a 2017 Masally district death of a 5-year-old (home circumcision by a retired surgeon; criminal case under Article 124.1 of Azerbaijan's Criminal Code); a 2011 Ganja genital amputation of a 4-year-old by an 82-year-old unlicensed barber (barely survived); and a 2020 regional clinic genital amputation of a 5-year-old. Azerbaijan's 2024 health insurance inclusion was an explicit policy response to the harm caused by high private-clinic costs driving families to unlicensed practitioners.","HIV: Azerbaijan has a concentrated HIV epidemic with very low general prevalence (~0.1 per 1,000). Historically PWID-driven (~47% of cumulative cases); by 2021 shifting toward sexual transmission (690 new infections that year). Near-universal circumcision makes VMMC epidemiologically irrelevant; no VMMC programme exists or has been proposed. FGM is not a documented Azerbaijani practice. No circumcision↔HIV protective claim is made.",{"iso3":101,"isoNumeric":102,"name":103,"region":27,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":104,"profileSources":105,"isFallback":40},"YEM","887","Yemen","Mostly before puberty — a fundamental Islamic rite (khitan); commonly performed by non-qualified traditional practitioners (muzayyin/barber); Shafi'i Sunni majority + Zaidi Shia",[106,107,108,109],"Prevalence: near-universal ~99% (Morris et al. 2016, Table 1), among the highest globally (alongside Iran, Iraq, West Bank), reflecting Yemen's ~99% Muslim population (Shafi'i Sunni majority + Zaidi Shia). Most boys are circumcised before puberty, and ritual circumcision is commonly performed by non-qualified traditional practitioners (the muzayyin/barber) rather than in medical settings.","THE DISTINCTIVE ANGLE — a HISTORICAL extreme \"salkh\"/flaying variant + a strong MODERN traditional-harm record: a 2016 history-of-medicine paper (re-describing a 1921 account) documents an EXTREME circumcision practice — \"salkh\" (flaying) / \"taqshir\" — that was localized to ONE narrow district (Al Hoora, ~15 days' journey from Aden, six named villages), in which far more than the foreskin was removed (all skin from just below the navel down the penis to the scrotum), performed on GROWN MEN about to marry, without anaesthetic, with severe harm (wounds healing over two to eight months, urethral fistula in ~1 in 10, hernia, and frequently fatal sepsis). This was a NARROW, HISTORICAL tribal custom — NOT a general or current Yemeni practice — and is recorded only to document the extreme end of the historical record honestly.","MODERN HARM: ritual circumcision by untrained traditional practitioners is a documented cause of severe injury in Yemen, aggravated by the war and health-system collapse — peer-reviewed Yemeni case reports/series document total penile skin loss in a 45-day-old (guillotine technique; Pan African Medical Journal 2022), complete penile skin loss in a 6-month-old requiring the penis to be buried in the scrotum for later reconstruction (Ibb 2020/21 series), glans/distal-penis amputation in a 5-month-old, and a 20-day-old who DIED of cardiac arrest after post-circumcision haemorrhage. (These are referred case reports, not a population rate.)","HIV: a very low-level epidemic — the wider MENA region runs adult prevalence ~0.07% (under 0.2% in most MENA countries), driven by key populations facing stigma/punitive laws rather than general-population transmission; an Aden MSM bio-behavioural survey found ~5.9% (2011), and Yemen's key-population surveillance is severely outdated (last FSW IBBS 2008, last MSM IBBS 2011). Because circumcision is already near-universal, VMMC is irrelevant (no protective claim applies) and the MENA HIV reports carry no VMMC recommendation. Sex-ed/other composite scores omitted.",{"iso3":111,"isoNumeric":112,"name":113,"region":114,"circumcisionRatePct":68,"adultPrevalencePct":56,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":116,"profileSources":117,"isFallback":40},"TJK","762","Tajikistan","Central Asia","uncommon","SUNNOT/KHUTNA ceremony: typically age 3-7, celebrated community feast with gifts. SUNATGAR (traditional healer) performed 70-80% of procedures until 2018 MoH ban. 693 licensed medical rooms established post-ban. 2020: mandatory HIV testing before circumcision introduced. Ismaili Pamiri communities in GBAO/Badakhshan: HONEST GAP — no survey data on their practice. Soviet-era: circumcision NOT systematically suppressed.",[118,119,120,121],"Prevalence: ~99% (Morris et al. 2016, PMC4772313; MODELED from ~96% Sunni Muslim composition; no DHS/MICS survey data for Tajikistan). Erratum PMC4820865 corrected six countries (USA, Germany, Thailand, Australia, Zambia, Pitcairn Island) but NOT Tajikistan. Authors acknowledge 5-10% uncertainty in modeled estimates for Muslim-majority countries without survey data.","Cultural practice (sunnot/khutna): Tajik male circumcision is called sunnot (also khutna). Typically performed age 3-7 at a celebrated family feast with music, gifts. 2018 Law on National Traditions and Ceremonies classifies it as national tradition (not purely religious). Persisted through Soviet period — not systematically suppressed unlike formal religious institutions. Ismaili Pamiri communities (GBAO/Badakhshan, ~5% of population, AKDN influence): honest gap — no confirmed circumcision rate data.","THE DISTINCTIVE: Sunatgar ban 2018 / HIV mandate 2020: Until 2018 MoH ban, 70-80% of circumcisions by traditional healers (sunatgars) using shared unsterilized instruments — documented HIV and hepatitis transmission risk. Post-ban: 693 licensed medical circumcision rooms established. 2020: mandatory HIV testing before circumcision introduced. Source: HIV Justice Network (hivjustice.net) + LoC Global Legal Monitor Apr 2018.","HIV: ~0.3% adult prevalence (UNAIDS 2024). Concentrated epidemic driven by PWID + labor migration to Russia. HCV in Central Asia is PWID-driven (PMC6376025, 2019 PRISMA systematic review). Women ~36% new infections. NOT a WHO VMMC priority country. No circ-HIV causal claim. FGM: STRICTLY SEPARATE.",{"iso3":123,"isoNumeric":124,"name":125,"region":27,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":126,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":127,"medicalNecessity":71,"avgAge":128,"profileSources":129,"isFallback":40},"TUR","792","Turkey",70,"common","Childhood ~4–6, up to ~10 (sünnet rite; ~1% neonatal)",[130,131,132,133,134],"Prevalence: ~98.6% (Morris et al. 2016, Population Health Metrics) / ~99% commonly cited — among the world's highest. ~96% for religious/cultural reasons (only 3.9% medical in a 17,345-boy cohort; Ergenç & Uprak, Istanbul Medical Journal 2023). A modelled estimate, not a national survey.","Age: a CHILDHOOD rite, not infancy — median 6 years (Sahin et al., Child Care Health Dev 2003, Ankara, n=1,235) and ~4 years (Istanbul Med J 2022, n=17,345; only ~1.1% neonatal, ~13.6% infancy). No fixed age; typically up to ~10.","Sünnet düğünü (\"circumcision wedding\"): an elaborate rite of passage — the boy (~7–8) dressed and paraded as an Ottoman sultan/prince (cape, sultan-style turban, \"Maşallah\" sash, sceptre), celebrated with gatherings and gifts (Başaran, \"Circumcision and Medicine in Modern Turkey\", UT Press 2023).","Medicalisation: shifted from itinerant traditional circumcisers (sünnetçi) → health officers (1960s) → hospital doctors (1990s); by 2003 only ~13.3% still done by a traditional circumciser (Başaran, Soc Sci Med 2020). Municipalities run free mass circumcisions (toplu sünnet) for poor families.","HIV context: Turkey is a low-but-rising-prevalence country; circumcision is cultural/religious and is NEVER cited as an HIV-prevention motive. (The exact UNAIDS adult-prevalence figure was not pinned in the June 2026 research pass; adultPrevalencePct ~0.1% is a conservative low-prevalence placeholder.)",{"iso3":136,"isoNumeric":137,"name":138,"region":27,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":139,"profileSources":140,"isFallback":40},"TUN","788","Tunisia","Childhood — a Sunni (Maliki) Islamic rite (khitan/tahara); now mainly performed by nurses (and doctors in clinics) rather than the customary circumciser",[141,142,143,144],"Prevalence: near-universal ~99.8% (Morris et al. 2016, Table 1), consistent with Tunisia's ~99% Sunni Muslim population — circumcision (khitan/tahara) is an established Islamic identity rite. CAVEAT: 99.8% is a RELIGION-DERIVED extrapolation (the model assumes ~99.9% of Muslims/Jews are circumcised; ~99% Muslim × 99.9% ≈ 99.8%), NOT a measured Tunisian survey. The locally-dominant Maliki madhhab recommends circumcision as noble/sunnah rather than strictly obligatory (wajib) — though it is popularly framed as an obligatory ritual. A small Jewish community (notably Djerba) practises brit milah.","THE DISTINCTIVE ANGLE — the most SECULAR + MEDICALISED Arab state: reflecting one of Africa/the Arab world's most developed health systems, Tunisian circumcision shifted from the customary circumciser to being MAINLY PERFORMED BY NURSES (and by doctors/urologists in clinics) — the subject of a Tunisian medico-legal literature on \"ritual circumcision by nurses\". This is the secular/medicalised pole of the Maghreb (vs Morocco's festival-rite and Algeria's Ramadan-clustering). Tunisia's broadly progressive women's-rights framework (the Code of Personal Status) is unrelated legal context, kept separate from male circumcision.","PRACTICE / MEDICALISATION + HARM: because the procedure is medicalised, Tunisia's verified harm sits INSIDE the medical context — the documented glans-amputation cases were caused by a urologist and a general practitioner (Sousse, 2009–2011, both reimplanted), and a forensic case series collected three judicial circumcision-accident cases (Kairouan, 2020). A widely-cited total-glans-amputation case (PMC8531556) is a DAKAR, SENEGAL case and is NOT Tunisian — excluded. Medicalisation reduces but does not eliminate the hazard; practitioner liability is legally unclear absent a specific statute.","HIV: a low, concentrated epidemic — national prevalence ~0.1% (historically \u003C0.1%; ~9,750 PLHIV in 2024), concentrated among key populations (men who have sex with men — HIV rose ~4.9% in 2009 to ~13.0% in 2011 — sex workers, and people who inject drugs) rather than the general population. Because circumcision is already near-universal AND the epidemic is concentrated (not a generalised heterosexual one), the WHO/UNAIDS VMMC scale-up rationale does not apply to Tunisia and no circ↔HIV protective claim is warranted. Sex-ed/other composite scores omitted.",{"iso3":146,"isoNumeric":147,"name":148,"region":27,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":149,"profileSources":150,"isFallback":40},"JOR","400","Jordan","Heavily neonatal — a 2011 cohort found ~70.5% circumcised in the neonatal period (mean age ~2 months); a Sunni (Shafi'i/Hanafi) Islamic rite (khitan/tahara), mostly performed by pediatricians/physicians",[151,152,153,154],"Prevalence: near-universal ~98.8% (Morris et al. 2016, Table 1 — the ~99% band, alongside Iraq 98.9%, Saudi 97.1%, Egypt 94.7%, Syria 92.8%), consistent with Jordan's ~97% overwhelmingly Sunni (Shafi'i/Hanafi) Muslim population. The ~2% Christian minority does not ritually circumcise. CAVEAT: 98.8% is a RELIGION-DERIVED estimate (the model sums Jewish+Muslim males × 99.9%), NOT a measured Jordanian survey (no DHS MC survey exists).","THE DISTINCTIVE ANGLE — the first LEVANTINE case + a strongly MEDICALISED, doctor-performed rite: Jordan has a well-regarded health system (a regional medical-tourism hub), and circumcision (khitan/tahara) is heavily NEONATAL and physician-performed. A University-of-Jordan hospital cohort (data 2011; Hatamleh et al. 2018) found 573/810 boys (66.6%) circumcised, 70.5% in the neonatal period (mean age ~2 months), mostly by a pediatrician (≈48% of those with a recorded provider) and other physicians (surgeons, urologists) rather than traditional practitioners — with all complications minor (1.9%). (The 66.6% is a young-child cohort, some still pending — NOT a ceiling, and not in tension with the ~98.8% adult estimate.)","CULTURAL determinants: in that cohort, families' cultural beliefs, higher paternal education, and a pediatrician performing the procedure at a low-cost clinic primarily determined completion of neonatal circumcision, while families' religious beliefs did NOT discriminate timing/completion — coherent in a near-universally-Muslim population where religion has little discriminating variance. Adds the Levant (Palestinian-refugee-heavy demographics) to the MENA set.","HIV: a very low-level, concentrated epidemic — ~0.02% general-population prevalence (roughly doubling to ~0.05% among key populations: sex workers, people who inject drugs, men who have sex with men), driven by sexual transmission (in 2011 heterosexual sex was the most common reported mode among men) and concentrated in key populations rather than the general male population; the wider MENA region runs ~0.07%. Because circumcision is already near-universal AND the epidemic is concentrated (not generalised), VMMC is epidemiologically irrelevant and no circ↔HIV protective claim is warranted for Jordan. Sex-ed/other composite scores omitted.",{"iso3":156,"isoNumeric":157,"name":158,"region":27,"circumcisionRatePct":68,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":159,"profileSources":160,"isFallback":40},"MAR","504","Morocco","Early childhood (no fixed age; often scheduled in spring/summer for the festivities) — Islamic rite (khitan/tahara); Berber elghetab",[161,162,163,164],"Prevalence: near-universal ~99.9% (Morris et al. 2016, the highest band) — male circumcision (khitan / tahara / الطهارة; Berber elghetab) is a fundamental Sunni (Maliki-school) Islamic rite (tahara = \"purification\"), performed in early childhood with no single fixed age (commonly scheduled in spring \"before the great heat\" or summer to align with school holidays + family gatherings). The tiny Moroccan Jewish community (~2,000–3,000, once one of the Arab world's largest) also circumcises (brit milah, 8th day) — statistically negligible for the national figure. FGM is essentially absent in Morocco.","THE DISTINCTIVE ANGLE — the FESTIVAL/CELEBRATION character: circumcision is a major family rite of passage (the boy in traditional dress; musicians — tabbala/ghaïta — playing to cover his cries; horseback baraka processions past shrines; gifts), with a strong CHARITY dimension (wealthy families sponsor poor children's circumcisions for baraka) and COLLECTIVE/mass events — historically tribal \"Sbouâ\" ceremonies the 7th day after Eid al-Mawlid at zawiyas/moussems, and royal/collective events (the 2015 circumcision of Crown Prince Moulay Hassan triggered ~3 days of national festivities with ~5,000 boys circumcised in Casablanca alone). (NB: a \"Bouya Omar\"-shrine mass-circumcision tradition is UNVERIFIED and not asserted.)","MEDICALISATION TENSION (live): traditionally performed by the hajjam (barber/coiffeur) — historically at home with scissors — increasingly by trained surgeons with anaesthesia; Moroccan pediatric surgeons (e.g. Prof. Lazrak; Dr. Alichane) urge treating it as genuine surgery and warn against non-medical hajjama. Medicalisation skews urban/higher-income; traditional/home procedures persist more in rural/lower-income settings (charity collective events serve poorer families). The unregulated traditional sector is precisely the harm gap.","HIV: very low prevalence (~0.08–0.15%; ~23,500 people living with HIV, 2025), a CONCENTRATED epidemic — key populations (MSM, people who inject drugs ~5%, sex workers ~2%, migrants ~4.6%) and their partners account for ~67% of new infections; new infections fell ~22% over the past decade (a relatively strong MENA response). Because circumcision is already near-universal, VMMC is irrelevant (no uncircumcised population) — no circ↔HIV protective relevance is implied (one review merely observes circ is already universal). Sex-ed/other composite scores omitted.",{"iso3":166,"isoNumeric":167,"name":168,"region":27,"circumcisionRatePct":68,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":170,"profileSources":171,"isFallback":40},"IRN","364","Iran",0.2,"No fixed age — traditional ideal the 7th day after birth; historically often later (ages ~5–7, up to ~13); urban trend toward neonatal/infant hospital procedures — Twelver Shia ritual-purity rite (khatneh / ختنه)",[172,173,174,175],"Prevalence: near-universal (~99%+; Morris et al. 2016 places Iran in the highest band — \"99.7%\" is a MODELLED estimate, not an Iranian census measurement). Iran (~88M) is the Shia-majority, Persian (non-Arab) heartland of the Twelver Shia world. Near-universal among Muslims (~80%+ of the population) and the small Jewish community (brit milah). Zoroastrians (~25,000) do NOT circumcise — it is absent from the Avesta/Pahlavi texts and was not part of ancient Persian custom; it entered with Islam. Armenian/Assyrian Christians (~110,000–300,000) do NOT ritually circumcise. The Hedjazi 2012 survey notes ~500,000 neonatal circumcisions performed in Iran in 2011 — corroborating near-total coverage.","THE DISTINCTIVE ANGLE — the SHIA RITUAL-PURITY framing: in Iranian (Twelver) Shia tradition male circumcision (khatneh; Arabic khitan) is framed as a ritual of PURIFICATION (taharah) — likened to baptism rather than a coming-of-age initiation — and tied to ritual purity for prayer; it is the most stringently expected form across Islamic schools. NUANCE: the \"obligatory/wajib\" characterisation is internally contested within Twelver fiqh — some maraji (e.g. Ayatollah Sistani) treat it as strongly recommended (mustahabb) rather than strictly wajib. The historic festive ceremony (khatneh-suran / sonnat-konan), tied to sacrifice symbolism and sometimes lavish, was performed by the local barber-surgeon and is increasingly displaced by quiet hospital procedures.","MEDICALISATION GRADIENT (the empirical core): traditional ideal is the 7th day after birth, historically often performed later (ages ~5–7, up to ~13). Urban trend is toward neonatal/infant hospital/clinic procedures, frequently using the Plastibell device; rural areas retain the traditional circumciser (dalak / barber). The Yegane 2006 school survey found 43.49% of circumcisions were done by traditional (non-medical) practitioners; an Iranian systematic review found complication rates of ~2.8% (urologists/surgeons) \u003C ~6.1% (GPs/pediatricians) \u003C ~9.1% (paramedical/traditional) — the urban-medical vs rural-traditional safety gap. (Note: the dominant FATAL risk is anesthesia, concentrated in the medicalised setting — see harm record.)","HIV: a concentrated, low-level epidemic (~0.2% adult prevalence; ~46,000–59,000 people living with HIV — present as a range), historically PWID-driven (HIV ~9.7–14.3% among people who inject drugs) and now shifting toward sexual transmission (HIV ~5.6% among men who have sex with men); new infections down ~21% since 2010. Iran has a pragmatic harm-reduction history (needle/syringe exchange, methadone, including in prisons) unusual for a theocratic state, credited with the post-2007 PWID decline. Because circumcision is already near-universal, VMMC is irrelevant — no circ↔HIV protective relevance is implied. Sex-ed/other composite scores omitted.",{"iso3":177,"isoNumeric":178,"name":179,"region":180,"circumcisionRatePct":68,"adultPrevalencePct":13,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":181,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":183,"profileSources":184,"isFallback":40},"GAB","266","Gabon","Sub-Saharan Africa","2021","traditional","Childhood (a traditional/cultural initiation norm spanning infancy/early childhood through adolescent initiation by community — Morris figure is mature-male prevalence; exact nationwide age/timing not firmly established)",[185,186,187,188],"Prevalence: near-universal ~99.2% (Morris et al. 2016, Table 1 — the highest in Central Africa), far above the ~37-39% global average, within a high-prevalence regional pattern (Cameroon 94%, Equatorial Guinea 87%, Republic of Congo 70%, Central African Republic 63%). Striking because Gabon is a CHRISTIAN-majority country (~75-80%): circumcision functions as a broad traditional/cultural norm crossing religious lines, NOT driven by the Muslim minority's khitan. NB: a MODELED meta-estimate (mature-male prevalence; widely regarded as upper-bound; no Gabon DHS circumcision module) — but corroborated directionally by older estimates (WHO 2006 >80%; Williams 2006 ~93%), so near-universality is robust even if the exact 99.2% is soft. FGM is essentially absent and is never conflated here.","THE DISTINCTIVE ANGLE — a deeply rooted traditional/cultural INITIATION rite. Gabonese sources describe circumcision as a 'rite d'initiation profondément ancré dans les traditions locales' and an 'acte d'identité et de transmission culturelle', very much alive in regions such as Ogooué-Ivindo, Woleu-Ntem and Ngounié, with many families remaining attached to the traditional (non-medical) form. MEDIUM confidence (local journalism + Kota/Bakota anthropology, not nationwide quantitative). Frame as a broad cultural norm, NOT specifically a Bwiti rite. AGE/TIMING is NOT firmly established — a specific '8-14 during summer vacation' claim was refuted; circumcision likely spans infancy/early childhood through adolescent initiation depending on community.","Providers / medicalisation: qualitatively a traditional→medical shift (urban/younger families more medical, rural families more attached to the traditional form), but no Gabon-specific medicalisation-rate or rural/urban split data was found. No verified Gabon-specific male-circumcision harm series survived verification (an honest evidence gap — no Libreville CHU/Owendo cohort located).","HIV: relatively HIGH generalized for Central Africa — adult (15-49) prevalence ~3.0% in 2021 (down from 5.9% in 2007; ~47,000 people living with HIV; ~2.9% in 2022), within a regionally declining epidemic (Western & Central Africa new infections down 46% and AIDS-related deaths down ~55-56% between 2010 and 2023). Because circumcision is already near-universal, Gabon is correctly NOT among the 15 WHO/UNAIDS voluntary-medical-male-circumcision priority countries (all in eastern/southern Africa; the priority criterion needs BOTH a generalized epidemic AND low circumcision — Gabon fails the low-circumcision arm). VMMC is irrelevant and no circumcision↔HIV protective claim is made or implied (the UNAIDS 2024 WCA profile mentions circumcision zero times).",{"iso3":190,"isoNumeric":191,"name":192,"region":180,"circumcisionRatePct":193,"adultPrevalencePct":194,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":195,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":196,"profileSources":197,"isFallback":40},"LBR","430","Liberia",98,1.3,"2020","Childhood (Muslim khitan often early; in traditional communities sometimes within Poro bush-school initiation, ages ~8-14, \"if not already done\")",[198,199,200,201],"Prevalence: near-universal ~97.7% (Morris et al. 2016, from the Liberia 2007 DHS Table 13.11 — survey-derived and uncontested; Wikipedia's 'Circumcision in Africa' puts it at ~98%). Far above the ~37-39% global average and consistent with the very high West-African/Mano-River regional pattern (Sierra Leone 96.1%, Senegal 93.5%, Ghana 91.6%, Guinea 84.2%). Performed across both the traditional system and the ~12% Muslim minority (Islamic khitan). FGM is a separate female practice and is never conflated here. NB: ~5-10% Morris estimate uncertainty; lead author is a circumcision advocate.","THE DISTINCTIVE ANGLE — Liberia is the Mano-River twin of Sierra Leone (the Poro male / Sande female secret societies) but majority CHRISTIAN (~85%, ~12% Muslim). In traditional communities male circumcision is associated with initiation into the male Poro society / bush school (typically ages 8-14, 'if not already done'); uninitiated males may be regarded as not full members of the community and unfit for marriage. CRUCIAL HONEST NUANCE: this Poro↔circumcision link is MEDIUM-confidence — popular/anthropological sources affirm it (Wikipedia 'Poro'), but the authoritative EUAA country-of-origin report documents Poro initiation WITHOUT attributing genital cutting to it (it attributes cutting only to the female Sande society). The strength of the link varies by ethnic group (Kpelle, Bassa, Gio, Mano, Loma, Vai, etc.).","Providers / context: traditional circumcisers and an Americo-Liberian settler dimension feature in the cultural background; the medicalisation gradient is not well documented. NO verified Liberia-specific male-circumcision harm case or series was located (an honest evidence gap — no Monrovia/JFK Medical Center series surfaced). Documented Poro institutional abuses (forced initiation, torture, two gang-rapes per OHCHR/UNMIL 2015) are context about the Poro society, NOT male-circumcision harm, and are not recorded as circumcision incidents.","HIV: low and generalized — national ~1.3% (2018, down from a wide 2.7-12.4% 2004 range), unevenly distributed (urban Monrovia 2.6% vs rural 0.8%) and concentrated in key populations (female sex workers 16.7%, men who have sex with men 37.9%, transgender people 27.6%). Because male circumcision is already near-universal and Liberia is not a voluntary-medical-male-circumcision scale-up setting, VMMC is irrelevant and no circumcision↔HIV protective claim is made or implied (the HIV literature makes none for Liberia; the only interventions discussed are ART, PrEP, condoms and PMTCT).",{"iso3":203,"isoNumeric":204,"name":205,"region":27,"circumcisionRatePct":193,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":206,"profileSources":207,"isFallback":40},"DZA","012","Algeria","Childhood (no fixed age; commonly a family celebration, often clustered during Ramadan — nights 15–27, peaking on the 27th / Leilat El Kadr) — Sunni (Maliki) Islamic rite (khitan / tahara)",[208,209,210,211],"Prevalence: near-universal ~97.9% (Morris et al. 2016, Table 1 — the >90% band), as a fundamental Sunni (Maliki-school) Muslim identity rite (khitan / tahara) among Algeria's overwhelmingly Muslim Arab and Berber/Amazigh population. CAVEAT: 97.9% is a MODELLED estimate (Algeria has no DHS/MICS circumcision module; it was computed from the Muslim/Jewish male population share × an assumed 99.9% circumcision rate) — robust as a characterisation of near-universal practice but NOT a directly measured Algerian datapoint (some aggregators round to 99.9%). Sits squarely in the regional Muslim-majority pattern (Egypt 94.7%, Iran 99.7%, Iraq 98.9%, Saudi 97.1%).","THE DISTINCTIVE ANGLE — the RAMADAN festival-clustering + STATE MEDICALISATION MANDATE: circumcision has a celebration/festival character, and Algerian families commonly cluster boys' circumcisions during Ramadan (the nights 15–27, peaking on the 27th / Leilat El Kadr, a symbolic and highly prized date), prompting the Ministry of Health to issue recurring communiqués urging families to spread procedures across the whole month to avoid overloading hospitals. Unusually for a \"no statute\" near-universal country, Algeria has an explicit administrative MEDICALISATION rule — MoH advisories + a referenced ministerial decree (arrêté 005/2006) requiring circumcision be performed by a specialist surgeon in a hospital or approved-clinic surgical setting, with mandatory pre-operative blood work.","MEDICALISATION (honestly bounded): the state push toward the operating theatre is real, but it is characterised in the sources as recurring administrative ADVISORIES (\"mises en garde\"), NOT a codified circumcision-specific statute, and it is widely UNENFORCED in practice — mass/festival circumcisions persist outside the mandated settings (\"quand la fête tourne au drame\"). The current quantified split between the traditional circumciser (hajjam/tahhar) and hospital/specialist provision, and the rural-vs-urban divide, could not be pinned to verified figures — the medicalisation push is documented, the exact breakdown is not.","HIV: a low, concentrated epidemic — Algeria ~0.1% adult (15–49) prevalence (with localised elevation in places like Tamanrasset and among key populations), within the wider MENA regional prevalence of 0.07%, where key populations and their partners account for ~84% of new infections (MSM, sex workers, PWID). Because circumcision is already near-universal AND WHO/UNAIDS VMMC is targeted exclusively at 15 East/Southern African priority countries with generalised epidemics and LOW circumcision, VMMC is irrelevant to Algeria — no circ↔HIV protective claim applies. (Algeria-specific figures are dated 2000/2003; the low/concentrated characterisation remains current; MENA incidence is rising even as prevalence stays low.) Sex-ed/other composite scores omitted.",{"iso3":213,"isoNumeric":214,"name":215,"region":27,"circumcisionRatePct":216,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":217,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":218,"profileSources":219,"isFallback":40},"LBY","434","Libya",97,"2019","Childhood (neonatal/infancy onward, per Libyan surgical series) — Sunni (Maliki) Islamic khitan/tahara, no fixed age",[220,221,222,223],"Prevalence: near-universal ~96.6% (Morris et al. 2016, Table 1), as Sunni (Maliki) Islamic khitan/tahara in an overwhelmingly Muslim Arab/Berber population. CRUCIAL CAVEAT: the 96.6% is RELIGION-DERIVED, not survey-measured — Libya has no circumcision survey (DHS/MICS don't cover it), and 96.6% equals Libya's Pew Muslim population share exactly, the fingerprint of Morris's '99.9% of Muslims/Jews are circumcised' imputation. Always cite as an estimate. Comparators (Muslim-majority near-universal): Iran 99.7%, Iraq 98.9%, Yemen 99.0%, Syria 92.8%. FGM is essentially absent in Libya and is never conflated here.","THE DISTINCTIVE ANGLE — the Maghreb war-disruption case (with Syria/Yemen): near-universal khitan seen through post-2011 state collapse, health-system fragmentation and rival governments. NB: the hypothesis that the war shifted WHERE/HOW circumcision is performed (traditional/home vs hospital, qualified vs non-qualified) is only weakly and indirectly supported — Libyan surgeons note higher complication rates with non-qualified providers (general literature), and Libya lacks a functioning surgical registry post-2011 — so no war-driven shift is asserted as established. Male pediatric circumcision is described as one of the most commonly performed surgical procedures in Libya.","Harm — an honest BOTH-SIDES picture from the Benghazi/Albayda pediatric-urology literature. On the harm side: a Hawari Center (Benghazi) series of 86 children treated for symptomatic post-circumcision MEATAL STENOSIS (2010-2018; all circumcised neonatally), a recognised late complication of neonatal circumcision (cited general-literature rate 5-20%, higher with non-qualified providers — NOT a Libya-measured rate). On the safety side: an Albayda series of 2,200 pediatric circumcisions (2020-2026, ring penile-block anaesthesia) reporting low, self-limiting complications (hematoma 1.81%, lethargy 0.40%, no severe or long-term adverse outcomes). Both are single-institution series with no national denominator.","HIV: low-level — national prevalence ~0.13% (2004) rising to ~0.2% (2019), far below the 1% generalized-epidemic threshold — but CONCENTRATED and injecting-drug-use-driven: HIV among people who inject drugs in Tripoli was ~87% (2010 survey), among the highest recorded worldwide, with >90% of infections attributed to contaminated needles (MoH 2003) and emerging sexual transmission (~40% of cases 2013-2017). The infamous ~1998 Benghazi children's-hospital HIV outbreak (400+ children) was NOSOCOMIAL/iatrogenic (contaminated syringe reuse) — entirely separate from circumcision. Because circumcision is already near-universal, VMMC is irrelevant and no circumcision↔HIV protective claim is made or implied.",{"iso3":225,"isoNumeric":226,"name":227,"region":180,"circumcisionRatePct":216,"adultPrevalencePct":228,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":229,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":230,"profileSources":231,"isFallback":40},"CIV","384","Côte d'Ivoire",2.2,"2022","Childhood (no fixed age — Muslim khitan and traditional/cultural circumcision across ethnic groups); shift toward earlier/clinical timing in cities",[232,233,234,235],"Prevalence: near-universal ~96.7% (Morris et al. 2016, derived from the nationally representative DHS Côte d'Ivoire 2011-2012; Williams et al. 2006 independently estimated 93%). Côte d'Ivoire is religiously MIXED — roughly ~42% Muslim, ~34% Christian, plus traditional African religion — yet male circumcision is near-universal across BOTH, and across the major ethnic clusters (Akan, Mandé/Malinké, Voltaic/Gur, Krou). It is therefore a traditional/cultural norm crossing religious AND ethnic lines as much as a Muslim khitan. FGM is a SEPARATE female practice and is never conflated here.","THE DISTINCTIVE ANGLE — circumcision near-universal ACROSS the religious split (the inverse of Lebanon, where the split makes the rate LOW). A genuine HISTORICAL twist: Sousa et al. 2016 (PLOS One) shows that in 1890–1920 ethnographic accounts about THREE-QUARTERS of Côte d'Ivoire belonged to NON-circumcising ethnic groups (Akan, Lagunaire, Baoulé, Kru, Gur) — male circumcision was historically far less common and geographically patchier, and SPREAD to near-universal only later. So the present blanket norm is a relatively recent convergence, not an immemorial constant.","Providers / medicalisation: circumcision is performed both by traditional practitioners (tradipraticiens) and by health workers, with a shift toward clinical settings, especially in cities — but the harm literature shows the traditional sector still dominates complicated cases. In the Abidjan series (1991–2004) complicated cases were caused by traditional practitioners in 19/35, paramedical members in 11, and physicians in 5; in the Bouaké series circumcision had been done by a tradipraticien in 77.78% vs a health worker in 22.22%. The unregulated traditional sector is the harm gap.","HIV: ~2.2% adult prevalence (UNAIDS 2022, ages 15+) — a low-but-concentrated West-African epidemic, with very high burden in key populations (HIV among men who have sex with men in Abidjan estimated ~18%). Côte d'Ivoire is NOT a WHO/UNAIDS voluntary-medical-male-circumcision (VMMC) priority country — those priority countries are all in eastern and southern Africa — and circumcision is already near-universal, so VMMC is irrelevant and no circumcision↔HIV protective relevance is implied. (An outdated 2.70% figure and a \"highest in West Africa\" claim were checked and refuted.)",{"iso3":237,"isoNumeric":238,"name":239,"region":180,"circumcisionRatePct":216,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":93,"medicalNecessity":71,"avgAge":240,"profileSources":241,"isFallback":40},"ERI","232","Eritrea","First week to first few years of life (Eritrean Orthodox cultural norm; NOT strictly 8th day); Muslim communities: age/timing not documented in indexed Eritrea-specific literature. Medicalisation: 89.2% by traditional health practitioners in Gash-Barka region (regional study, not national rate).",[242,243,244,245],"Prevalence: ~97.2% (Morris et al. 2016, PMC4772313, citing Eritrea Population and Health Survey 2010 / EPHS 2010 as the underlying nationally representative data source). EPHS 2010 is the most recent DHS-style survey for Eritrea; no post-2010 round exists in public databases. The EPHS 2010 PDF was not directly parseable to confirm the exact table value; the 97.2% figure is consistent across Morris 2016 and multiple secondary citations. Eritrea's near-universal rate reflects circumcision being practiced by both major communities: Eritrean Orthodox Tewahedo (cultural tradition) and Muslim communities (Islamic khitan).","Cultural practice: TWO communities, both circumcising. (1) Eritrean Orthodox Tewahedo: male circumcision is a widespread cultural tradition; the church's own liturgy explicitly disclaims religious obligation ('let us not be circumcised like the Jews'), but the practice persists as a deeply embedded cultural norm. Circumcision occurs in the first week to first few years of life — NOT strictly on the 8th day (the strictly 8th-day timing is more precisely documented for Ethiopian Orthodox; in Eritrea, the indexed range is 'first week to first few years'). Baptism for Orthodox males is on the 40th day, distinct from circumcision timing. (2) Muslim communities (~37–52% per Pew 2016 / USCIRF 2021; contested demographic): practice male circumcision as Islamic khitan/sunnah. Age distribution and setting for Muslim circumcisions in Eritrea are not documented in indexed literature. Regional data: In Gash-Barka region (PMC7893741, 2021), 96.8% of families reported circumcising at least one male child; 89.2% of circumcisions were performed by traditional health practitioners (THPs) — a regional figure, not a national medicalisation rate. Urban Asmara has higher medicalisation, but no nationally representative rate is confirmed.","Harm: No verified male circumcision harm cases with dates, ages, settings, and outcomes were identified in indexed medical literature for Eritrea as of the June 2026 research date. The 89.2% THP-performed rate in Gash-Barka raises concern about potential complications, but no documented cases appear in PubMed or other indexed sources. This is an honest evidence gap — not a claim of no harm. Incidents recorded: 0.","HIV, FGM and legal: HIV ~0.2% adult prevalence (UNAIDS 2024; declining incidence 0.100/1,000 in 2024). Low-level epidemic — NOT generalised (below 1% threshold). Not among the 14 WHO/UNAIDS VMMC priority countries. VMMC irrelevant (near-universal circ + low HIV). No circ↔HIV claim. No statute on male circumcision (Penal Code 2015 silent). FGM (~83%, EPHS 2010) is a completely separate female practice, criminalised under Proclamation 158/2007 (2–3 years; up to 10 years if death results; 155 prosecutions). NEVER conflated with male circumcision.",{"iso3":247,"isoNumeric":248,"name":249,"region":27,"circumcisionRatePct":216,"adultPrevalencePct":250,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":251,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":252,"profileSources":253,"isFallback":40},"SAU","682","Saudi Arabia",0.01,"GCC/UNAIDS","Neonatal / early infancy (mean ~19 days), hospital-based, doctor-performed (Gomco/Plastibell) — Islamic rite (khitan/tahara)",[254,255,256,257],"Prevalence: ~97.1% near-universal (Morris et al. 2016, verified from the source table) — refined the indicator from 99 to 97. The figure concerns the Muslim CITIZENRY (~93% Muslim, overwhelmingly Sunni/Hanbali with an eastern Shia minority); the very large expatriate population is not the denominator, and there is no public non-Muslim religious practice. Among the highest rates in the world (global MC ~38%).","THE TYPE — Gulf Islamic heartland, strongly MEDICALISED: male circumcision (khitan/tahara, \"purification\") is a fundamental Sunni Islamic rite (obligatory/wajib in the dominant Hanbali school; recommended in Hanafi/Maliki), reinforced by the Kingdom's custodian-of-the-two-holy-mosques status. It is now overwhelmingly neonatal/early-infancy, hospital-based and doctor-performed — Bawazir (2019) reports a mean age of ~19 days and that ~85% of Saudi circumcisions are done by surgeons (vs 5–10% in Pakistan); the standard devices are the Gomco clamp and Plastibell (bone cutter in a minority).","There is essentially no domestic debate about whether to circumcise — the practice is near-universal and uncontested as religious custom; the Saudi medical literature debates technique/timing/complications, not the practice itself. Completes the MENA quartet alongside Egypt (African Sunni), Israel (Jewish brit milah) and Turkey (secular).","HIV: very low prevalence (GCC review: \u003C0.01% adult — among the lowest globally), a concentrated epidemic historically dominated among Saudi citizens by heterosexual transmission and (now-eliminated) transfusion. Because circumcision is already near-universal, VMMC as an HIV-prevention strategy is irrelevant (that strategy targets low-coverage, high-prevalence generalised epidemics) — no circumcision-HIV protective relevance is implied. Data caveat: Saudi HIV figures are limited/conservatively reported (mandatory/facility-based surveillance, stigma, large transient expatriate denominator). Female genital cutting is low among citizens and is kept strictly separate. Sex-ed/other composite scores omitted.",{"iso3":259,"isoNumeric":260,"name":261,"region":180,"circumcisionRatePct":216,"adultPrevalencePct":262,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":264,"profileSources":265,"isFallback":40},"COD","180","Democratic Republic of the Congo",1.1,"not-infant","TRADITIONAL: Near-universal across DRC's ~200+ ethnic groups. CHOKWE in SW DRC (Kwilu/Kwango corridor): mukanda initiation, boys held in bush enclosure away from village, 'couple of months to a year', vilombola caretakers, circumcision as central act — same tradition as eastern Angola/NW Zambia. Other major groups (Mongo/central, Luba/Katanga-Kasai, Kongo/west, Ngbandi/Ngbaka, Zande, Mangbetu, Hema-Lendu/Ituri): traditional circumcision broadly documented but specific primary-sourced rite details (ages/ceremonies) not retrieved in this research pass — honest evidence gap beyond Chokwe. No VMMC programme (near-universal existing baseline; not a priority country).",[266,267,268,269],"Prevalence: 97.2% (Morris et al. 2016, PMC4772313, Table 1; source cited as 'DRC DHS 2007 Table 14.12, 2008'). HIGH confidence — direct DHS survey measurement, not modeled (unlike Angola's 57.5%). The published erratum (PMC4820865) corrected six other countries and did not revise DRC's figure. 97.2% makes DRC one of the highest nationally representative male circumcision prevalence figures globally. This is consistent with near-universal traditional circumcision practices across DRC's predominantly circumcising ethnic composition.","Traditional practices: Near-universal circumcision across DRC's ~200+ ethnic groups. The CHOKWE in southwestern DRC (Kwilu/Kwango corridor) practice the mukanda male initiation rite — the same tradition as documented for their Angola and Zambia branches. The mukanda places boys in a bush enclosure away from the village for months to a year, under vilombola caretakers; circumcision is the central initiatory act. The Chokwe span Angola/DRC/Zambia as a single cultural bloc. Other major DRC ethnic groups with documented circumcision traditions include the Mongo (central DRC), Luba (Katanga and Kasai), Kongo (western DRC), Ngbandi, Ngbaka, Zande, Mangbetu, Hema-Lendu (Ituri province) — traditional circumcision among these groups is broadly documented but specific primary-sourced details (ages, ceremonial structures, seclusion periods) were not retrieved in this research pass. This is an honest evidence gap in indexed English-language research, not a claim of uniformity or absence.","VMMC and legal context: DRC is NOT among the 15 WHO/UNAIDS/PEPFAR VMMC priority countries (all in Eastern and Southern Africa). DRC is in Central Africa; near-universal existing circumcision (~97%) makes targeted VMMC scale-up programmatically irrelevant. No PEPFAR or CDC VMMC programme for DRC was confirmed in the verified research. ATTRIBUTION GUARD: DRC (COD, Kinshasa, cd) ≠ Republic of Congo (COG, Brazzaville, cg) — these are completely different countries. Any reference to CHU Brazzaville, Bakouélé people, or Republic of Congo data is from COG (already built), never DRC. No DRC statute specifically regulating male circumcision confirmed — UNREGULATED. DRC Child Protection Code (2009) addresses violence/sexual abuse against children but with a 'limited definition of torture' (secondary source); no specific male circumcision provision confirmed. FGM is a completely separate female issue, strictly separate.","HIV: DRC's HIV epidemic is geographically heterogeneous with spatial variability across Kinshasa health zones (2-1 verified from AIDS Research and Therapy 2020, PMC7682026). ~610,000 PLHIV in DRC per UNAIDS 2026 press release (Ebola/HIV context). Specific national prevalence figures were unverifiable (UNAIDS 2024 PDF >10MB); earlier estimates proposed in this research pass were refuted: Kinshasa 11.0% (0-3 refuted — hospital catchment bias at large infectious disease centres), DRC ~0.7-1.3% DHS 2007 (0-3 refuted — outdated), '50% burden in 3 provinces' (1-2 refuted), sex workers 5.7% vs general 0.7% (0-3 refuted). Current HIV figures: use UNAIDS DRC country page. No circumcision harm cases specifically verified for DRC — honest evidence gap.",{"iso3":271,"isoNumeric":272,"name":273,"region":27,"circumcisionRatePct":274,"adultPrevalencePct":275,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":35,"profileSources":276,"isFallback":40},"DJI","262","Djibouti",96.5,1.4,[277,278,279],"Morris et al. 2016 PMC4772313: 96.5%; three estimates converge — WHO 2006 >80%, Williams & Kapila 2006 94%, Morris 2016 96.5%; 96.5% from primary PMC4772313, not the erratum PMC4820865","Djibouti: ~94% Muslim; Issa (Somali) ~60%, Afar ~35% — both are Muslim ethnic groups that circumcise; ethnic and religious overlap reinforces near-universal practice","HIV 1.4% is a CONCENTRATED epidemic (historically high among sex workers and military); not a generalised epidemic; NOT a proxy for circumcision policy",{"iso3":281,"isoNumeric":282,"name":283,"region":284,"circumcisionRatePct":285,"adultPrevalencePct":169,"plhivPer1000":275,"newInfectionsPer1000":169,"onTreatmentPct":7,"childPrevalencePct":286,"hivYear":69,"hivSource":32,"epidemicGrowthPct":287,"sexEducationGapScore":288,"preventionContextScore":289,"policyEnvironmentScore":290,"stigmaIndex":291,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":292,"profileSources":293,"isFallback":40},"PAK","586","Pakistan","Asia & the Pacific",96,0.02,84,85,34,38,66,"Early childhood — often within weeks of birth to age ~7 (Islamic rite, sunnat/khatna/musalmani)",[294,295,296,297],"Prevalence: near-universal (~96%+) among the ~96% Muslim majority — male circumcision (sunnat / khatna / musalmani) is an Islamic religious rite performed on effectively all Muslim boys (Morris et al. 2016 highest band; Anwer et al. 2017). The exact national % is an estimate (no authoritative census). Non-Muslim minorities — Hindus (~1.6%), Christians (~1.6%), Sikhs — do NOT practise religious circumcision; distinguish the Muslim near-universality from these minorities.","Religious/cultural: circumcision is sunnat (following Prophetic tradition) and a marker of Muslim identity — the dominant lived reality for nearly all Pakistani boys, often a family/celebration event. In Pakistani studies religious requirement is the overwhelmingly dominant motive (92.6% of parents in one Karachi survey; 96.2% in a WHO-published cohort). Timing is early childhood (many believe within ~60 days of birth, though delays are common).","THE SAFETY STORY (provider mix): only ~5–10% of boys are circumcised by qualified surgeons/physicians; the rest go to barbers (hajjam), traditional circumcisers, quacks and untrained paramedics — frequently by the open-blade \"bone cutter\" method without anaesthesia, ~20% performed at home, often with unsterilised instruments (median cost ~PKR 300/~$3). Reported overall complication rate ~12.1% (bleeding commonest, then infection; glans/urethral injury rare but serious). Driven by a severe pediatric-surgeon shortage (~0.4/million) against ~3.2M male infants/year.","HIV: low general prevalence (~0.2%) but a CONCENTRATED, rising, INJECTION-DRIVEN epidemic — heavy burden in key populations (HIV ~38% among PWID; ~7.5% among hijra/transgender sex workers) and a defining iatrogenic driver (unsafe medical injections; ~1 in 3 Pakistanis gets an unsafe injection yearly). The 2019 Larkana/Ratodero pediatric outbreak (~1,353 positive, ~75% children) was caused by reused syringes/unsafe injections — NOT circumcision. Circumcision is already near-universal and Pakistan is not a WHO VMMC-priority country: it plays NO role in HIV prevention here.",{"iso3":299,"isoNumeric":300,"name":301,"region":180,"circumcisionRatePct":285,"adultPrevalencePct":194,"plhivPer1000":302,"newInfectionsPer1000":56,"onTreatmentPct":303,"childPrevalencePct":304,"hivYear":31,"hivSource":32,"epidemicGrowthPct":305,"sexEducationGapScore":126,"preventionContextScore":306,"policyEnvironmentScore":10,"stigmaIndex":307,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":308,"profileSources":309,"isFallback":40},"NGA","566","Nigeria",8.9,87,0.4,-38,42,63,"South: neonatal/infancy (cultural custom); North: childhood ~5–10 (Islamic rite)",[310,311,312,313],"Prevalence: near-universal (~95–99%) — among the highest in the world for a non-Arab country (NDHS 2008 ≈97.9%; Morris 2016 ≈98.9%; NAIIS 2018 implies \u003C4% uncircumcised). THE ANGLE: it CROSSES the Muslim-north/Christian-south divide — a rare unifying practice rather than a faith marker. Cite as a range; no specific low-prevalence ethnic pockets asserted (unsourced).","North (Islamic rite): among predominantly Muslim Hausa/Fulani populations circumcision is religious observance (~98%; ~79% citing religious reasons in a Kano study), typically performed around ages 5–10. South (cultural/traditional custom): Yoruba and Igbo customarily circumcise infant sons, framed as hygiene/custom and done overwhelmingly neonatally (in one Ibadan sample 83.9% within the first month, 80.7% in hospitals). Rarely questioned; treated as the default.","Provider mix (medicalised but imperfect): in an Ibadan community series the split was nurses ~56% / doctors ~35% / traditional circumcisers ~9% — a REGIONAL southern/urban figure, not a national breakdown. Severe harm is NOT only a \"traditional\" phenomenon (nurse-performed injuries are documented), though traditional circumcisers account for a disproportionate share of the SEVERE injuries, especially in rural settings.","HIV: national adult prevalence ~1.4% (NAIIS 2018, the world's largest HIV survey; revised down from ~2.8%), with ~1.9 million people living with HIV — one of the world's largest ABSOLUTE burdens (driven by population size), declining (5.8% in 2001 → 1.4% in 2018); a peer-reviewed 2023 model gives ~2.1%. Burden concentrates in key populations (FSW ~15.5%, MSM ~25%, PWID ~10.9%). Because circumcision is ALREADY near-universal there is no foreskin \"gap\" to close — Nigeria is NOT a WHO VMMC scale-up country; circumcision is cultural/religious, not an HIV intervention. Sex-ed/other composite scores omitted.",{"iso3":315,"isoNumeric":316,"name":317,"region":180,"circumcisionRatePct":285,"adultPrevalencePct":56,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":318,"profileSources":319,"isFallback":40},"NER","562","Niger","Childhood — a Sunni (Maliki) Islamic rite (khitan); traditionally performed by the barber-circumciser (the wanzami among the Hausa)",[320,321,322,323],"Prevalence: near-universal ~95.5% (Morris et al. 2016; range ~92–99%), driven by the ~99% Muslim majority, across the Hausa, Zarma-Songhai, Fula/Peul, Tuareg and Kanuri. CAVEAT: the Niger figure is partly an inference from the Muslim population share (the model assumes ~99.9% of Muslim males are circumcised) rather than direct circumcision-survey data, so confidence in the exact percentage is moderate (best framed as \"near-universal, ~92–99%\"). Male circumcision (khitan) is an established Sunni (Maliki) Islamic identity rite.","THE DISTINCTIVE ANGLE — a Sahelian Muslim near-universal rite that INVERTS Mali's FGM picture: like its neighbour Mali, Niger has near-universal male circumcision and a Hausa traditional-barber (wanzami) circumciser tradition — but unlike Mali, Niger BOTH criminalised FGM (in June 2003, Penal Code Law No. 2003-025) AND has LOW FGM prevalence (~2% of women aged 15–49, regionally concentrated). It completes a West-African Sahel trio with Senegal and Mali, the three differing sharply on the FGM axis even as male circumcision is near-universal across all three.","PRACTICE: traditionally performed by the barber-circumciser — among the Hausa, the wanzami — with a medicalisation trend that is weaker/less documented than in wealthier countries; Niger is a poor Sahelian state with very limited published male-circumcision literature. (No quantified national operator split or rural-vs-urban breakdown survived as a verified Nigerien figure.)","HIV: a very low, concentrated (not generalised) epidemic that is significantly sex-work-driven — an estimated ~37% of HIV incidence in Niger was linked to sex work in 2012, despite only ~1% of HIV expenditure (2007–2012) targeting sex-work interventions. Because circumcision is already near-universal AND Niger is not among the East/Southern-African VMMC priority countries (the program targets generalised epidemics with LOW circumcision), VMMC is irrelevant and no circ↔HIV protective claim applies — the national HIV literature does not invoke circumcision. Sex-ed/other composite scores omitted.",{"iso3":325,"isoNumeric":326,"name":327,"region":180,"circumcisionRatePct":285,"adultPrevalencePct":328,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":217,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":329,"profileSources":330,"isFallback":40},"SLE","694","Sierra Leone",1.7,"Childhood (no fixed age — Muslim khitan often early; traditional circumcision sometimes within Poro forest initiation, \"if not already done\")",[331,332,333,334],"Prevalence: near-universal ~96.1% (Morris et al. 2016, Table 1; the figure was unaffected by the 2016 erratum, which corrected only 6 of 237 countries — Sierra Leone was not among them) — far above the ~37-39% global average. A MODELED estimate (compiled from PubMed/DHS/AIDS Indicator Surveys/Behavioral Surveillance Surveys; the authors are advocacy-aligned), but consistent with both Muslim and traditional circumcision norms. Circumcision is performed across BOTH systems: among the ~78% Muslim majority via Islamic khitan, and in the traditional Poro male secret society. FGC (female cutting) is a separate practice and is never conflated here.","THE DISTINCTIVE ANGLE — the PORO male secret society. In Poro forest initiation, boys 'if they have not already been circumcised, they are circumcised at the start of their time in the forest and given a Poro name' (Sierra Leone Heritage glossary; the Sage Encyclopedia of African Religion lists circumcision among Poro ceremonies symbolising the death of childhood). Sierra Leone's secret societies are gender-split into Poro (male) and Bondo/Sande (female) — parallel decision-making bodies, membership a prerequisite for gendered personhood, with most ruling male elites holding Poro membership. Practice varies by ethnic group/region (Temne, Mende, Limba, Fula, etc.).","Providers / medicalisation: circumcision is performed by both traditional/secret-society circumcisers and health workers, with a shift toward clinical settings — but the medical-regulation laws expressly leave 'native systems of therapeutics' / customary therapeutics OUTSIDE their prohibitions, so the traditional sector operates outside formal regulation. No Sierra-Leone-specific male-circumcision harm series was located (an honest evidence gap); the general literature finds fewer complications when circumcision is performed by trained professionals in hospital settings than by ritual circumcisers.","HIV: low and generalized — adult (15-49) prevalence ~1.7% (UNAIDS 2016; reaffirmed DHS 2019 and Lancet 2023), below the 5% generalized-epidemic threshold (somewhat higher urban/Western Area ~2.0-3.4%, lower rural ~1.2%). Because male circumcision is already near-universal, voluntary medical male circumcision (VMMC) as an HIV-prevention intervention is irrelevant and no circumcision↔HIV protective claim is made or implied.",{"iso3":336,"isoNumeric":337,"name":338,"region":180,"circumcisionRatePct":339,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":340,"profileSources":341,"isFallback":40},"MDG","450","Madagascar",95,"TRADITIONAL CULTURAL RITE (fomban-drazana): performed across virtually all Malagasy ethnic groups on boys ~2-4 years. ANTAMBAHOAKA SAMBATRA (most distinctive): every 7 years during the 'Friday year,' ~1 month Oct-Nov, all boys born in preceding 7-year cycle, Ampanjaka authority, Raminia/Ndohanina ancestry origin, boys become Zafiraminia. BETSIMISARAKA: sambatra as major custom (folanaka/zebu/house = companion rites). REGIONAL NAMES: famorana (Merina highlands), sambatra (Antambahoaka/coastal), to-laza (Betsimisaraka), savatse (SW). Traditional healer rain-jaza performs in some communities. FORESKIN RITUAL (MEDIUM conf): consumed by grandfather or maternal uncle (zaman-jaza) with banana; varies by tribe; sourced from blogs/Wikipedia only — no primary monograph.",[342,343,344,345,346],"Prevalence: 94.7% (Morris et al. 2016, PMC4772313, Table 1; from DHS nationally representative survey data; HIGH confidence — direct survey measurement, not modeled). Erratum PMC4820865 did not revise Madagascar. 2024 PLOS ONE systematic review (PMC10936832) independently corroborates approximately 94.7%. Near-universal practice documented across virtually all major Malagasy ethnic groups; certain Antandroy clans (southern Madagascar) may be partial exceptions to the near-universal pattern.","Cultural practices (famorana / sambatra): Madagascar's near-universal male circumcision is driven entirely by fomban-drazana (ancestral customs), not by religion. Madagascar is majority-Christian (~40% Protestant, ~36% Catholic); the churches do not require circumcision. The rite predates Christian and Muslim influences on the island. General name: famorana (Merina/Imerina highlands and wider usage). Regional names: sambatra (Antambahoaka and Betsimisaraka coastal groups), to-laza (Betsimisaraka), savatse (southwest). Typically performed on boys aged approximately 2-4 years in most ethnic groups. Traditional healer ('rain-jaza') performs the ceremony in some communities (Fr. Wikipedia / mediummagazine.net). Sambatra is listed as one of the four major customs among the Betsimisaraka alongside folanaka (birth of 10th child), zebu sacrifice for ancestors, and house inauguration (Wikipedia Betsimisaraka; 3-0).","THE ANTAMBAHOAKA SAMBATRA — most distinctive Malagasy expression: held every seven years during the 'Friday year' (when January 1st falls on a Friday by the Malagasy lunar calendar; a rule established by royal decree); lasts approximately one month (the 2014 event ran October 3 to November 1); circumcises all boys born in the preceding seven-year period; conducted under authority of the Ampanjaka (local king), who presides in distinctive black-and-red robes; rooted in the ancestor Raminia's circumcision of his son Ndohanina (Antambahoaka origin narrative), after which boys become 'Zafiraminia' (sons of Raminia), marking their entry into the paternal clan. Reuters archive footage and Smithsonian photo contest documentation corroborate the ceremony in practice. All these elements 3-0 verified.","Foreskin ritual (MEDIUM confidence): the removed foreskin is consumed by the grandfather or maternal uncle (zaman-jaza) with a piece of banana; which specific relative performs this varies by ethnic group. CAVEATS: (a) 2-1 verified — MEDIUM confidence; (b) ALL sources are secondary (travel-ethnography blogs, Wikipedia); no primary peer-reviewed anthropological monograph was located; (c) REFUTED variants that were over-specific: 'grandmother alone' (0-3), 'father/uncle alone' (0-3), 'grandfather/maternal uncle with banana NOT grandmother' (0-3 as a specific exclusion). The surviving claim correctly frames it as tribe-dependent variation. Do not assert which specific relative with certainty — frame as 'grandfather or maternal uncle, varies by group (zaman-jaza = generic relative term).'","HIV, legal context, VMMC: Madagascar has a concentrated HIV epidemic (~0.2% adult prevalence) primarily affecting key populations (sex workers, MSM, truck drivers); it is NOT a generalised epidemic by current classification. A 2023 modelling study (BMC IDP Journal) warned of potential transition to generalised (9-24%) without sustained intervention. Madagascar is NOT among the 15 WHO VMMC priority countries (all 15 = Eastern and Southern Africa). VMMC is irrelevant to Madagascar's HIV context. Legal: UNREGULATED — no statute specifically governing non-therapeutic male circumcision. Madagascar Law No. 2024-001 modified the Penal Code on sexual crimes against minors but does not address circumcision. FGM practiced in some Malagasy communities — STRICTLY SEPARATE. 0 traditional circumcision harm cases verified in indexed literature — honest evidence gap.",{"iso3":348,"isoNumeric":349,"name":350,"region":180,"circumcisionRatePct":339,"adultPrevalencePct":194,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":351,"profileSources":352,"isFallback":40},"GIN","324","Guinea","Childhood (a Conakry harm series spanned ages 10 days–32 years) — a Sunni (Maliki) Islamic rite (khitan), performed by traditional and paramedical operators",[353,354,355,356],"Prevalence: near-universal MALE circumcision in line with the ~85–90% Muslim majority. Morris 2016 gives a CONSERVATIVE model-based figure of 84.2% (derived from the Muslim demographic share — the \">80%\" band) but the same paper notes Guinea SURVEY data of ~96.0%, so true prevalence is likely near-universal. Performed overwhelmingly as Muslim khitan (circumcision is virtually universal among Muslim populations; 95–100% in survey data) across the Fula/Peul, Malinké/Mandinka and Susu. (A forest-region traditional MALE-initiation dimension was sought but did not surface in verification, so it is not asserted.)","THE DISTINCTIVE ANGLE — a second extreme male-circ/FGM disambiguation (with Sudan), plus a domestic MALE harm series: Guinea carries near-universal male circumcision AND among the world's highest FEMALE genital-mutilation rates (~95%), so the two practices must be kept rigorously separate (FGM is female, never conflated). And unlike many near-universal countries, Guinea has a genuine domestic MALE-circumcision harm literature — the CHU de Conakry series — documenting serious injury (fistulas, haemorrhage, glans amputation).","MALE harm (verified): Diallo et al. 2008 (CHU de Conakry, Urology-Andrology + Paediatric Surgery) documented 44 circumcision complications over 102 months — 28 urethro-cutaneous fistulas, 10 penile haemorrhages, 2 glans amputations, patients aged 10 days to 32 years — with operators split paramedic 64% / traditional circumciser 36%. CRITICAL CAVEAT: this is a hospital complication case series, so the 64/36 split is selection-biased to REFERRED complications and does NOT represent the general provider mix or the population complication rate; it is a single institution and a single 2008 paper.","HIV: a low, concentrated epidemic — DHS 2018 estimated ~1.3% prevalence among men (~1.5% national), with the burden concentrated in key populations, especially men who have sex with men (~9.4%, roughly seven times the general young-male rate; sex workers far higher). Because male circumcision is already near-universal, Guinea is NOT among the WHO/UNAIDS VMMC priority countries (15 East/Southern-African nations), VMMC is irrelevant and no circumcision-HIV protective claim applies. Sex-ed/other composite scores omitted.",{"iso3":358,"isoNumeric":359,"name":360,"region":180,"circumcisionRatePct":339,"adultPrevalencePct":361,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":362,"profileSources":363,"isFallback":40},"TGO","768","Togo",1.6,"Childhood (Muslim khitan north + traditional/cultural circ south; in Lomé hospital series often newborn/infant — but national age pattern not directly documented)",[364,365,366,367],"Prevalence: near-universal ~95.2% (Morris et al. 2016, Table 1), alongside neighbours Benin (92.9%) and Ghana (91.6%). Togo is religiously mixed (~43% traditional/Vodun, ~36% Christian, ~14% Muslim), so the near-universal rate makes circumcision a broad traditional/cultural norm crossing religious lines as much as a Muslim rite. NB: a partly MODELED estimate (~10y old) where DHS/MICS data are absent; read as near-universal. FGM is a separate female practice and is never conflated here.","THE DISTINCTIVE ANGLE — the cross-divide confirmation. CHU de Lomé hospital series record 'religious' as the dominant stated indication (75.5%, 79.85%), but the authors EXPLICITLY attribute that religious predominance to Lomé's large CHRISTIAN majority ('en raison de la forte proportion de chrétiens') — i.e. NOT framed as a Muslim rite. Togo is in the Vodun belt (with Benin), but no source links male circumcision to Vodun ritual specifically — that is geographic/cultural backdrop. SCOPE CAVEAT: the hospital evidence covers the Christian-majority SOUTH (Lomé); the northern Muslim (Tem/Kotokoli) khitan and Ewe/Mina/Kabye traditional patterns are not directly documented.","Providers / medicalisation: circumcision in Togo is largely NON-medicalised — most often performed by unqualified paramedical staff or traditional healers (tradithérapeutes) 'whose knowledge of anatomy, surgery and asepsis is sometimes uncertain', because the act is regarded as benign; the hospital/surgeon-performed cases are the medicalised minority. This non-medical sector is where the documented harm arises (see the CHU Lomé complication series). (A claim that parents refuse hospital circumcision on cost grounds was refuted on verification and is not asserted.)","HIV: low and generalized — adult prevalence ~1.6% (2024, World Bank; declining from ~2% in 2019; ~105,000 people living with HIV, 2023). Togo (West Africa) is NOT among the 14-15 WHO/UNAIDS voluntary-medical-male-circumcision priority countries, which are all in eastern and southern Africa. Because circumcision is already near-universal, VMMC is irrelevant and no circumcision↔HIV protective claim is made or implied.",{"iso3":369,"isoNumeric":370,"name":371,"region":92,"circumcisionRatePct":339,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":372,"profileSources":373,"isFallback":40},"UZB","860","Uzbekistan","Childhood — typically ages 3/5/7 (Islamic rite, sunnat/khatna); home \"medicine man\" or urban clinic (medicalisation incomplete)",[374,375,376,377],"Prevalence: near-universal (~95%; Morris 2016 places Muslim-majority states in the ≥90% band) — tracking Uzbekistan's ~96–97% Muslim (Sunni Hanafi) population, among the highest circumcision rates in the non-Arab world. (A ~98.5% figure circulates but is Morris-derived via a partisan tertiary host — keep ~95%.) There is NO national circumcision survey; present any number as an estimate. The uncircumcised share concentrates in non-Muslim minorities — chiefly ethnic Russians/Slavs (Russian Orthodox tradition does not circumcise); historic Bukharan Jews do circumcise. This split is inferential from demographics, not a direct survey.","THE SUNNAT-TOY — a state-recognised cultural institution: male circumcision (sunnat/khatna) is a fundamental Islamic rite, and the sunnat-toy (circumcision feast) is a defining social event, FORMALLY LISTED as protected national Intangible Cultural Heritage by Uzbekistan (ICH national inventory). National Geographic (2017) documents it as \"a celebration almost as important as a wedding\" — special dress, gifts of candy and money, a large pilaf feast — with boys \"generally aged three, five, or seven.\"","Practitioner + medicalisation: historically performed by a barber or traditional \"medicine man\" at home; the modern urban trend is toward surgeons under anaesthesia in clinics — but medicalisation is INCOMPLETE (NatGeo confirms home/medicine-man cuts on young children persist alongside clinics). Post-Soviet revival context: sunnat persisted through Soviet atheism as an ethnic/cultural-identity marker and resurged openly after 1991 (well-attested context; no specific figure). Contrast with Kazakhstan: Uzbekistan is overwhelmingly Muslim, so the rite is near-total rather than split by a large Slavic minority.","HIV: low general prevalence (~0.1–0.3%), a concentrated epidemic — injection- and key-population-driven (HIV among PWID historically up to ~30% in Tashkent; female sex workers ~6–10%), now shifting toward sexual transmission, with labour-migrants a factor. People living with HIV is best cited as a range (~48,000 registered to ~60,000 modelled; Uzbek HIV data is credibly accused of under-reporting). The defining iatrogenic harm event is the 2007–08 NAMANGAN nosocomial pediatric outbreak (~147–150 children infected via contaminated equipment/transfusions) — NOT circumcision. Circumcision is already near-universal, so VMMC is irrelevant and plays no role. FGM is not a documented Uzbek practice. Sex-ed/other composite scores omitted.",{"iso3":379,"isoNumeric":380,"name":381,"region":180,"circumcisionRatePct":382,"adultPrevalencePct":328,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":383,"profileSources":384,"isFallback":40},"GMB","270","Gambia",94.5,"8-13 (Mandinka initiation)",[385,386],"Morris et al. 2016 PMC4772313 — modelled; Gambia ~95-96% Muslim; near-universal among Muslim population","Kankurang initiation: UNESCO-inscribed Mandinka male initiation masked figure accompanies and protects boys during circumcision ceremonies; most boys circumcised by age 15; Mandinka typically age 8-13",{"iso3":388,"isoNumeric":389,"name":390,"region":180,"circumcisionRatePct":391,"adultPrevalencePct":392,"plhivPer1000":393,"newInfectionsPer1000":394,"onTreatmentPct":395,"childPrevalencePct":304,"hivYear":396,"hivSource":32,"epidemicGrowthPct":397,"sexEducationGapScore":398,"preventionContextScore":10,"policyEnvironmentScore":399,"stigmaIndex":400,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":401,"profileSources":402,"isFallback":40},"CMR","120","Cameroon",94,2.7,18,0.8,81,"2018",-50,68,45,61,"Regionally variable — anglophone Southwest early infancy (0–60 days); francophone Littoral/Central ages 2–10 (Muslim khitan north + traditional/cultural circ south)",[403,404,405,406],"Prevalence: near-universal 94% (Morris et al. 2016, Table 1, erratum-unchanged; UNAIDS Cameroon 2024 independently reports 94% for men 15-49, 2022 data); the UNICEF-commissioned GHSP formative review (Kenu et al. 2016, from the 2011 Cameroon DHS) gives a 90% national average ranging 75-100% across regions. Circumcision crosses Cameroon's religious + regional divide — Muslim-north khitan (Fulani/Hausa) plus traditional/cultural circumcision in the Christian/animist south and west (Bamileke, Beti, Douala). NB: a modeled meta-estimate; no verified source surfaced an ethnicity-resolved or direct Muslim-vs-Christian split — the cross-religious near-universality is inferred from the national average + the 75-100% regional range, not a per-group table. FGM is a separate female practice and is never conflated here.","THE DISTINCTIVE ANGLE — Cameroon is the Central/West-African HINGE (bridging the West-African and Central-African coverage sets) and, unlike the rest of this wave, the INCOMPLETE-MEDICALISATION-HARM case. Timing is regionally variable: the anglophone Southwest circumcises in early infancy (0-60 days), while the francophone Littoral and Central regions circumcise sons between ages 2 and 10 (Kenu/GHSP 2016 — a small qualitative study of stated preferences; harm-series mean ages 6.25-7.75y corroborate the later francophone timing).","Providers / medicalisation: Cameroon has a GENUINE, multi-centre pediatric-surgery/urology harm literature (5 peer-reviewed Yaoundé/Douala series, 150+ complication cases) driven by an INCOMPLETE-MEDICALISATION gradient — ritual procedures performed by paramedical/non-medical practitioners rather than qualified physicians. One Yaoundé series reports 0% of the complicated circumcisions were done by physicians; a Douala series attributes 66.7% of complications to paramedics; and a 2020 campaign study contrasts 3 botched home/traditional cases with 55 cleanly-performed campaign circumcisions (one bleed, one infection, no deaths) — evidence that the medicalisation gap, not circumcision per se, drives the injury burden. Dominant complications: urethrocutaneous fistula, urethral meatal stenosis, glans amputation.","HIV: a generalized but DECLINING epidemic — adult (15-49) prevalence fell 5.4% (2004) → 4.3% (2011) → 2.7% (2018, the verified anchor; CAMPHIA 2017 ~3.4% intermediate), with strong regional variation (~1% in the Far North to 5.6% in the East and 5.8% in the South). Because circumcision is already near-universal (~94%), voluntary medical male circumcision is irrelevant and Cameroon is NOT a WHO VMMC priority country (it is excluded from the 2010-2023 sub-Saharan VMMC review) — no circumcision↔HIV protective claim is made or implied.",{"iso3":408,"isoNumeric":409,"name":410,"region":180,"circumcisionRatePct":391,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":93,"medicalNecessity":71,"avgAge":411,"profileSources":412,"isFallback":40},"SOM","706","Somalia","Before age 10 (typically early childhood, organised by the father; no fixed universal age); traditional practitioners dominant in rural areas",[413,414,415,416],"Prevalence: ~93–94% (Morris et al. 2016, modelled from Muslim population proportion; no DHS-standard nationally representative male circumcision survey published for Somalia). The 99% Sunni Muslim population — predominantly Shafi'i madhab, which classifies khitan as wajib (obligatory) rather than merely sunnah (recommended) — drives near-universal male circumcision. This is among the world's highest rates. DISAMBIGUATION: Somalia also has approximately 98% female genital cutting (Type III pharaonic/infibulation — the world's highest) — an entirely separate practice with separate causes, history, and legal context; never conflated here.","Practice: Shafi'i Islamic jurisprudence classifies male circumcision (khitan) as wajib — religiously obligatory — distinguishing Somalia from most other Sunni-majority countries where it is sunnah (recommended). The practice predates Islam in the Horn of Africa and is culturally embedded as a marker of Somali male identity. It is typically performed before age 10, organised by the child's father. Traditional non-medical practitioners dominate in rural settings; medicalisation is increasing in Mogadishu, Hargeisa (Somaliland), and Puntland.","HIV: ~0.1% adult HIV prevalence (World Bank 2024, citing UNAIDS data) — one of Africa's lowest, a marked decline from over 1% in 2013. UNAIDS estimated approximately 7,700 people living with HIV as of 2021. Somalia is classified as a low-level HIV epidemic country and is NOT among the 14 WHO/PEPFAR VMMC priority countries. Circumcision is already near-universal, making VMMC irrelevant. No circumcision↔HIV protective claim is made.","Harm: one verified 2025 peer-reviewed case report of post-circumcision penile necrosis in a 6-year-old boy from Middle Shabelle (rural Somalia), following a traditional circumcision by an untrained practitioner using non-sterile, rudimentary equipment on 4 children without sterilisation between cases. Developed wound infection, urinary retention, tissue necrosis, and penile discharge. Referred to Dr. Sumait Hospital (tertiary, Mogadishu); made a full recovery at one-month follow-up.",{"iso3":418,"isoNumeric":419,"name":420,"region":180,"circumcisionRatePct":421,"adultPrevalencePct":422,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":423,"profileSources":424,"isFallback":40},"GNB","624","Guinea-Bissau",93.3,1.8,"varies by ethnic group",[425,426,427,428],"Morris et al. 2016 PMC4772313: 93.3% national total-population male circumcision prevalence","Bandim Health Project (PMC4856489): suburban Bissau ethnic breakdown — Balanta animist 65-69%, Muslim Mandinga/Fula ~99%, Papel 88-97%, Manjaco/Mancanha 95-97%","Circumcision extends well beyond Muslim communities in Guinea-Bissau; Balanta (animist, ~30% of population) have high rates via traditional initiation","FGM: ~45% prevalence. STRICTLY SEPARATE from male circumcision — not conflated here",{"iso3":430,"isoNumeric":431,"name":432,"region":180,"circumcisionRatePct":433,"adultPrevalencePct":262,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":229,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":434,"profileSources":435,"isFallback":40},"BEN","204","Benin",93,"Childhood (no fixed age — Muslim khitan + traditional/cultural circumcision; granular age/timing not field-measured in Benin)",[436,437,438,439],"Prevalence: high/near-universal ~92.9% (Morris et al. 2016, derived from the Benin 2011-2012 DHS Table 13.13; corroborated by WHO 2006 >80% and Williams et al. 2006 84% — three estimates spanning 2006–2016 converging near-universal). Because this far exceeds the ~24% Muslim share, circumcision in Benin is best understood as a traditional/cultural norm crossing religious lines as much as a Muslim rite. NB: a MODELED figure (partly religion/ethnicity-imputed; lead author is a circumcision advocate; Benin DHS does not routinely field-measure male circumcision) — read as a near-universal estimate. FGM is a separate female practice and is never conflated here.","THE DISTINCTIVE ANGLE — Benin is the VODUN (voodoo) heartland (Ouidah) and religiously mixed (~28% Christian / ~24% Muslim / ~17% Vodun-traditional + others). CRUCIAL HONEST GUARD: no source links male circumcision to Vodun ritual specifically — the Vodun context is geographic/cultural backdrop, NOT a circumcision rite. Circumcision crosses the divide (Muslim khitan + traditional/cultural practice among Fon, Yoruba, Bariba, Adja, etc.).","UNVERIFIED granular detail (flagged honestly): no verified source disaggregates Benin's ~92.9% by religion/ethnicity, by age/timing (infancy vs early childhood), by traditional-circumciser-vs-hospital provider, or by rural/urban. The Muslim-khitan-vs-traditional split, the medicalisation gradient, and any Vodun-context framing are plausible-but-unverified and are presented as such rather than asserted as fact. No dedicated Beninese male-circumcision harm series exists (an honest evidence gap).","HIV: low and concentrated — adult general-population prevalence ~1.0–1.2% (1.2% in 2006; ~1.1% later), historically SEX-WORK-DRIVEN. The canonical Cotonou female-sex-worker (FSW) cohort shows HIV falling from 53.3% (1993) to 30.4% (2008) under targeted interventions (condom promotion, STI control), with FSW prevalence ~20–25% vs ~1.1% general. Because circumcision is already near-universal and Benin is NOT a WHO VMMC priority country (excluded from the 2024 sub-Saharan VMMC meta-analysis), voluntary medical male circumcision is irrelevant and no circumcision↔HIV protective claim is made or implied.",{"iso3":441,"isoNumeric":442,"name":443,"region":67,"circumcisionRatePct":433,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":444,"profileSources":445,"isFallback":40},"BGD","050","Bangladesh","No fixed age — boys, typically early childhood; the musulmani (sunnat) is a Sunni Islamic identity rite, traditionally performed by the hajam (barber-circumciser)",[446,447,448,449],"Prevalence: ~93.2% national (Morris et al. 2016, the highest band), tracking the ~90% Sunni (Hanafi) Muslim majority — male circumcision (musulmani / sunnat / মুসলমানি) is so woven into Muslim identity that Banglapedia states \"from the religious and social aspect of view it is almost unimaginable to find a Muslim male without circumcision.\" It is confined to the Muslim majority and essentially absent among Hindu, Buddhist and Christian minorities. CAVEAT: 93.2% is a 2016 MODELLED estimate (partly resting on a 2003 Dhaka-slum STI survey), not a recent national census — but a \"pure religion-proxy\" reading was refuted, so it is better-grounded than imputation alone.","THE DISTINCTIVE ANGLE — a South-Asian Sunni near-universal rite on an EARLY-STAGE medicalisation gradient: the musulmani is a Sunni (Hanafi) religious-social rite of identity/coming-of-age (rooted in sunnah/hadith, not the Qur'an), traditionally performed by the untrained hajam / Hazam (barber-circumciser), historically with non-sterile instruments. The shift toward doctor/hospital provision is REAL but uneven and early — only ~10% of circumcisions are doctor-performed nationally; the clearest documented hajam→hospital shift is the localized WHO program in the Cox's Bazar Rohingya refugee camps (8 facilities, 413 children June–Aug 2023), which must NOT be generalized to national policy.","HARM: documented Bangladeshi harm spans BOTH ends of the gradient. Traditional: a 2010 case report of penile myiasis (a 10-year-old, ~30 maggots, 7 days after an unsterile hajam circumcision, Narayanganj → Dhaka Medical College). Medical: a recent cluster of GENERAL-ANAESTHESIA DEATHS of healthy boys in private Dhaka hospitals — a 5-year-old (Ayaan/Ayan Ahmed, United Medical College Hospital, Satarkul; operated 31 Dec 2023, died 7 Jan 2024) and a 10-year-old (Ahnaf Tahmin Ayham, JS Diagnostic, Malibagh, ~Feb 2025; two doctors arrested), with a Detective-Branch probe and a 2016 court conviction of a hospital for a circumcision death — echoing the finding that medicalisation introduces its own (anaesthetic) hazard.","HIV: a very low (\u003C0.1% general population — among the lowest globally; national programme reports \u003C0.01% since 1989), CONCENTRATED epidemic driven by people who inject drugs (mainly Dhaka — HIV among PWID rose from 5.3% in 2011 to 22% in 2016, crossing the WHO concentrated-epidemic threshold), with sex workers, MSM, transgender (hijra), migrant workers and Rohingya refugees as further key populations. Because circumcision is already near-universal AND WHO's VMMC recommendation is scoped ONLY to generalized (East/Southern African) epidemics, VMMC is irrelevant to Bangladesh — no circ↔HIV protective claim applies. Sex-ed/other composite scores omitted.",{"iso3":451,"isoNumeric":452,"name":453,"region":180,"circumcisionRatePct":433,"adultPrevalencePct":56,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":454,"profileSources":455,"isFallback":40},"SEN","686","Senegal","Varies widely by community — 7th day after birth (Layenne), 4–5 with a faith healer, 12–15 in Koranic school, infant circumcision the norm in Dakar; a Sunni (Maliki) Islamic rite (khitan)",[456,457,458,459],"Prevalence: near-universal, driven by the ~93–97% Muslim majority. Empirical national rate ~80% (2010–11 DHS-MICS, ranging 75–100% by region — \"almost universal\"); the Morris 2016 MODELLED estimate is 93.5% (assuming ~99.9% of Muslim/Jewish males circumcised) — reconciled as different methods, both confirming near-universal practice. Khitan is conceptualised across religious, spiritual and biomedical dimensions among a wide range of ethnic groups (Wolof, Manding/Mandinka, Fulbe/Pulaar, Serer, Laobe and others). (Some studies span Senegal + Guinea-Bissau.)","THE DISTINCTIVE ANGLE — West-African Sahelian Sufi-Muslim near-universal rite, TRADITIONAL-sector-dominant + a real harm literature: timing varies widely (7th day after birth among the Layenne; 4–5 with a faith healer; 12–15 in Koranic school in Malem Hodar; early-infant circumcision the norm in Dakar). Most procedures are performed by TRADITIONAL circumcisers and nurses — 83% of sampled parents used traditional circumcisers, for religious reasons and because they are far cheaper (3,000–5,000 CFA / ~US$5–8.50 vs up to 25,000 CFA at a facility) — with medical doctors involved less often; medicalisation is a growing URBAN trend. (Senegal's strong Sufi brotherhoods, Mouride/Tijaniyya, shape the religious context.)","HARM: unlike most near-universal countries where harm is an honest gap, Senegal has a documented pediatric/urology harm literature — a 9-year-old's glans amputation during a night-time pharmacy circumcision by an unqualified pharmacist (Aristide Le Dantec Hospital, Dakar; Urology Case Reports 2021), and a Louga Regional Hospital case series of 29 patients treated for circumcision complications over 2009–2015 (93% performed by paramedical operators, 97% outside an operating theatre, 100% by the guillotine technique): 3 glans amputations, 7 urethrocutaneous fistulas, 9 infections, 5 haemorrhages, 3 meatal stenoses, 1 penile denudation. These are complications-SELECTED referral cases, not a population complication rate — but they document the traditional/paramedical-sector harm directly.","HIV: Senegal's famous LOW and STABLE epidemic — general-population prevalence under 1% (~0.3% in 2023; ~0.7% in 2012; ~1.4–1.8% in the late 1990s), rising to ~18–20% among key populations (sex workers, MSM). This is widely attributed to EARLY, sustained prevention efforts (an early-response success story), NOT to circumcision — which is already near-universal, so VMMC is irrelevant and no circ↔HIV protective claim applies (a circ-HIV protective-association claim was adversarially refuted in research and is not asserted). Sex-ed/other composite scores omitted.",{"iso3":461,"isoNumeric":462,"name":463,"region":27,"circumcisionRatePct":433,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":464,"profileSources":465,"isFallback":40},"SYR","760","Syria","Childhood — a Sunni (Shafi'i/Hanafi) Islamic rite (khitan/tahara); pre-war largely medicalised, with wartime provision shifting toward NGO/relief delivery",[466,467,468,469],"Prevalence: near-universal ~92.8% (Morris et al. 2016, Table 1; ~93% rounded), consistent with Syria's broadly Muslim majority (Sunni ~74–80%, plus Alawite/Shia/Ismaili/Druze). CAVEAT: 92.8% is a RELIGION-MODELLED estimate (the model assumes ~99.9% of Muslims/Jews circumcised; ~Muslim share × 99.9% ≈ 92.8%), NOT a Syrian survey — and no Syrian circumcision survey exists, least of all after 2011. The Christian minority (~2–2.5% now, down from ~10% pre-war as Christians emigrated during the war) does NOT ritually circumcise; khitan/tahara is an Islamic (and Jewish) rite.","THE DISTINCTIVE ANGLE — a near-universal rite seen THROUGH WAR: pre-war Syria had a reasonably medicalised health system, but the 2011 civil war collapsed health-system GOVERNANCE — \"one of the most significant weaknesses... was the ineffectiveness of regulatory and monitoring frameworks\" (Al-Abdulla et al. 2025) — and circumcision provision visibly shifted toward NGO/relief delivery. The most vivid datapoint: the Turkish NGO IHH circumcised ~1,100 Syrian boys over six days in May 2017 in opposition-held Idlib (Atmah/Sarmada/Salkin), with children transferred \"from places under assault to the safe zone\" and equipment donated by Turkish businessmen. (This is ONE illustrative event, NOT proof of a system-wide shift; an NGO self-report with an internal 1,100-vs-100 headline/body discrepancy.)","PRACTICE / HARM context: the general surgical-safety literature establishes that complications rise sharply when circumcision is performed by inexperienced providers in non-sterile or poorly-equipped settings (traditional/untrained settings reaching ~80% complication prevalence in some studies) — a mechanism DIRECTLY relevant to wartime/displacement circumcision in Syria, but this is an INFERENCE, not a Syria-specific measured rate: NO verified Syria-specific male-circumcision harm case or series was located (an honest gap, aggravated by the war's data collapse). No fabricated cases.","HIV: a very low-level epidemic — Syria is \"a country with low endemicity of HIV (\u003C0.1% among the general population)\", within the wider MENA region's ~0.07% adult prevalence (blood-donor seroprevalence ~0.23%, a low-risk proxy). Because circumcision is already near-universal, VMMC has no rationale (WHO recommends it only for high-prevalence, low-circumcision settings — Syria qualifies on neither) and no circ↔HIV protective claim applies. CRITICAL CAVEAT: Syria's HIV surveillance collapsed during the war (the National AIDS program estimates up to a ~99% reduction in surveillance among key populations), so all Syrian HIV data carries severe uncertainty. Sex-ed/other composite scores omitted.",{"iso3":471,"isoNumeric":472,"name":473,"region":180,"circumcisionRatePct":474,"adultPrevalencePct":328,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":476,"profileSources":477,"isFallback":40},"GHA","288","Ghana",92,"not-routine","Often early/infant (a rural cohort circumcised infants \u003C12 weeks); a deep traditional/cultural norm across the Akan, Ewe, Ga-Dangme and Mole-Dagbani, + Muslim khitan in the north",[478,479,480,481],"Prevalence: near-universal — ~91.6% (Morris et al. 2016, from the 2008 DHS — survey-based, NOT religion-imputed) and ~95% in the 2022 Ghana DHS (~5% / ~835,000 men uncircumcised); a rural infant cohort found 90.7% of male infants circumcised. THE DISTINCTIVE POINT: Ghana is ~71% Christian and only ~20% Muslim, yet circumcision is near-universal ACROSS religious and ethnic lines (Akan, Ewe, Ga-Dangme, Mole-Dagbani) — so it is a deep TRADITIONAL/cultural norm, NOT primarily an Islamic rite. (Estimates range 85–95% by age band/source; near-universality is undisputed.)","THE DISTINCTIVE ANGLE — a near-universal CULTURAL rite with a counter-history of REJECTION: among the pre-20th-century Asante (Akan), circumcision was NOT indigenous — it was regarded as MUTILATION linked to enslaved/non-freeborn status, and Akan chieftaincy custom disqualifies a circumcised man from the stool (a bodily-wholeness norm). It spread later via Hausa Muslim \"Wanzam\" barbers, who historically operated without anaesthesia using homemade, unsterilised instruments (hemorrhage/infection reported). (This historical-rejection account rests largely on a single source and is presented as historical/contested; the specific attribution of the spread to an 1898 Hausa migration is NOT asserted.) A useful counterpoint to the \"circumcision = ancient universal good\" framing.","PRACTICE / HARM — the MEDICALISED-sector problem: distinctively, MOST circumcision injuries in Ghana follow procedures by HEALTH-CARE PROFESSIONALS in hospitals/facilities, not only traditional circumcisers — and many of those professionals are UNTRAINED (of 378 surveyed medical circumcisers, 74.3% midwives and 23.5% general nurses, NONE had formal training in the procedure). A Komfo Anokye Teaching Hospital (Kumasi) series found ~86% of 72 child injuries caused by formal health workers. So Ghana shows that medicalisation without training does not, by itself, make circumcision safe.","HIV: Ghana has a low, concentrated epidemic; because circumcision is already near-universal, VMMC (designed for low-circumcision, high-prevalence generalised settings) has no application here and no circumcision-HIV protective claim is supported. (NB: this is an inference from near-universal prevalence + the absence of any contrary claim — no direct Ghana HIV-epidemiology figure was independently re-verified this run; the existing indicator value is retained.) Sex-ed/other composite scores omitted.",{"iso3":483,"isoNumeric":484,"name":485,"region":27,"circumcisionRatePct":474,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":181,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":486,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":127,"medicalNecessity":71,"avgAge":487,"profileSources":488,"isFallback":40},"EGY","818","Egypt",75,"Infancy/early childhood (heavily medicalised; pediatric surgeons)",[489,490,491,492,493],"Prevalence: 92.3% of Egyptian boys circumcised (urban 94.1%, rural 90.1%) — Salama II et al., \"A Nationwide Community Survey of Prevalence of Circumcision among Egyptian Children…,\" Open Access Macedonian Journal of Medical Sciences 2021 (n=3,306). Near-universal across the Muslim majority and the Coptic Christian minority. (This is the MALE rate; the survey reported a separate, lower female-cutting rate — do not conflate.)","Age/medicalisation: heavily medicalised, mostly early infancy — Shehata, Almetaher & Mansour, \"Male Circumcision: Contemporary Practice Pattern of the Egyptian Pediatric Surgeons,\" Medical Journal of Cairo University 2019 (survey at the 33rd EPSA Congress, n=126): 35% prefer neonatal, 58.7% age 1–3 months, only 6.3% after 3 months; 27% perform >150 cases/year. (Surgeons' stated practice, not a population age-at-circumcision measure.)","History/religion: ancient Egyptian practice — the Saqqara Ankhmahor Sixth-Dynasty relief (c. 2400 BCE) is thought to be the oldest depiction (a Fifth-Dynasty Djedkare relief may predate it). Grounded in Islamic sunnah/hadith (Shafi'i & Hanbali jurists obligatory; Hanafi recommended) and retained as Coptic Christian custom. A deep cultural norm, not legally mandated.","Sex-education-gap score (M9 = 75, editorial composite, 0–100 where higher = larger gap): Egypt has limited, conservative formal sex education and strong normative pressure; near-universal circumcision is an unquestioned default rather than an informed individual choice — a large information gap.","HIV context: low-prevalence — adult HIV \u003C0.1% since 1990 (Ghazy et al., BMC Public Health 2023); ~22,000 people living with HIV at end-2019 (UNAIDS), concentrated epidemics only among PWID/MSM. No VMMC programme — circumcision in Egypt is cultural/religious, not an HIV intervention.",{"iso3":495,"isoNumeric":496,"name":497,"region":92,"circumcisionRatePct":474,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":181,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":498,"medicalNecessity":71,"avgAge":499,"profileSources":500,"isFallback":40},"KGZ","417","Kyrgyzstan","not-practiced","Ages 3–7 (Islamic practice favouring odd-numbered years); not infant. Medicalisation shifting in Bishkek (hospital procedure + separate feast); southern/rural retains mosque and traditional settings.",[501,502,503,504],"Prevalence: ~91.9% modelled (Morris et al. 2016, PMC4772313), derived from ~80–90% Sunni Muslim population share (Pew 2012) × 99.9% assumed Muslim male circumcision rate. No nationally representative DHS or MICS male circumcision survey exists for Kyrgyzstan. The higher estimate relative to Kazakhstan (~56%) reflects Kyrgyzstan's larger Muslim majority and smaller Russian Orthodox minority (~7–10%). An alternate '~45%' figure appears in some aggregator sources — it likely uses a different denominator; the Morris 2016 peer-reviewed estimate is the authoritative academic source.","Cultural practice: The Kyrgyz circumcision ceremony is called Sunnot Toy (sünöt). It is considered a sacred duty for Muslim families and is described as the most important lifecycle celebration for a Muslim boy, comparable in scale to a wedding. Boys are typically circumcised between ages 3 and 7, with Islamic practice favouring odd-numbered years. The ceremony includes multi-day feasting, national games (ulak tartish — goat-carcass polo, er odarysh — wrestling, balban koresh), and gift-giving, with a horse traditionally the most valued gift. Urban Bishkek has shifted toward hospital procedures with the Sunnot Toy feast held separately; rural and southern Kyrgyzstan retains mosque-based and traditional non-clinical settings (Eurasianet 2018).","Harm: Two documented cases. (1) 2 April 2022: a 7-year-old boy died at Bishkek Children's Hospital following a circumcision procedure; reports noted anaesthesia was administered twice and no autopsy was initially performed. This is the documented Bishkek fatal case explicitly excluded from the Kazakhstan seed (seed-kz.js) as being in Kyrgyzstan. MODERATE confidence (hospital setting, news-reported, possible criminal proceedings). (2) 29 July 2019: a 9-year-old boy in Jeti-Oguz district, Issyk-Kul region, was taken home in shock after being circumcised in a mosque. Outcome beyond the immediate shock state is unconfirmed. LOW confidence (single Kyrgyz-language news report).","HIV and legal: HIV ~0.2% adult prevalence (concentrated/PWID-driven; heterosexual transmission ~39% and growing). Kyrgyzstan is not among the 14 WHO/UNAIDS VMMC priority countries (all sub-Saharan Africa). No circ↔HIV claim. No statute specifically regulates male circumcision — UNREGULATED (Children's Code Art. 5 prohibits corporal punishment but does not address circumcision; absence-of-evidence). FGM is not documented as widespread in Kyrgyzstan — disambiguation only, strictly separate.",{"iso3":506,"isoNumeric":507,"name":508,"region":27,"circumcisionRatePct":474,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":399,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":127,"medicalNecessity":71,"avgAge":509,"profileSources":510,"isFallback":40},"ISR","376","Israel","Day 8 (Jewish brit milah); childhood (Muslim minority)",[511,512,513,514],"Prevalence: ~91.7–92% of Israeli males circumcised (Morris et al. 2016, Population Health Metrics), near-universal among both the Jewish majority (brit milah) and the Arab/Muslim minority, including secular Jews. A modelled estimate, not a census.","Brit milah: Jewish boys are circumcised on the 8th day of life as the Abrahamic covenant (Genesis 17), traditionally by a mohel (ritual circumciser, \"need not be a physician\") outside the hospital/medical system (UNAIDS jc1360; My Jewish Learning).","Sex-education-gap score (M9 = 45, editorial composite, 0–100 where higher = larger gap): Israel has reasonable formal health education, but circumcision itself is a near-unquestioned identity default rather than an informed individual choice — a mid-range gap.","HIV context: low-prevalence — heterosexual HIV diagnosis ~0.46/100,000/yr (Chemtob et al., IJHPR 2015), far below France/Netherlands; ~6,579 cumulative cases 1981–2010 (Mor et al., BMJ Open 2013). Circumcision is religious/identity-based, NOT an HIV intervention (the causal HIV-reduction claim for developed countries was refuted).",{"iso3":516,"isoNumeric":517,"name":518,"region":180,"circumcisionRatePct":474,"adultPrevalencePct":519,"plhivPer1000":520,"newInfectionsPer1000":521,"onTreatmentPct":287,"childPrevalencePct":29,"hivYear":31,"hivSource":32,"epidemicGrowthPct":397,"sexEducationGapScore":522,"preventionContextScore":523,"policyEnvironmentScore":4,"stigmaIndex":524,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":525,"profileSources":526,"isFallback":40},"ETH","231","Ethiopia",0.9,4.8,0.06,60,50,55,"Orthodox-Christian: 8th day (infant); Muslim: childhood; ~66% before age 5 — mostly traditional/home (~82%), not clinical",[527,528,529,530],"Prevalence: near-universal ~91–92% (EDHS meta-analysis: 92% in 2011, 91.2% in 2016; Morris 2016 >90% band). The \"~99%\" figure in some tertiary sources is unverified and rejected. KEY HARM-RISK FACT: ~82% of circumcisions are TRADITIONAL (non-clinical), ~80% performed at home, only ~14–18% at health facilities; ~66% before age 5.","THE DISTINCTIVE ANGLE — the Ethiopian Orthodox Tewahedo Christian tradition: the largest single driver (Orthodox ~43% of the population), the Church circumcises male infants on the 8TH DAY after birth (the naming day), an Old-Testament-rooted custom (Genesis 17; Leviticus 12:3; commemorating Christ's own 8th-day circumcision, Luke 2:21; feast Gizret/Gezret, ~mid-January) that PREDATES European missionary Christianity — one of very few Christian traditions retaining infant male circumcision. Theological nuance: the Church frames baptism as the New-Testament fulfilment (doctrinally superseding circumcision) yet the custom persists near-universally. Being Orthodox was a strong statistical predictor of circumcision (AOR ~8.5 vs Protestants).","Other channels: ISLAMIC circumcision among the ~31–35% Muslim minority (childhood, not fixed to the 8th day; Muslim was the single strongest statistical predictor, AOR ~9.5). ETHNIC/REGIONAL variation: higher in Tigray/Amhara/Afar/Benishangul-Gumuz; lower \"cold spots\" in Gambella (~61%, the national outlier), parts of SNNPR/central Oromia/Addis Ababa, and Protestant-majority southern zones (e.g. Konso infant-circumcision only 24.9%). NB: Ethiopia ALSO has high female genital cutting — a SEPARATE practice with its own law, kept strictly distinct and never merged into these male-circ figures.","HIV: low-intensity concentrated epidemic — adult prevalence ~0.9% (concentrated urban ~2.9% vs rural ~0.4%), ~610,000 people living with HIV (2023), ~510k on ART (PEPFAR funds ~53% of the response). Because circumcision is already near-universal nationally, VMMC is NOT a general scale-up strategy — the ONLY VMMC-relevant context is GAMBELLA, the national HIV hotspot (~4.8% in 2016) which also has the lowest male-circumcision coverage (~61%). No general circ↔HIV protective relevance is implied. Sex-ed/other composite scores omitted.",{"iso3":532,"isoNumeric":533,"name":534,"region":180,"circumcisionRatePct":535,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":536,"profileSources":537,"isFallback":40},"SDN","729","Sudan",90,"Childhood — a Sunni (Maliki) Islamic rite (khitan/tahur); often performed on boys in early-to-mid childhood (a 2012 mass campaign had mean age ~5.7 years)",[538,539,540,541],"Prevalence: near-universal MALE circumcision by inference — Sudan is ~97% Muslim, and male circumcision (khitan/tahur) is accepted as an established Islamic rite across all schools (Maliki, dominant here, treats it as recommended sunnah; Shafi'i as obligatory wajib), so near-universality follows the religious-affiliation pattern Morris 2016 documents across Muslim-majority countries. DATA-QUALITY FLAG: Morris 2016's Sudan-SPECIFIC figure is an anomalously LOW 39.4% (vs Williams 2006 ~47%; within the WHO 2006 20–80% band) — internally inconsistent with a ~97%-Muslim population and Morris's own assumption that 99.9% of Muslim males are circumcised, implying a flawed/old survey input. We therefore treat male circumcision as near-universal and flag the 39.4% as an anomalous datapoint, NOT the true rate. (South Sudan is listed separately at 23.6% — no Sudan/South-Sudan conflation.)","THE DISTINCTIVE ANGLE — the SHARPEST male-circ/FGM disambiguation in the set: Sudan carries near-universal MALE circumcision AND one of the world's highest FEMALE genital-mutilation rates, side by side. The two are entirely separate practices and are kept rigorously distinct here — Islamic terminology itself distinguishes khitan (male circumcision) from khafd (the female practice). FGM is included ONLY as the required disambiguation and is never conflated with, or used as evidence about, male circumcision.","MALE practice / HARM: khitan/tahur is performed on boys in childhood, by traditional and medical operators; the only verified Sudanese MALE-circumcision harm series is a 2012 mass/collective campaign of 5,871 boys (aged 7 days to 17 years, mean ~5.7) circumcised by thermocautery under local anaesthesia, which reported LOW early-complication rates. No verified Sudanese male-circ DEATH or amputation series was located; all FGM cases and non-Sudanese cases are excluded.","HIV: Sudan has a low, concentrated epidemic; because male circumcision is already near-universal, VMMC (designed for low-circumcision, high-prevalence generalised settings) is irrelevant and no circumcision-HIV protective claim applies. (HIV specifics were not deeply re-verified in this burst; the existing indicator value is retained.) Sex-ed/other composite scores omitted.",{"iso3":543,"isoNumeric":544,"name":545,"region":92,"circumcisionRatePct":535,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"TKM","795","Turkmenistan",{"iso3":547,"isoNumeric":548,"name":549,"region":284,"circumcisionRatePct":535,"adultPrevalencePct":550,"plhivPer1000":9,"newInfectionsPer1000":29,"onTreatmentPct":551,"childPrevalencePct":286,"hivYear":69,"hivSource":32,"epidemicGrowthPct":552,"sexEducationGapScore":553,"preventionContextScore":306,"policyEnvironmentScore":10,"stigmaIndex":554,"legalStatus":33,"routineInfant":127,"medicalNecessity":71,"avgAge":555,"profileSources":556,"isFallback":40},"IDN","360","Indonesia",0.26,31,-8,78,62,"Childhood ~5–12, pre-puberty (Muslim sunat/khitan rite)",[557,558,559,560,561],"Prevalence: male circumcision (sunat/khitan) is near-universal in Indonesia (~90–93%) — Morris et al., \"Estimation of country-specific and global prevalence of male circumcision,\" Population Health Metrics 2016 (~93%); Bailey et al., AIDS & Behavior 2025 (\"nearly universal except in Papua\"). Notable exception: Papua, ~5% of ethnic Papuans.","Age/religion: performed in childhood, commonly ages 5–12 before puberty (akhil baligh), NOT infancy — a peer-reviewed Paediatrica Indonesiana cohort reported median age 10.5 (range 5–16). Framed as an Islamic obligation in the Shafi'i-dominant Indonesian context (khitan); globally the wajib-vs-sunnah question is debated.","Mass circumcision: large free \"sunatan/khitanan massal\" events are a documented charity/CSR/government phenomenon — e.g. Medan's \"Khitanan Massal 3000\" (29 Jun 2011) targeting 3,000 boys in a day (organised by Laziswa Muhammadiyah, UMSU, Medan City Health Office).","Sex-education-gap score (M9 = 78, editorial composite, 0–100 where higher = larger gap): Indonesia has limited, conservative formal sex education and strong religious normative pressure; near-universal circumcision is an unquestioned default — a large information gap.","HIV context: ~0.26% adult prevalence (2018); ~570,000 people living with HIV (UNAIDS Feb 2025); concentrated epidemic EXCEPT in Tanah Papua, where it is generalized (~2.3%) and the government has piloted VMMC per WHO/UNAIDS. Outside Papua, circumcision is religious/cultural, not an HIV intervention.",{"iso3":563,"isoNumeric":564,"name":565,"region":284,"circumcisionRatePct":535,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"BRN","096","Brunei",{"iso3":567,"isoNumeric":568,"name":569,"region":180,"circumcisionRatePct":570,"adultPrevalencePct":571,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":572,"profileSources":573,"isFallback":40},"BFA","854","Burkina Faso",88,0.6,"Childhood — high across faiths: Muslim khitan (Sunni Maliki) + non-Muslim/traditional circumcision among the largely Christian/traditional Mossi (largest group), animist Lobi, Bobo, Gurunsi etc.",[574,575,576,577],"Prevalence: very high — ~88.3% (Morris et al. 2016; DHS-grounded at 88.7% in 2010 and 90.4% in 2003 among males 15–49) — far above the ~37–39% global average. DISTINCTIVELY, this is NOT simply a Muslim-majority figure: Burkina Faso is religiously MIXED (~60% Muslim, ~25% Christian, ~15% traditional African religion), yet circumcision is near-universal ACROSS faiths — including the largely Christian/traditional Mossi (the largest ethnic group) and animist Lobi — so it functions as both a religious (Muslim khitan) AND a broad cultural/traditional norm, unlike the pure-Islamic near-universality of Senegal/Mali/Niger.","THE DISTINCTIVE ANGLE — near-universal circumcision that crosses the religious divide + the sharpest FGM-reduction contrast: where Senegal/Mali/Niger are near-universal because they are near-universally Muslim, Burkina is near-universal despite being only ~60% Muslim — the Mossi, Lobi, Bobo and Gurunsi circumcise as a traditional/cultural rite, and Muslims as khitan. Burkina is ALSO a celebrated FGM-REDUCTION SUCCESS for the FEMALE practice: it banned FGM in 1996 with strong enforcement (mobile community courts, multi-language outreach, judge/police training), and a regression-discontinuity analysis of DHS data confirms the law cut FGM — prevalence fell from 83.6% (1999) to 76.1% (2010). That female practice is kept STRICTLY separate from male circumcision.","PRACTICE / HARM: circumcision is performed both by traditional/non-medical circumcisers and increasingly medically; the harm record sits in the non-medical sector — a retrospective study at Souro Sanou University Hospital (Bobo-Dioulasso) documented 23 cases of non-medical-circumcision complications over five years (2014–2018), and a verified case at Yalgado Ouedraogo University Teaching Hospital (Ouagadougou) reimplanted the distal third of an 8-year-old's penis after an iatrogenic amputation during circumcision. These are referred surgical cases, not a population complication rate; non-Burkinabè (Mali/Niger/Ghana) cases are excluded.","HIV: a LOW and DECLINING epidemic — general-population prevalence fell from a 1997 peak of ~7.17% to ~0.6% by 2021/2023 (~94,000 people living with HIV in 2017), now concentrated among key populations (female sex workers and their networks) rather than generalised. Because circumcision is already near-universal AND Burkina is not among the East/Southern-African VMMC priority countries, VMMC is irrelevant and no circ↔HIV protective claim applies. Sex-ed/other composite scores omitted.",{"iso3":579,"isoNumeric":580,"name":581,"region":27,"circumcisionRatePct":582,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":583,"profileSources":584,"isFallback":40},"OMN","512","Oman",87.7,"7 (Islamic default)",[585,586,587],"Morris et al. 2016 PMC4772313 — modelled from Pew religious-demographic data; not a survey","Oman is majority Ibadhi Muslim (~75%); the Ibadhi school of Islam accepts khitan in line with other major schools; no Ibadhi-specific published position was found that contradicts this","~40% expatriate workforce depresses total-population figure from near-universal among Omani Muslim nationals",{"iso3":589,"isoNumeric":590,"name":591,"region":180,"circumcisionRatePct":303,"adultPrevalencePct":592,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":593,"profileSources":594,"isFallback":40},"GNQ","226","Equatorial Guinea",1,"initiation (age varies)",[595,596,597,598],"Morris et al. 2016 PMC4772313 — modelled at 87%; confirmed 3-0 from PMC4772313 primary. NOTE: the erratum (PMC4820865) as source for the EQ 87% figure was REFUTED (0-3) — cite PMC4772313 only","EQ is ~94% Christian yet 87% prevalence: explained by the Fang ethnic group (~80% of population) who circumcise as a Bantu ethnic initiation rite independent of Islamic practice","Bubi (island of Bioko, non-circumcising by tradition) are the minority population; Fang majority drives the high overall figure","Self-report caveat (Morris 2016): initiation circumcision may or may not be complete — applies to Fang initiation context",{"iso3":600,"isoNumeric":601,"name":602,"region":27,"circumcisionRatePct":603,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":583,"profileSources":604,"isFallback":40},"KWT","414","Kuwait",86.4,[605,606],"Morris et al. 2016 PMC4772313 — modelled; 86.4% reflects ~70% expat population including non-Muslim workers depressing the total from near-universal among Muslim nationals","Both Sunni and Shia Muslims (Shia ~20-30% of Kuwaiti nationals) circumcise; khitan is accepted across all major schools",{"iso3":608,"isoNumeric":609,"name":610,"region":180,"circumcisionRatePct":611,"adultPrevalencePct":571,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":612,"profileSources":613,"isFallback":40},"MLI","466","Mali",86,"Childhood — among the Bambara, boys pass through the N'tomo initiation society (~ages 6–13) BEFORE circumcision; a Sunni (Maliki) Islamic rite (khitan); traditional circumciser often of the numu (blacksmith) caste",[614,615,616,617],"Prevalence: near-universal ~86% (Morris et al. 2016), driven by the ~94% Muslim majority. NOTABLY, the Mali figure is SURVEY-BASED — Mali was one of the countries with both survey data and a religion-based prediction, showing a close match (86.0% survey vs 92.4% religion-predicted) — a stronger basis than the pure religion-estimate used for many countries. Circumcision is near-universal across the Bambara, Fula/Peul, Soninke, Dogon, Tuareg and other groups as a Sunni (Maliki) Islamic identity rite.","THE DISTINCTIVE ANGLE — Sahelian Mande-Muslim khitan with a documented INITIATION tradition + a numu-caste circumciser: among the Bambara (Bamana), the N'tomo society is the FIRST of six initiation societies (N'tomo, Komo, Nama, Kono, Chi Wara, Kore) and trains UNCIRCUMCISED boys (~6–13) — it PRECEDES circumcision, which marks the transition out of the N'tomo stage. In Mande societies the traditional circumciser is often of the numu (blacksmith) caste. The Maliki school dominant in West Africa treats male circumcision as an established, expected practice (its legal status ranging recommended-to-obligatory across the Sunni schools).","HARM: Mali has a real, country-specific harm series — a study at the Koutiala Reference Health Center (rural southern Mali) documented 21 cases of GLANS AMPUTATION during circumcision over a 5-year period (18 total amputations, 3 partial). This is a complications-selected surgical-referral series (not a population complication rate), but it documents the traditional-sector harm directly and is genuinely Malian (cases from Senegal/Nigeria/Burkina Faso are excluded).","HIV: a LOW and DECLINING general-population epidemic — about 1% (0.7–1.2) in 2012 falling to ~0.6% (0.4–0.8) by 2022 — concentrated among key populations (much higher among men who have sex with men, clients of sex workers, sex workers), within the wider western-and-central-Africa pattern (regional adult ~1.2%; key-population prevalence far higher). Because circumcision is already near-universal AND Mali is not among the 15 East/Southern-African VMMC priority countries, VMMC is irrelevant and no circ↔HIV protective claim applies. Sex-ed/other composite scores omitted.",{"iso3":619,"isoNumeric":620,"name":621,"region":284,"circumcisionRatePct":288,"adultPrevalencePct":169,"plhivPer1000":228,"newInfectionsPer1000":56,"onTreatmentPct":622,"childPrevalencePct":250,"hivYear":69,"hivSource":32,"epidemicGrowthPct":623,"sexEducationGapScore":624,"preventionContextScore":10,"policyEnvironmentScore":625,"stigmaIndex":522,"legalStatus":33,"routineInfant":127,"medicalNecessity":71,"avgAge":626,"profileSources":627,"isFallback":40},"PHL","608","Philippines",43,450,80,46,"Ages 9–14 (rite of passage)",[628,629],"Near-universal \"tuli\" (~91.7% modelled — Morris et al. 2016), usually ages 9–14 as a non-religious rite of passage; sustained by peer pressure / the \"supot\" stigma.","Not medically necessary: no medical body recommends routine circumcision; DOH promotes safe provision, not necessity.",{"iso3":631,"isoNumeric":632,"name":633,"region":180,"circumcisionRatePct":287,"adultPrevalencePct":634,"plhivPer1000":635,"newInfectionsPer1000":56,"onTreatmentPct":636,"childPrevalencePct":571,"hivYear":31,"hivSource":32,"epidemicGrowthPct":637,"sexEducationGapScore":524,"preventionContextScore":638,"policyEnvironmentScore":639,"stigmaIndex":640,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":641,"profileSources":642,"isFallback":40},"KEN","404","Kenya",4.3,25.4,89,-68,51,52,57,"Adolescence (traditional rite-of-passage, most groups) / childhood (Islamic, coast & NE) / VMMC any age (HIV program, Nyanza)",[643,644,645,646],"Prevalence: ~85% (KAIS 2007) rising to ~91% (2012) — very high. THE CENTRAL STORY is the LUO EXCEPTION: most Kenyan ethnic groups circumcise (Kikuyu, Kalenjin, Kisii/Gusii, Maasai, Bukusu traditionally; coastal/NE Muslims religiously), but the Luo of Nyanza traditionally do NOT (the historic rite of passage was removal of six lower teeth, now abandoned). In 2007, 66.7% of all uncircumcised Kenyan men were Luo. No verified 2022-KDHS ethnic-split figure — not asserted.","Three circumcision channels: (1) TRADITIONAL rite-of-passage — adolescent, manhood/ethnic identity, ceremonial cutting in \"seasons\" (school holidays); (2) ISLAMIC — coastal and north-eastern Muslim communities; (3) VMMC — the medical, HIV-prevention program. Circumcision is politically charged: the 2007–08 trope that an uncircumcised man is \"not fit to rule\" targeted the Luo (Raila Odinga) vs the circumcising Kikuyu (Kibaki).","VMMC program (the headline): launched Nov 2008 after the WHO/UNAIDS 2007 recommendation, concentrated in Nyanza (Luo homeland; pre-program coverage ~46%, HIV ~15%); task-shifted to trained nurses. Kenya circumcised >1.1 million males by ~2016 (~132% of target) — among the strongest of the ~15 WHO VMMC-priority countries. Luo circumcision rose from ~13–16% (2007) to ~47–53% (2012) and ~75–85% among young men by 2018.","HIV: generalized epidemic, adult prevalence ~4.3% (2023), down from a late-1990s peak near 10% (~75% fall in new infections 2010–2023), with the historic burden in Nyanza/Luo region (~15% vs ~5.6% national). Kenya is the one context with genuine RCT-backed circ-HIV evidence (Kisumu RCT, Bailey 2007, ~53–60% reduction) — BUT that benefit is female-to-male, heterosexual, adult-men only, and the scale-up raised documented voluntariness/consent concerns (esp. among adolescents). Sex-ed/other composite scores omitted.",{"iso3":648,"isoNumeric":649,"name":650,"region":180,"circumcisionRatePct":624,"adultPrevalencePct":651,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":652,"profileSources":653,"isFallback":40},"TCD","148","Chad",1.2,"Childhood (a Chadian harm series found mean age ~7.5 years, 61.9% aged 6–10) — Muslim khitan in the north + traditional/cultural circumcision among the Christian/traditional south (Sara), crossing religious lines",[654,655,656,657],"Prevalence: HIGH and crossing religious lines, though the precise figure is uncertain. Morris et al. 2016 gives 73.5%, but the authors themselves note this religion-PROXY method (summing Jewish+Muslim males × 99.9%) tends to UNDERESTIMATE real prevalence (\"reported MC prevalence generally exceeded religion-based predictions\") — it cannot count the non-Muslim/traditional circumcision among Chad's Christian/traditional (e.g. Sara) populations, so the true rate is likely higher/near-universal. (WHO 2006 estimated >80%; Williams 2006 64%.) THE DISTINCTIVE POINT: Chad is religiously MIXED (~55% Muslim north, ~40% Christian, plus traditional religion), yet male circumcision is high across BOTH — Muslim khitan in the north AND a traditional/cultural rite among the Sara, Arab, Kanembu and Toubou.","THE DISTINCTIVE ANGLE — a near-universal rite that crosses the Muslim/Christian divide (like Burkina Faso): high MC ecologically tracks Muslim-majority populations, but Chad's prevalence is high despite being religiously mixed, and Morris's own caveat (reported > religion-predicted) shows circumcision occurring among non-Muslim/traditional Chadians beyond what religion alone predicts. So in Chad circumcision functions as both Muslim khitan AND a broad traditional/cultural norm conferring acceptance \"into the community of men.\"","PRACTICE / HARM: circumcision is typically performed in childhood (a Chadian complication series found mean age 7.5±2 years, 61.9% aged 6–10) and substantially by TRADITIONAL (non-medical) practitioners. The verified harm comes from a single N'Djamena Mother & Child Hospital case series (31 cases, Jul 2011–May 2014) — ~61% following traditionally-performed circumcisions — documenting urethral fistula (10, 32%), meatal stenosis (8, 26%), 2 glans amputations and 1 penile amputation. CAVEAT: a referred COMPLICATION series (not a population rate), from a single low-prestige source — the figures describe harm cases, not the general circumcised population.","HIV: a generalised but low epidemic — ~1.2% adult prevalence (~120,000 people living with HIV), down from ~1.6% (2014–15). Because male circumcision is already near-universal AND Chad is not among the 15 WHO/UNAIDS VMMC priority countries (East/Southern Africa), VMMC is irrelevant and no circumcision-HIV protective claim applies. Sex-ed/other composite scores omitted.",{"iso3":659,"isoNumeric":660,"name":661,"region":284,"circumcisionRatePct":624,"adultPrevalencePct":56,"plhivPer1000":662,"newInfectionsPer1000":663,"onTreatmentPct":664,"childPrevalencePct":250,"hivYear":31,"hivSource":32,"epidemicGrowthPct":665,"sexEducationGapScore":486,"preventionContextScore":523,"policyEnvironmentScore":666,"stigmaIndex":664,"legalStatus":33,"routineInfant":127,"medicalNecessity":71,"avgAge":667,"profileSources":668,"isFallback":40},"MYS","458","Malaysia",2.4,0.13,58,-22,48,"Childhood ~6–12 (Malay-Muslim berkhatan rite; increasingly clinical)",[669,670,671,672,673],"Prevalence/ethnicity: male circumcision (berkhatan/bersunat) is near-universal among Malay-Muslims (constitutionally Malay=Muslim) and largely absent among the Chinese (Buddhist/Christian) and Indian (mostly Hindu) minorities, except Indian Muslims and some medical/hygiene adoption — so the national ~80% reflects Malaysia's ethnic composition. (The precise national % and minority-group figures were not pinned to a single sourced statistic in this pass; the split is well-established context.)","Age/culture: performed on Malay-Muslim boys ~6–12 (mode ~9 in a rural Kedah study; some as young as 4), as a pre-adolescent rite of passage — historically communal, with thousands circumcised in mass ceremonies during school holidays (Malaysiakini; Rashid et al., IeJSME 2009).","Medicalisation: increasingly clinical — group circumcisions performed by Medical Assistants under doctor supervision using disposable clamp devices (Schmitz et al., Tropical Doctor 2001, reported \"no major complications\" with the TaraKlamp in Malaysian pediatric use).","Clamp production: Malaysia manufactures circumcision clamps — the Tara KLamp (Dr. Gurcharan Singh / Taramedic Corp), the Ismail Clamp and Sunathrone (Malaysian MOH Health Technology Assessment).","HIV context: ~0.3% adult prevalence (UNAIDS); circumcision in Malaysia is religious/cultural, NOT an HIV intervention — WHO scopes VMMC to high-prevalence generalized epidemics in East/Southern Africa, and the 2024 UNAIDS Asia-Pacific report lists no VMMC/circumcision at all.",{"iso3":675,"isoNumeric":676,"name":677,"region":180,"circumcisionRatePct":624,"adultPrevalencePct":678,"plhivPer1000":679,"newInfectionsPer1000":519,"onTreatmentPct":680,"childPrevalencePct":681,"hivYear":69,"hivSource":32,"epidemicGrowthPct":682,"sexEducationGapScore":554,"preventionContextScore":4,"policyEnvironmentScore":523,"stigmaIndex":664,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":683,"profileSources":684,"isFallback":40},"TZA","834","Tanzania",4.5,25.2,71,0.5,-52,"Mixed by channel — Muslim religious circumcision in childhood; traditional jando rite on adolescents ~10–18 (ngariba circumciser, no anaesthesia/suturing); VMMC targets ages 10–34 but is heavily adolescent-skewed (70–78% aged 10–19)",[685,686,687,688],"Prevalence: national male circumcision rose from ~72% (2010–12 DHS/THMIS) to ~80% (2015–16) — one of only THREE sub-Saharan countries (with Kenya and Ethiopia) to reach the WHO 80% target in at least one survey, a rise driven by the WHO/PEPFAR VMMC scale-up layered onto strong pre-existing variation. HUGE regional/ethnic/religious range: coastal/eastern (traditionally-circumcising + Muslim) regions near-universal at 95–99%, vs historically LOW-circumcising inland \"cold spots\" — a northern Lake-zone cluster (Shinyanga, Geita, Mwanza, Kagera, Simiyu) and a southwestern cluster (Mbeya, Njombe, Rukwa, Katavi) — as low as 26–29%. (Those low figures are DATED ~2001 baselines that VMMC has since raised substantially, e.g. Shinyanga ~89% post-program — present-tense use of the old lows understates current prevalence.) Circumcision is far more prevalent among Muslims (rural Mwanza: 80.7% Muslims vs 43.3% Christians).","THE DISTINCTIVE ANGLE — THREE coexisting channels: (i) Muslim religious circumcision (khitan/tohara); (ii) the traditional JANDO rite-of-passage initiation, performed by a traditional circumciser (ngariba) on adolescents ~10–18 with \"neither anaesthesia nor suturing of the wound allowed\", where pain is deliberately ritualised and both the uncircumcised AND the medically-circumcised can be stigmatised (Wambura 2011, Kurya of Tarime/Mara; on Mafia Island a mila [customary] vs sunna [orthodox Islamic] distinction, with higher-status individuals rejecting mila as non-Islamic); and (iii) the medical VMMC program in the historically low-circumcising inland. In Tarime District 98.8% of surveyed males were circumcised (63.7% traditionally, 36.3% medically) — high prevalence driven by TRADITION, an exception within the otherwise low-circumcising Lake zone.","VMMC PROGRAM: Tanzania's WHO/PEPFAR program performed over ONE MILLION circumcisions (July 2010–Oct 2014) across 11 priority regions targeting ages 10–34, and is heavily ADOLESCENT-skewed — 70–78% of clients were aged 10–19 (one large series: 51.6% aged 10–14, 26.7% aged 15–19), the great majority minors. This makes the bodily-autonomy/MINOR-CONSENT caveat load-bearing: the RCT-backed protective benefit is real but specific (adult, female-to-male, heterosexual transmission), so circumcising boys whose stake in that benefit lies years away raises a voluntariness question. (Even in low-baseline rural Mwanza, MC had more than doubled to 40.6% by 2007/08 BEFORE formal campaigns, despite the dominant Sukuma traditionally NOT circumcising.)","HIV: a GENERALISED epidemic (~4–5% adult) — the genuine driver of VMMC. Observational data show HIV prevalence >50% higher among uncircumcised (5.2%) than circumcised (3.3%) men 15–49, and cold-spot males carried ~2.73× the HIV risk (2012). CRITICAL CAVEAT: these are CROSS-SECTIONAL/ECOLOGICAL associations CONFOUNDED by religion/ethnicity/region (Muslim/coastal Tanzanians both circumcise more AND have lower HIV) — NOT the randomized-trial evidence, and not to be read as causal. The ~60% protective effect comes from the African RCTs and applies only to adult female-to-male heterosexual transmission. Sex-ed/other composite scores omitted.",{"iso3":690,"isoNumeric":691,"name":692,"region":27,"circumcisionRatePct":693,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":583,"profileSources":694,"isFallback":40},"QAT","634","Qatar",77.5,[585,695],"Qatar nationals (~10% of residents) are Muslim and circumcise near-universally; ~90% expat workforce (South Asian, Southeast Asian, African) depresses the total-population figure to 77.5%",{"iso3":697,"isoNumeric":698,"name":699,"region":27,"circumcisionRatePct":700,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":34,"medicalNecessity":34,"avgAge":583,"profileSources":701,"isFallback":40},"ARE","784","United Arab Emirates",76,[585,702],"Expat note: ~90% of UAE residents are non-national; Emirati nationals (Muslim ~100%) circumcise near-universally; the 76% total-population figure reflects non-Muslim South/Southeast Asian workforce",{"iso3":704,"isoNumeric":705,"name":706,"region":180,"circumcisionRatePct":707,"adultPrevalencePct":708,"plhivPer1000":709,"newInfectionsPer1000":710,"onTreatmentPct":474,"childPrevalencePct":275,"hivYear":69,"hivSource":32,"epidemicGrowthPct":711,"sexEducationGapScore":524,"preventionContextScore":524,"policyEnvironmentScore":712,"stigmaIndex":522,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":713,"profileSources":714,"isFallback":40},"LSO","426","Lesotho",72,23,111,3.1,-45,54,"LEBOLLO INITIATION (letsoalloa / 'going to the mountain'): boys aged ~14-18, months of mountain seclusion, circumcision by ngaka ya setso (traditional initiator); uncircumcised men called lekhokhono ('dog') — severe Basotho social stigma; NOT optional for Basotho men. By 2014, only 31.2% of men 15-29 reported circumcision by medical officer — traditional lebollo remains dominant uptake mechanism. VMMC operates in an already 72% circumcised population.",[715,716,717,718],"Prevalence trajectory: 48.1% (2004 DHS) → 52.0% (2009 DHS) → 72.2% (2014 DHS, men aged 15-59). By 2014, 31.2% of men aged 15-29 reported circumcision by a medical officer — VMMC scale-up concentrated in younger cohorts. Source: Cambridge Journal of Biosocial Science (peer-reviewed; 2-1 adversarial verification). Multiple alternative prevalence claims were refuted: 5.3% (2009), 55% national, 91.42% traditional vs 8.57% medical — all excluded. High baseline driven by lebollo initiation tradition; Lesotho is atypical among VMMC priority countries in having a substantial pre-VMMC circumcision prevalence.","Lebollo initiation (also letsoalloa, sekoele, male initiation school): The Basotho traditional male initiation school involves months of seclusion in the mountains, with circumcision performed by a ngaka ya setso (traditional initiator/healer). Boys aged approximately 14-18 enter as a cohort; the ceremony transmits social values, intergenerational guidance, and communal identity alongside the circumcision procedure — structurally identical to the resistance dynamics documented in Malawi's Yao jando (PMC8555288). Uncircumcised men are called lekhokhono (Sesotho: 'dog') and face severe social stigma; participation in marriage and community life may be affected. The practice is effectively obligatory for Basotho men. Traditional circumcision dominates uptake: by 2014, only 31.2% of men 15-29 were circumcised by medical officer, implying the majority of the 72.2% were traditionally circumcised.","VMMC and tension: Lesotho is one of the 15 WHO/UNAIDS VMMC priority countries. VMMC operates in an already substantially circumcised population (72% by 2014), creating a different challenge than low-baseline countries like Eswatini. Cultural resistance to VMMC parallels Malawi's jando dynamics: the lebollo transmits identity and values inseparable from the circumcision event, which clinical VMMC cannot replicate. Lesotho's government has pursued regulation of initiation schools (World Vision International secondary source confirms child protection discussions; no statute confirmed). PEPFAR-funded VMMC targets men not yet circumcised by lebollo — a shrinking pool as traditional coverage has climbed to 72%.","Legal and HIV: No Lesotho statute specifically regulating or prohibiting non-therapeutic male circumcision confirmed — UNREGULATED (absence of evidence for male circumcision; government is exploring regulation of initiation schools per secondary sources). FGM is a completely separate female issue — strictly separate, never conflated. HIV adult prevalence ~23% (UNAIDS 2024), the second highest in the world after Eswatini. Lesotho is one of 15 WHO/UNAIDS VMMC priority countries. VMMC is one component of combination HIV prevention — no circ↔HIV causal claim. PHIA pooled data (2015-17, 8 countries including Lesotho): statistically significant association only in medically circumcised men aged 15-34; no protective association in 35-59 (reversed, nonsignificant). No Lesotho-specific lebollo harm cases verified — honest gap; Eastern Cape SA (OR Tambo June 2013) is the documented regional comparator.",{"iso3":720,"isoNumeric":721,"name":722,"region":723,"circumcisionRatePct":680,"adultPrevalencePct":304,"plhivPer1000":724,"newInfectionsPer1000":29,"onTreatmentPct":291,"childPrevalencePct":14,"hivYear":229,"hivSource":725,"epidemicGrowthPct":726,"sexEducationGapScore":664,"preventionContextScore":486,"policyEnvironmentScore":126,"stigmaIndex":727,"legalStatus":33,"routineInfant":127,"medicalNecessity":71,"avgAge":728,"profileSources":729,"isFallback":40},"USA","840","United States","North America",3.6,"National",-12,40,"Newborn (in hospital)",[730,731],"Routine neonatal circumcision common (~71% adult males): CDC / NHANES; inpatient newborn rate ~49% (2022, Johns Hopkins/JAMA Pediatrics).","Not medically necessary: AAP 2012 policy — benefits \"not great enough\" to recommend routine circumcision.",{"iso3":733,"isoNumeric":734,"name":735,"region":180,"circumcisionRatePct":126,"adultPrevalencePct":736,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":195,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":182,"medicalNecessity":71,"avgAge":737,"profileSources":738,"isFallback":40},"COG","178","Republic of the Congo",3.3,"Adolescent/youth initiation (Bakouélé rite marks transition to manhood); no fixed universal age",[739,740,741],"Prevalence: ~70% (2005 DHS nationally representative survey, Republic of Congo; cited in Morris et al. 2016, PMC4772313). The occasionally cited 75% figure is not confirmed by this primary source. This high figure is driven almost entirely by traditional ethnic rite, not Islamic mandate — only ~2% of the population is Muslim, while ~87% is Christian. Male circumcision in the Republic of Congo is a traditional cultural practice crossing religious and ethnic lines, with the Bakouélé people practicing it as a painful initiation rite into manhood. Attribution guard: all data here is for the REPUBLIC OF THE CONGO (Brazzaville, COG/cg), not the DR Congo (Kinshasa, COD/cd).","The Republic of Congo is NOT a WHO/PEPFAR Voluntary Medical Male Circumcision (VMMC) priority country. All 14 VMMC priority countries are in Eastern and Southern Africa. Brazzaville hosted a WHO Regional Office for Africa expert consultation on male circumcision and HIV prevention on 2–4 April 2008 — as host location of the WHO AFRO headquarters, not as an implementation target. Adult HIV prevalence is approximately 3.3% (UNAIDS/CIA World Factbook 2020). Blood donor surveillance at Brazzaville's National Center of Blood Transfusion (520,823 tests) recorded a declining trend from 3.6% (2016) to 2.1% (2022). No circumcision↔HIV protective claim is made.","Harm: CHU de Brazzaville Pediatric Surgery Department documented 20 circumcision accident cases (0.37% hospital frequency) over five years (2013–2018), including hemorrhage (40%), incomplete circumcision (20%), complete glans amputation (15%), and one death from septic shock (5% case fatality rate). Published 2024 in Health Sciences and Disease (Université Marien Ngouabi, Brazzaville). Female genital mutilation/cutting is kept strictly separate from male circumcision and is not conflated here.",{"iso3":743,"isoNumeric":744,"name":745,"region":180,"circumcisionRatePct":307,"adultPrevalencePct":724,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":746,"profileSources":747,"isFallback":40},"CAF","140","Central African Republic","CONFLICT-HEALTHCARE-COLLAPSE CONTEXT: 126 documented attacks on healthcare facilities 2016-2020 in Ouaka/Haute-Kotto/Vakaga (PMC11351750; 3-0); MSF suspended activities (July 2021; 3-0). Traditional and religious circumcision primary in conflict zones. ETHNIC PROFILE: Muslim communities (~15-20%; Fulani/Mbororo/Hausa north) practice circumcision. Baka Pygmy initiation: NO circumcision (REFUTED 0-3). Banda/Gbaya/Sara/Azande: NOT confirmed — honest gap. Christian majority (~80%): varying practice undocumented. PREVALENCE: 63.0% (Morris 2016, MODELED; WHO range 20-80% reflects data uncertainty; conflict precludes updated measurement).",[748,749,750,751],"Prevalence: 63.0% (Morris et al. 2016, PMC4772313, Table 1; MODELED using likely religious-proportion data — no nationally representative DHS or MICS survey specifically measuring male circumcision in CAR was identified). KEY CAVEAT: the WHO's own range for CAR is 20-80%, indicating very low data confidence; the precision of '63.0%' is overstated given the absence of a direct survey. This figure is now over a decade old and the ongoing armed conflict since 2013 has made any contemporary ground-truth measurement impossible. Williams et al. 2006 estimated 67% and the directional comparison (moderate prevalence, substantially lower than near-universal West and East African Muslim-majority countries) is well-supported. MEDIUM confidence.","Cultural and religious context: CAR is majority Christian (~80%, mostly Catholic and Protestant) with a Muslim minority (~15-20% of population) concentrated in the north (Fulani/Mbororo/Hausa pastoralists). Circumcision is practiced as a religious rite by Muslim communities. Circumcision among CAR's Christian majority varies and is not uniformly documented in verified claims. In Central Africa generally, circumcision is practiced as part of ethnic rituals or local custom rather than primarily for religious reasons (Wikipedia Circumcision in Africa). ETHNIC GAPS: Specific circumcision practices among the Banda, Gbaya, Sara, Azande, and other major CAR ethnic groups were NOT confirmed in verified claims — honest evidence gap. BAKA PYGMY: their male initiation ('Male Initiation Rite to the Spirit of the Forest') does NOT include circumcision — confirmed REFUTED 0-3 (pygmies.org Baka article; no circumcision mentioned). BAKOYA PYGMIES: do not themselves practice circumcision but participate as invited musicians at Bakota (Bantu neighbour) circumcision ceremonies — REFUTED 0-3 for the claim they DO circumcise.","CONFLICT-HEALTHCARE CONTEXT: The Central African Republic has been in armed conflict since 2013 (Seleka/Anti-Balaka; LRA [Lord's Resistance Army] presence in eastern prefectures; MINUSCA UN peacekeeping mission since 2014; APPR 2019 peace agreement with partial implementation). This conflict has caused a documented collapse of healthcare infrastructure. PMC11351750 (Conflict and Health, 2024 peer-reviewed): 126 documented attacks on healthcare facilities, staff, or patients in Ouaka, Haute-Kotto, and Vakaga prefectures between 2016 and 2020. Attack types include killings, physical and sexual assault, abductions, arson, grenade shelling, pillaging, facility occupations, and verbal threats. Documented consequences include prolonged and permanent facility closures, missing HIV medication doses, suspended vaccination campaigns, eliminated surgical capabilities, and disrupted malnutrition treatment. MSF officially suspended medical activities multiple times (MSF USA July 2021): suspended lifesaving care, supervising health center staff, supplying drugs, and transporting patients following repeated attacks. 3-0 verified for both the 126-attack finding and the MSF suspension.","VMMC, HIV, legal context: CAR is NOT among the 15 WHO VMMC priority countries (all 15 = Eastern and Southern Africa; CAR = Central Africa; 3-0 confirmed). HIV adult prevalence: approximately 3.6% per UNAIDS data — a generalized epidemic representing a significant burden among Central African countries. Armed conflict affects HIV treatment continuity (missing ARV doses documented in the healthcare-under-attack literature). No CAR statute specifically addressing male circumcision was identified — UNREGULATED. FGM in CAR is practiced among some specific communities — COMPLETELY SEPARATE from male circumcision. 0 circumcision-specific harm cases verified — honest evidence gap; the general healthcare collapse creates context for potential unmonitored traditional circumcision harm, but no specific cases were documented in verified research.",{"iso3":753,"isoNumeric":754,"name":755,"region":180,"circumcisionRatePct":554,"adultPrevalencePct":519,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":756,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":757,"profileSources":758,"isFallback":40},"BDI","108","Burundi","WHO/UNAIDS","HONEST OPEN QUESTION: Burundi's 61.7% circumcision (DHS 2012) in a Catholic-majority country (~65-80% Christian, mostly Catholic) is not fully explained by confirmed research. Muslim Burundians (~3-10%): circumcision as religious practice (accounts for some of the 61.7%). Traditional Rundi initiation involving circumcision: NOT confirmed in indexed peer-reviewed sources — umuganura/ubushingantahe/Intore have no confirmed circumcision connection. Hutu/Tutsi/Twa: no differentiated ethnic circumcision tradition confirmed. The majority of the 61.7% is an honest evidence gap. DHS 2012 figure is 12+ years old and may not reflect current conditions.",[759,760,761,762],"Prevalence: 61.7% (DHS 2012, Table 14.13, as cited in Morris et al. 2016, PMC4772313). This is the best-evidenced estimate for Burundi and is based on a nationally representative DHS survey — a DIRECT measurement, not a model. The ~90% figure sometimes cited in informal sources has no credible primary source identified in verified research; the 61.7% DHS-backed figure is the correct reference. MEDIUM confidence overall: the DHS 2012 survey is over a decade old and may not reflect current conditions given regional circumcision trends and VMMC spread since 2012. The erratum to Morris 2016 (PMC4820865) is presumed not to revise Burundi's figure based on consistent methodology. 2-1 verified (one agent noted the year-recency concern).","Cultural drivers — HONEST OPEN QUESTION: Burundi is a predominantly Catholic country (~65-80% Christian, mostly Catholic) with a Muslim minority (~3-10%). At 61.7% circumcision, the majority of Burundian men are circumcised, yet: (1) Catholic Christianity does not require circumcision; (2) no specific Rundi traditional initiation rite involving circumcision was confirmed in indexed peer-reviewed English-language sources (umuganura = harvest festival; ubushingantahe = council of elders; Intore = traditional warrior/dance — none have confirmed circumcision connections); (3) Muslim practice (~3-10% of population) explains some but not most of the 61.7%. The majority drivers of Burundi's circumcision prevalence at 61.7% in a Catholic-majority country are an honest open question. It is possible that a widespread but poorly-documented Kirundi/Rundi traditional practice exists that has not been captured in indexed English-language research, or that Burundi's circumcision reflects a regional Sub-Saharan Central African cultural pattern (similar to DRC's 97.2% in a majority-Christian country). This is genuinely unresolved.","VMMC and HIV: Burundi is NOT among the 15 WHO/UNAIDS/PEPFAR VMMC priority countries (3-0 confirmed across PMC8454680, PMC11002756, CDC MMWR 2017). Epidemiologically consistent: Burundi's HIV prevalence (~0.9%) and relatively high existing circumcision (~62%) do not meet the VMMC prioritisation threshold criteria. Burundi achieved the 90-90-90 UNAIDS HIV targets by 2020 (89% of PLHIV knew their status, 98% on ART, 90% viral suppression) and is targeting 95-95-95 by 2025. This is a well-managed epidemic at low baseline prevalence. No PEPFAR VMMC programme for Burundi confirmed.","Legal context: No Burundi statute specifically regulating non-therapeutic male circumcision confirmed — UNREGULATED (absence-of-evidence). No verified traditional or medical circumcision harm cases for Burundi identified in confirmed claims — honest evidence gap. FGM in Burundi is practiced among some specific border communities and is a completely separate female issue, strictly separate from male circumcision matters.",{"iso3":764,"isoNumeric":765,"name":766,"region":767,"circumcisionRatePct":522,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"PRI","630","Puerto Rico","Latin America",{"iso3":769,"isoNumeric":770,"name":771,"region":284,"circumcisionRatePct":522,"adultPrevalencePct":772,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":725,"epidemicGrowthPct":30,"sexEducationGapScore":522,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":774,"profileSources":775,"isFallback":40},"KOR","410","South Korea",0.17,"rare","Older boys ~age 11–12 (post-Korean-War legacy; rapidly declining)",[776,777,778,779,780],"History/prevalence/age: Pang MG & Kim DS, \"Extraordinarily high rates of male circumcision in South Korea: history and underlying causes,\" BJU International 2002;89:48–54. Circumcision was essentially absent before 1945 (1 of 1,400+ men born pre-1945), spread under post-Korean-War American influence but never became neonatal; overall national rate ~60%, >90% among high-school boys, \u003C10% among men over 70; prevalent age 9–14 (~12).","Parental attitudes/age: Oh SJ et al., \"Knowledge and attitudes of Korean parents towards their son's circumcision: a nationwide questionnaire study,\" BJU International 2002;89:426–432 (n=4,183 parents) — circumcision \"most common in boys when aged 11 years,\" with no religious or medical basis.","Decline: Kim DS, Koo SA & Pang MG, \"Decline in male circumcision in South Korea,\" BMC Public Health 2012;12:1067 — among males 14–29 the rate fell from 86.3% (2002) to 75.8% (2009–2011); ages 14–16 fell 88.4%→56.4%, attributed to internet/media information available from ~1999.","Sex-education-gap score (M9 = 60, editorial composite, 0–100 where higher = larger gap): South Korea has formal school sex education but it is widely criticised as conservative, abstinence-leaning and inconsistently delivered; circumcision itself was historically taught/assumed as normative. Mid-range composite reflecting decent formal coverage but a real information gap that the documented post-internet decline itself illustrates.","HIV context: 2023 national HIV seroprevalence ~0.165% (peer-reviewed Korean surveillance, Scientific Reports 2024); a low-prevalence, concentrated epidemic. UNAIDS does not publish a modelled adult-prevalence rate for Korea, so this is national surveillance, not a UNAIDS estimate.",{"iso3":782,"isoNumeric":783,"name":784,"region":27,"circumcisionRatePct":522,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":396,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":785,"profileSources":786,"isFallback":40},"LBN","422","Lebanon","Childhood — Muslim (Sunni + Shia) khitan/tahara as a religious identity rite (Druze also practise it culturally); the large Christian population is largely intact",[787,788,789,790],"Prevalence: Morris et al. 2016 estimate Lebanon at 59.7% — by far the LOWEST male-circumcision rate in the Arab world, more than 33 points below every Muslim-majority neighbour (Syria 92.8%, Jordan 98.8%, Egypt 94.7%, Saudi Arabia 97.1%, Iraq 98.9%, Iran 99.7%). The reason is demographic: Lebanon has the largest Christian (non-circumcising) population of any Arab country — roughly 30% Christian, predominantly Maronite Catholics — alongside ~69% Muslim (Sunni + Shia) and ~5.5% Druze. Circumcision tracks the Muslim + Druze share; the large Christian population is largely intact. FGM is essentially absent in Lebanon and is never conflated here.","THE DISTINCTIVE ANGLE — Lebanon is the Arab world's cleanest RELIGIOUS-SPLIT natural experiment (the inverse of Côte d'Ivoire, where a similar split leaves the rate near-universal). The 59.7% is a direct OUTPUT of Morris's religion-based imputation method: where survey data were absent, prevalence was estimated as the Muslim+Jewish male share × 99.9% (assuming ~none of others are circumcised). Lebanon's Muslim share (~56-60%) × 99.9% ≈ 59.7% — a population-proportion figure, NOT a national survey value (Lebanon's last official census was 1932). Muslims (Sunni + Shia) practise khitan/tahara as a religious identity rite; Druze practise it as a cultural custom (not a religious mandate, with some abstaining).","Medicalisation: Lebanon has a strong, largely private health system, and circumcision is performed predominantly in a medical/hospital setting; a Lebanese academic-surgical literature exists, anchored at the American University of Beirut Medical Center (AUBMC) Division of Urology (e.g. Labban et al. 2020, a best-evidence review of neonatal pain control). The only Lebanon-specific empirical prevalence data point is a 2025 Research Square preprint (KAP study, n=174, mostly 18-21 urban university students, no religious breakdown) reporting 36.2% sample prevalence — useful as corroborating context, but NOT a national estimate (the national figure remains Morris's 59.7%).","HIV: Lebanon's epidemic is low-level (\u003C0.1% general population) but CONCENTRATED and male/MSM-driven — HIV among men who have sex with men rose sharply from 1.2% (2008) and 1.5% (2012) to ~12.3-12.6% (2014-15) and ~12.0% (2018); a large Beirut clinic series (2,238 MSM, 2015-2018) found 5.6%; over 90% of new diagnoses are in men. The wider MENA region was, for 2020-22, one of the few world regions with rising HIV incidence, concentrated in key populations. Circumcision is NOT a VMMC intervention in Lebanon — the country is a religious-split natural contrast, not an HIV-prevention context, and NO circumcision↔HIV protective claim is made.",{"iso3":792,"isoNumeric":793,"name":794,"region":180,"circumcisionRatePct":664,"adultPrevalencePct":9,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":795,"profileSources":796,"isFallback":40},"AGO","024","Angola","TRADITIONAL: Chokwe (mukanda, ages ~8-15, bush enclosure away from village, 'couple of months to a year', vilombola caretakers; NE/central Angola + SW DRC + NW Zambia); Luvale (mukanda, boys aged 8-12, start of dry season, isolated bush camp 1-3 months; Moxico Province Angola + NW Zambia); Mbunda (Mukanda, bush camp 3-6 months historically / 6-10 weeks modern; Moxico + Cuando Cubango + western Zambia + DRC border). All three verified for Angola's eastern regions. UNVERIFIED for Angola's other major ethnic groups: Ovimbundu (central highlands), Ambundu (Luanda), BaKongo (north), Nyaneka-Khumbi/Herero-related (SW) — honest evidence gaps.",[797,798,799,800],"Prevalence: 57.5% (Morris et al. 2016, PMC4772313, Table 1). The published erratum (PMC4820865) corrected six other countries but left Angola unchanged — 57.5% is the final figure. Critically, this is a MODELED estimate, not a direct survey measurement. The Morris 2016 methodology explicitly uses ethnic and religious composition proxies for countries lacking DHS coverage — Angola falls in this category because the civil war (1975-2002) precluded representative fieldwork for nearly three decades. No Angola DHS survey measuring male circumcision has been identified in the verified research literature. The figure could differ significantly by region — eastern circumcising groups (Chokwe/Luvale/Mbunda) vs potentially lower-prevalence groups in central/western/southern Angola. MEDIUM confidence overall.","Traditional circumcision practices (VERIFIED): (1) CHOKWE — mukanda male circumcision initiation rite: boys confined in a bush enclosure away from the village for 'a couple of months to a year', under the supervision of vilombola caretakers. The Chokwe are distributed across NE/central Angola (particularly Moxico, Lunda Norte, Lunda Sul), southwestern DRC (Kwilu/Kwango corridor), and northwestern Zambia. Ages cited 8-15 across sources, with regional variation. Circumcision is the central initiatory act. 3-0 verified for the rite; 2-1 for 'Kwilu/Kwango' as the DRC portion (geographic precision). (2) LUVALE — mukanda: boys aged 8-12, beginning of the dry season, isolated bush camps (1-3 months). Located in Moxico Province (Angola) and North-Western Province (Zambia). UNESCO Makishi Masquerade intangible heritage inscription covers Luvale mukanda. 3-0 verified. (3) MBUNDA — Mukanda: boys live 3-6 months at a bush camp (historical/traditional; some sources cite 6-10 weeks for modern practice). Located in Moxico + Cuando Cubango (Angola), western Zambia, northern Namibia border, DRC border. 2-1 verified on duration; 3-0 for the rite's existence. All three sources are secondary (Wikipedia, ethnography blogs, UNESCO) — no peer-reviewed primary ethnographic publications retrieved for Angola specifically.","HONEST ETHNIC GAPS: The circumcision status of Angola's other major ethnic groups was NOT confirmed in this research pass: Ovimbundu (Umbundu-speaking, central highlands; largest single ethnic group ~25%); Ambundu (Luanda area; ~25%); BaKongo/Kikongo-speaking (northwest; broadly associated with circumcision across the Kongo region but no Angola-specific rite documentation retrieved); Nyaneka-Khumbi and Herero-related groups (southwest). These represent the majority of Angola's population and are honest evidence gaps — absence of confirmed research is not a claim of non-circumcision.","VMMC and legal context: Angola is NOT one of the 15 WHO/UNAIDS/PEPFAR VMMC priority countries, all of which are in Eastern and Southern Africa (ESA). Angola is geographically in Central-Western Africa (outside the ESA corridor). No PEPFAR or CDC VMMC programme for Angola was confirmed in the verified research. No Angola statute specifically regulating non-therapeutic male circumcision was confirmed — UNREGULATED (absence-of-evidence). HIV context: specific prevalence figure unverified (UNAIDS 2024 PDF >10MB; 2.2% adult / ~280,000 PLHIV claims refuted 0-3 — likely outdated rather than wrong, but not confirmed from 2024 source). Refer to UNAIDS Angola country page for current estimates. FGM is a completely separate female issue, strictly separate, never conflated. No traditional or medical circumcision harm cases verified for Angola — honest evidence gap.",{"iso3":802,"isoNumeric":803,"name":804,"region":92,"circumcisionRatePct":805,"adultPrevalencePct":56,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":70,"medicalNecessity":71,"avgAge":806,"profileSources":807,"isFallback":40},"KAZ","398","Kazakhstan",56,"Childhood (odd-numbered age ~3–9, often 5–7) — Islamic rite (sünnet); historically by a mullah, now usually a surgeon",[808,809,810,811],"Prevalence: ~56.4% (Morris et al. 2016) — but this is a MODELED estimate from religious demography (the method assumes 99.9% of Muslim males and no non-Muslim males are circumcised); there is NO national Kazakh circumcision survey. It is the LOWEST of the six Central Asian republics (the others exceed ~80–93%) because of Kazakhstan's large Slavic, non-circumcising population. Present any number as an estimate (\"≈ the Muslim share, mid-50s to ~70%\"), not measured. Refined the indicator from 70 to ~56.","THE KEY DISTINCTION: near-universal among Muslim Kazakhs and other Turkic Muslims (Uzbeks, Uyghurs, Tatars), near-ZERO among the large Slavic/Russian-Orthodox minority — so the national rate essentially tracks the Muslim share (2021 census ~69% Muslim, ~17% Christian). The ~56% sits just below the Muslim share, consistent with incomplete uptake among secularised/Russified urban Kazakhs.","THE REVIVAL CASE: male circumcision (sünnet / сүндет) is the Islamic rite among Muslim Kazakhs. Suppressed under 70 years of Soviet state atheism, it survived as a persistent life-cycle ritual (alongside Muslim burial/naming customs) and REVIVED strongly after 1991 independence — in a constitutionally secular state that gives Islam no special status. It is celebrated with the SÜNDET-TOY feast (\"equal to a wedding\"), performed at an odd-numbered age (~3–9, often 5–7), historically by a mullah and now typically by a surgeon. Treated neutrally as established religious custom returning in a post-atheist state.","HIV: low general prevalence (~0.3%), but a concentrated, rising, INJECTION-DRIVEN epidemic (Eastern Europe & Central Asia is the world region where HIV is still rising) — concentrated in key populations (PWID ~8.3%, MSM ~3–7%, prisoners, sex workers). The defining iatrogenic harm event is the 2006 SHYMKENT nosocomial pediatric outbreak (~150 children infected via contaminated transfusions/reused syringes) — NOT circumcision. Kazakhstan is not a WHO VMMC country and circumcision plays no role in its HIV picture. FGM is not a Kazakh practice. Sex-ed/other composite scores omitted.",{"iso3":813,"isoNumeric":814,"name":815,"region":180,"circumcisionRatePct":816,"adultPrevalencePct":13,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":217,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":498,"medicalNecessity":71,"avgAge":817,"profileSources":818,"isFallback":40},"RWA","646","Rwanda",53,"Adult/adolescent voluntary (VMMC targets males 15–49 for HIV prevention); no infant tradition; only Abungura/Bakiga clan circumcised ~age 11 traditionally",[819,820,821,822],"Prevalence: 52.5% (Rwanda Demographic and Health Survey 2019–20, RDHS, nationally representative, n=15,965 men aged 15–59, 95% CI 51.3–53.7). Historical trajectory: 13.3% (DHS 2010, pre-VMMC baseline) → 27.8% (DHS 2014–15) → 52.5% (RDHS 2019–20). This near-quadrupling reflects Rwanda's VMMC scale-up, not a shift in cultural practice. Rwanda was historically a non-circumcising majority society (Hutu and Tutsi populations); the 2010 baseline of 13.3% reflected largely Muslim men and the Abungura/Abahitira clan of the Bakiga people. Female genital mutilation is criminalised in Rwanda (Organic Law 59/2008) and is strictly separate from VMMC.","VMMC scale-up: Rwanda is one of 14 WHO/UNAIDS priority countries designated in 2007 for VMMC scale-up, selected on evidence of a generalised HIV epidemic with prevalence below 80% among adult males. President Kagame personally promoted VMMC and the military ran a highly publicised voluntary circumcision campaign from 2011. Rwanda conducted 569,172 PEPFAR-supported VMMCs during 2017–2021, consistently exceeding annual targets, achieving an overall target-attainment rate of 107%. Rwanda led all 13 PEPFAR-supported VMMC countries in use of WHO-prequalified devices, with 19.0% of procedures using PrePex or other non-surgical devices (compared to 9.7% across all PEPFAR VMMC countries).","HIV and attribution: Rwanda achieved approximately 84–98–90 on the UNAIDS 90-90-90 cascade targets by 2019, with ~210,200 PLHIV and an annual incidence of approximately 0.08% (~5,400 new infections/year, RPHIA 2018–19). Adult prevalence is ~3.0% (women 3.7%, men 2.2%; urban 4.8%, rural 2.5%; Kigali 4.3%). Isolating VMMC's independent contribution to epidemic control from ART access, condom use, testing scale-up, and behaviour change is methodologically challenging. VMMC is one component of Rwanda's comprehensive HIV prevention strategy. No circumcision↔HIV causal claim is made or implied.","Harm: The 2011–12 PrePex clinical study at Rwanda Military Hospital documented a 4.7% adverse event rate (27/570 cases), comprising diffuse oedema (4), bleeding (4), wound infection (5), productive exudate (3), and 11 other events; no fatalities in this cohort. A Wikipedia-sourced claim of VMMC fatalities (denied by the Rwandan Ministry of Health) could not be corroborated in peer-reviewed literature and is not included. Traditional Bakiga circumcision (Abungura/Abahitira clan only, ~age 11) is documented ethnographically; no verified harm series located.",{"iso3":824,"isoNumeric":825,"name":826,"region":284,"circumcisionRatePct":523,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"VUT","548","Vanuatu",{"iso3":828,"isoNumeric":829,"name":830,"region":284,"circumcisionRatePct":523,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"FJI","242","Fiji",{"iso3":832,"isoNumeric":833,"name":834,"region":180,"circumcisionRatePct":666,"adultPrevalencePct":835,"plhivPer1000":836,"newInfectionsPer1000":837,"onTreatmentPct":553,"childPrevalencePct":422,"hivYear":69,"hivSource":32,"epidemicGrowthPct":552,"sexEducationGapScore":838,"preventionContextScore":399,"policyEnvironmentScore":666,"stigmaIndex":522,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":839,"profileSources":840,"isFallback":40},"MOZ","508","Mozambique",12.6,71.4,5.6,65,"NORTH (Yao Muslim communities — Niassa/Cabo Delgado/Nampula): traditional jando initiation, ages 10–14, conducted July–late September in bush seclusion camps. SOUTH (7 priority provinces — Maputo City/Province/Gaza/Zambezia/Manica/Tete/Sofala): VMMC programme targets ages 10–49, shifting toward adolescents (51.5% of Mozambique VMMC clients under age 15 as of 2017–2021, consistent with the jando starting-age tradition). National figure (48%, 2011 DHS) masks this regional split.",[841,842,843,844,845],"Prevalence: 48% (95% CI 46.5–49.5) nationally among men aged 15+ per the 2011 DHS (PMC10936832, PLOS One 2024 systematic review). This national average masks a fundamental north-south split: near-universal circumcision in the Yao Muslim north (Niassa/Cabo Delgado/Nampula — jando initiation tradition) vs historically low circumcision in southern provinces (Maputo City, Gaza, Sofala, Tete, Manica, Zambezia — VMMC target regions, 27% baseline 2009). The national figure likely exceeds 48% post-2011 given VMMC scale-up; no post-2011 nationally representative DHS figure was confirmed in the verified research pass. Note: Morris 2016 estimate for Mozambique was not confirmed in verified claims — 48% (2011 DHS) is the primary authoritative survey figure.","Cultural/traditional practice (NORTH): Yao communities in northern Mozambique (Niassa/Cabo Delgado/Nampula) practice traditional initiation circumcision as part of the jando ceremony — ages 10-14, July–late September, bush seclusion camp (ndagala). The jando is a cultural-moral formation rite as much as a circumcision procedure: in Malawi (where the documented Yao ethnography is richest), Yao communities articulate it as 'circumcision of the brain, not of the penis.' Mozambique-specific jando ethnographic documentation in the verified literature is limited — the Malawi-based peer-reviewed studies are the best available proxy for northern Mozambican Yao practice, given the Yao people's colonial-border split across the two countries. This limitation is explicitly flagged. Makua communities (largest ethnicity overall, partly Muslim in northern provinces) also partly circumcise; Makua-specific practice documentation was not confirmed in verified claims.","VMMC programme (SOUTH + nationwide): The 2013-2017 National Male Circumcision Strategy (NMCS) targeted 2 million males aged 10-49 across 7 priority provinces with high HIV incidence and low baseline circumcision. MoH target: 80% prevalence among males 10-49 by 2019 under PEN IV (Plano Estratégico Nacional de Resposta ao HIV e SIDA 2015-2019). VMMC delivered 2017-2021: 811,937 procedures total (2017: 189,225 / 62.5%; 2018: 233,069 / 90.9%; 2019: 222,887 / 83.1%; 2020: 120,464 / 42.9% COVID-impacted; 2021: 46,292 / 84.3%). Chókwè District 15-24 cohort: reached 90.2% by 2019, exceeding the national 80% target for that cohort. 51.5% of VMMC clients under 15 — consistent with tradition-aligned jando starting age.","VMMC safety findings: PrePex device pilot at José Macamo General Hospital, Maputo (PMC4936427): 504 males aged 18-49; overall moderate/severe AEs 1.0% (5/504); 84.2% complete wound healing by day 49; nurse-performed. HOWEVER: 59.5% (300/504) experienced moderate or severe pain specifically at the device removal step — a documented safety signal requiring improved analgesia at removal (not applicable to surgical VMMC methods). VMMC AE undercount (PMC8555288, Gimbel et al., 16 clinics): official rate 0.15% (8/5,352) vs retrospective record review 0.67% (36 AEs) vs prospective observation 5.9% (10/167) — an 8.3-fold undercount, raising concerns about routine VMMC surveillance quality in Mozambique.","HIV and legal: Adult HIV prevalence ~12.6% (UNAIDS 2024; among the world's highest sub-Saharan Africa). Mozambique is one of the 14 WHO/UNAIDS VMMC priority countries. VMMC is one component of combination HIV prevention (alongside ART, condom promotion, PrEP) — isolating VMMC's independent contribution to HIV-incidence change is methodologically challenging; NO circ↔HIV causal claim. No statute on non-therapeutic male circumcision confirmed — UNREGULATED (absence-of-evidence). FGM: present in some Mozambican provinces (some northern communities document FGC practices); strictly separate from male circumcision, not independently sourced in detail — disambiguation only. No traditional (jando-setting) circumcision harm cases with specific dates, ages, settings, and outcomes were located in indexed literature for Mozambique — an honest evidence gap.",{"iso3":847,"isoNumeric":848,"name":849,"region":850,"circumcisionRatePct":666,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":851,"profileSources":852,"isFallback":40},"ALB","008","Albania","Europe","SYNETIA ceremony (from Ottoman Turkish sunnet): feasting, music, dancing, cash gifts for the boy. Age at circumcision: HONEST GAP — no survey data establishes a population norm for Albania specifically. BEKTASHI EXCEPTION: Bektashi Sufis (world HQ Tirana since 1925) circumcise at ~21% vs ~46.5% Albanian Muslims overall (DHS 2017-18). Bektashism is syncretic — historically treats circumcision as optional. HOXHA 1967: Albania declared world's first atheist state; 2,169 institutions closed; religious practices including circumcision suppressed 1967-1990.",[853,854,855,856],"Prevalence: 47.7% from DHS 2008-09 — a DIRECT SURVEY measurement (Morris et al. 2016, PMC4772313, Table 1). This is below Albania's ~58% Muslim population share. Morris 2016 flagged: Albania is ~77.9% Muslim (then-estimate) but only 47.7% circumcised — gap attributed to Bektashi non-obligation and Hoxha-era suppression. Erratum PMC4820865 corrected six other countries but NOT Albania. DHS 2017-18 breakdown: Albanian Muslims 46.5%, Bektashi 21% circumcised.","THE DISTINCTIVE — Bektashi exception: The Bektashi Sufi order has its world headquarters in Tirana since 1925. DHS 2017-18 shows Bektashi Albanians at ~21% circumcised vs ~46.5% Albanian Muslims overall — a 25-point gap reflecting Bektashi theological non-obligation. Bektashism is syncretic (incorporates Christian/pre-Islamic elements); some branches historically considered circumcision optional. This makes Albania uniquely informative for studying Sufi vs. Sunni circumcision norms within the same country.","Hoxha atheist state 1967-1990: In 1967 Hoxha declared Albania the world's first atheist state, closing/repurposing 2,169 mosques, churches, and religious institutions. Religious practices including circumcision were suppressed. No quantitative circumcision-specific data exists from 1967-1990. The post-1990 DHS figure of 47.7% reflects both Bektashi non-obligation and the legacy of this suppression. The claim that circumcision was 'reframed as health measure' under communism was REFUTED 1-2 — no evidence located.","Synetia ceremony: Albanian Muslim circumcision is called synetia (Albanian) or synet/syneti — from Ottoman Turkish sunnet (Arabic sunna). Ceremony involves feasting, music, dancing, and cash gifts for the boy. Documented in academic ethnographic literature (Marinković 2020, Folklore: Electronic Journal of Folklore). Age at circumcision: HONEST GAP — no survey data for Albania. HIV: ~0.1% concentrated epidemic (UNAIDS 2024); NOT VMMC priority. UNREGULATED — no statute. Balkan comparison: Kosovo 91.7%, Bosnia 41.6%, N.Macedonia 33.9% (all Morris 2016 modeled). FGM: STRICTLY SEPARATE.",{"iso3":858,"isoNumeric":859,"name":860,"region":180,"circumcisionRatePct":399,"adultPrevalencePct":861,"plhivPer1000":862,"newInfectionsPer1000":863,"onTreatmentPct":553,"childPrevalencePct":361,"hivYear":69,"hivSource":32,"epidemicGrowthPct":864,"sexEducationGapScore":399,"preventionContextScore":666,"policyEnvironmentScore":524,"stigmaIndex":554,"legalStatus":865,"routineInfant":115,"medicalNecessity":71,"avgAge":866,"profileSources":867,"isFallback":40},"ZAF","710","South Africa",16.6,127,2.8,-55,"RESTRICTED","Adolescence (initiation) / N/A infant",[868,869],"Children’s Act prohibits circumcision under 16 except for religious or medical reasons; traditional initiation (ulwaluko) circumcision is performed in adolescence.","Not medically necessary: regulated VMMC is offered for HIV prevention but routine infant circumcision is not a norm.",{"iso3":871,"isoNumeric":872,"name":873,"region":92,"circumcisionRatePct":399,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"BIH","070","Bosnia and Herz.",{"iso3":875,"isoNumeric":876,"name":877,"region":92,"circumcisionRatePct":878,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"MKD","807","Macedonia",35,{"iso3":880,"isoNumeric":881,"name":882,"region":883,"circumcisionRatePct":884,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":885,"epidemicGrowthPct":30,"sexEducationGapScore":19,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":886,"profileSources":887,"isFallback":40},"NZL","554","New Zealand","Oceania",33,"Burnett/NZ MoH","Not applicable for Pakeha (infant practice near-abandoned); Pacific Islander communities: late childhood (traditionally age 6-10); not publicly funded",[888,889,890,891],"Prevalence: ~33% overall is a cohort artifact reflecting older Pakeha men circumcised during the 1940s-70s peak (rates up to ~95% of Pakeha male infants 1941-48). Current Pakeha infant rate under 2% and falling. Public hospital funding defunded from 1962 (Prof Denis Bonham, National Women's Hospital). NZMA estimated \u003C1% of Pakeha infant boys by early 2000s.","Maori: Traditional Maori culture does NOT include male circumcision; historically, exposure of the glans (tehe) was considered shameful. Medical/missionary circumcision reached some tribal regions (e.g. Waikato) in the 20th century as an imported practice, not a traditional one.","Pacific Islanders: Polynesian Pacific Islander communities in NZ (Samoan, Tongan, Niuean) maintain near-100% circumcision as a culturally mandated rite of passage, typically late childhood. 2002 Christchurch study (n=123 Pacific Island parents): 89% favoured circumcision; preferred age 6-10 years. Procedures performed privately at families' own expense.","HIV: Burnett Foundation Aotearoa (2025): low-prevalence concentrated epidemic; ~3,507 people on treatment; 95 new diagnoses in 2024 (53 GBM/MSM); GBM face 348x greater HIV acquisition risk than heterosexuals; 31% reduction in locally acquired infections since 2010. Not a VMMC priority country.",{"iso3":893,"isoNumeric":894,"name":895,"region":723,"circumcisionRatePct":6,"adultPrevalencePct":169,"plhivPer1000":328,"newInfectionsPer1000":896,"onTreatmentPct":700,"childPrevalencePct":14,"hivYear":229,"hivSource":897,"epidemicGrowthPct":898,"sexEducationGapScore":878,"preventionContextScore":624,"policyEnvironmentScore":899,"stigmaIndex":878,"legalStatus":33,"routineInfant":900,"medicalNecessity":71,"avgAge":901,"profileSources":902,"isFallback":40},"CAN","124","Canada",0.05,"PHAC / UNAIDS",6,79,"declining","Neonatal (secular elective, declining, out-of-pocket) / Jewish 8th day (brit milah) / Muslim childhood — minority practice",[903,904,905,906],"Prevalence: the Canadian Paediatric Society cites a \"current Canadian average of 32%, with significant regional variability\" (CPS 2015) — far below the US (~55–80% historically). Long-term DECLINE since the CPS's 1975 statement (e.g. Alberta ~67% in 1970–71; Ontario ~39% in 1989–92 → ~30% by 1994–95; ~30% of males 15+ circumcised for non-religious reasons by 2007). NOTE metric mismatch: the CPS \"32% average\" (current, broad) ≠ CIHI \"9.2% in 2005\" (single-year hospital neonatal procedure rate) — cite year + source.","Provincial variation (the key structural fact): historically and currently HIGHER in the Prairies (Alberta) and Ontario; LOWEST in Quebec, the Atlantic provinces and BC. Quebec has long had Canada's lowest rates. Specific cross-province numbers vary by source/year.","THE CENTERPIECE — the CPS position: the Canadian Paediatric Society's 2015 statement \"Newborn male circumcision\" states plainly \"The CPS does not recommend the routine circumcision of every newborn male\", judging the benefit-harm balance too closely balanced (it may be considered only for some higher-risk boys). It cites a ~1.5% neonatal complication median (rising to ~6% in childhood), that 111–125 average-risk infants must be circumcised to prevent one UTI, and that the African HIV-trial results are of \"unclear\" applicability to developed countries. Reaffirms the stance set in 1996 (building on 1975).","DE-LISTING + culture: essentially all provinces removed NON-THERAPEUTIC newborn circumcision from medicare (medically-necessary cases still covered), making it an out-of-pocket elective procedure (a few hundred dollars) — a long-run structural driver of the decline (only BC 1984 is a well-attested date; others reported). The bulk of Canadian circumcision is now secular, parental-choice and cost-bearing; religious minorities (Jewish brit milah, Muslim) continue it on religious grounds. Canada deliberately walked away from the Anglo-American medicalised-circumcision legacy the US retained. HIV: low (~0.17–0.2%), concentrated in gbMSM + PWID + disproportionately Indigenous peoples; circumcision plays no role (not a VMMC country). Sex-ed/other composite scores omitted.",{"iso3":908,"isoNumeric":909,"name":910,"region":180,"circumcisionRatePct":551,"adultPrevalencePct":911,"plhivPer1000":291,"newInfectionsPer1000":275,"onTreatmentPct":433,"childPrevalencePct":592,"hivYear":69,"hivSource":32,"epidemicGrowthPct":864,"sexEducationGapScore":523,"preventionContextScore":639,"policyEnvironmentScore":816,"stigmaIndex":664,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":912,"profileSources":913,"isFallback":40},"ZMB","894","Zambia",9.4,"No routine infant circumcision among the non-circumcising majority; VMMC targets adolescents/adults (~37.7% of FY2013–16 procedures were on under-15s); traditional mukanda initiates boys ~7–13 in North-Western Province; EIMC (neonatal) promoted but low uptake (~11% pilot)",[914,915,916,917],"Prevalence: Zambia is a HISTORICALLY LOW-circumcising country. Most ethnic groups — the Bemba-speaking majority, plus Tonga, Lozi and Ngoni — are traditionally NON-circumcising. National prevalence rose from ~12.8% (2007) → 21.6% (2013–14) → 30.9% (2018) (systematic review/meta-analysis), placing Zambia in the Southern-Africa pattern (~33%), far below Eastern Africa (~70%). The rise is overwhelmingly VMMC-DRIVEN, layered on a small pre-existing base: the mukanda traditional rite + a Muslim minority. (A documented self-report problem — some men reporting \"circumcised\" were not clinically circumcised, partly confusing VMMC with traditional initiation — adds uncertainty; an anomalous 11.4% 2023 point estimate conflicts with the trend and is NOT cited.)","THE DISTINCTIVE ANGLE — VMMC SCALE-UP onto a non-circumcising baseline: Zambia adopted Voluntary Medical Male Circumcision for HIV prevention in 2007 following the WHO/UNAIDS recommendation, with PEPFAR-funded scale-up accelerating from ~2010. The HIV rationale is genuine and RCT-backed (a ~60% reduction in female-to-male heterosexual acquisition, established by trials in Kenya, Uganda and South Africa), which is why WHO designated Zambia a priority country. Demand was initially LOW in a largely non-circumcising population, requiring active demand-creation. By Feb 2021 the Ministry of Health cited >3 million men circumcised cumulatively (~31% of eligible — below PEPFAR's 80% saturation goal); cumulative totals are program/partner-reported (treat as approximate).","BODILY-AUTONOMY lens (the load-bearing caveat): the protective benefit is adult, female-to-male and heterosexual-only — it does not protect the circumcised man's partners directly, nor address male-to-male transmission. Consent of minors/adolescents is the central concern: in FY2013–2016, ~37.7% of circumcisions were on under-15s; school-holiday campaigns (\"August circumcision month\") and demand-creation targeting adolescents raise voluntariness questions for a permanent procedure whose HIV benefit only materialises at adult sexual debut. Early-infant MC (EIMC) — fully parental pre-consent — was promoted (~361,000 neonates/year eligible; ~97% hypothetical acceptability but only ~11% actual pilot uptake).","TRADITIONAL / RELIGIOUS: mukanda is the traditional male puberty circumcision-and-initiation rite of North-Western Province (into Western Province and cross-border Angola/DRC), practiced by the Luvale, Lunda, Chokwe, Luchazi and Mbunda (and partially the Kaonde): boys ~7–13 are circumcised by a traditional circumciser and secluded in a bush lodge for ~1–3 months until healing, taught by counsellors (vilombola); the associated Makishi masquerade is UNESCO-recognised (2005). In 2016 Zambia adopted a policy permitting trained medical personnel to perform circumcisions inside traditional mukanda camps — medicalising the rite to bridge custom with the VMMC program. A small Muslim minority also circumcises. HIV: a severe generalised epidemic (~9–11% adult; the genuine driver of VMMC) with strong treatment progress (ZAMPHIA 2021 cascade 89-98-96). FGM is NOT a documented Zambian practice and is kept strictly separate.",{"iso3":919,"isoNumeric":920,"name":921,"region":180,"circumcisionRatePct":922,"adultPrevalencePct":923,"plhivPer1000":924,"newInfectionsPer1000":925,"onTreatmentPct":303,"childPrevalencePct":519,"hivYear":69,"hivSource":32,"epidemicGrowthPct":637,"sexEducationGapScore":639,"preventionContextScore":816,"policyEnvironmentScore":639,"stigmaIndex":524,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":926,"profileSources":927,"isFallback":40},"MWI","454","Malawi",28,8,47,0.65,"YAO TRADITION (Southern Region — Mangochi/Machinga/Phalombe): jando initiation, boys aged 8–13, July–late September, ~1 month, bush seclusion camp (ndagala). Gule Wamkulu (Chewa masked initiation, Central Region) does NOT involve circumcision — never conflated. VMMC programme: 91.9% of clients aged 15–29 (adult-focused; only 8.1% under 15 — contrasts with Mozambique's tradition-aligned 51.5% under 15). Lomwe ethnic group: lupanda (partial circumcision rite) — medium confidence, single source.",[928,929,930,931],"Prevalence: 19.1% (95% CI 17.9–20.3) or 22% (95% CI 21.1–23.0) in 2010 DHS (two analytical cuts); 28% (95% CI 27.1–29.0) in 2015-2016 DHS (PMC10936832, PLOS One 2024 systematic review). These figures are halved from raw DHS self-report at country stakeholder request to adjust for circumcision over-reporting. The 2015-16 DHS (28%) is the current reference. Sharp regional variation (2010, halved): Northern region 2.5% (historically non-circumcising Tumbuka/Ngonde), Central region 10.1% (Chewa/Ngoni, predominantly non-circumcising), Southern region 37.8% (Yao Muslim concentration in Mangochi/Machinga/Phalombe). The gap between Yao near-universal traditional circumcision and a low Southern region aggregate (37.8%) reflects both the Yao as a minority within the region and self-report correction.","Yao jando ceremony: The Yao, a predominantly Muslim ethnic group in the Southern Region concentrated in Mangochi/Machinga/Phalombe districts (~13% of national population), practice traditional initiation circumcision as part of the jando ceremony. Boys aged 8-13 enter the ndagala bush seclusion camp between July and late September for approximately one month. The ceremony is conducted under strict secrecy norms that historically extended to uncircumcised males, women, and the initiates' own mothers ('even the boy's mother did not know why her child was going to ndagala'). The jando is a moral-cultural formation rite, explicitly distinguished from medicalised circumcision by community members: 'Our circumcision is of the brain, not of the penis.' In Machinga District, 97% of circumcised men (223/238) underwent traditional jando circumcision; VMMC accounted for only 6.3% (15/238). Note: Gule Wamkulu (the Chewa masked initiation, Central Region) is a separate cultural institution that does NOT involve circumcision — never conflated with jando. Lomwe ethnic group: the lupanda partial circumcision rite (medium confidence, single source PMC4433597).","VMMC programme and resistance: Malawi is one of the 14 WHO/UNAIDS VMMC priority countries. 2017-2021 VMMC volume: 232,619 procedures, with 91.9% of clients aged 15-29 and only 8.1% under 15 — an adult-focused programme contrasting with Mozambique's tradition-aligned 51.5% under-15 share. Cumulative VMMCs approximately 150,000 by 2014 (far short of 80% national coverage target), and approximately 939,573 by 2020 (38% of the 2.458 million 2020 target). Documented VMMC resistance factors in Mangochi district (peer-reviewed qualitative fieldwork, 156 participants): (1) VMMC is framed as alien medicalisation of a sacred rite; (2) clinical settings violate jando secrecy norms; (3) female circumcisers are perceived as culturally inappropriate; (4) VMMC threatens chiefs' ceremonial authority and income; (5) witchcraft concerns and government mistrust. These are the most extensively documented VMMC resistance factors for any WHO priority country.","Legal and HIV: No Malawian statute specifically regulates or prohibits non-therapeutic male circumcision — UNREGULATED (absence-of-evidence). FGM is criminalised under the Gender Equality Act 2013 — a completely separate female practice and legal category, never conflated with male circumcision. HIV ~8% adult prevalence (UNAIDS 2024; Southern Malawi is the national hotspot). Malawi is one of 14 WHO/UNAIDS VMMC priority countries. VMMC is one component of combination HIV prevention. No circ↔HIV causal claim. No traditional jando harm cases with specific dates, ages, settings, and outcomes verified for Malawi in indexed medical literature — honest evidence gap (PMC2995181 systematic review cites 35-83% traditional-setting complication rates in East/Southern Africa generally, but no Malawi-specific case series was confirmed).",{"iso3":933,"isoNumeric":934,"name":935,"region":883,"circumcisionRatePct":936,"adultPrevalencePct":937,"plhivPer1000":938,"newInfectionsPer1000":939,"onTreatmentPct":636,"childPrevalencePct":14,"hivYear":31,"hivSource":32,"epidemicGrowthPct":940,"sexEducationGapScore":399,"preventionContextScore":287,"policyEnvironmentScore":15,"stigmaIndex":6,"legalStatus":865,"routineInfant":900,"medicalNecessity":71,"avgAge":941,"profileSources":942,"isFallback":40},"AUS","036","Australia",27,0.14,1.13,0.03,-35,"Historically newborn (1950s-70s); now variable — neonatal in private clinics; not offered in public hospitals since 2007-08",[943,944,945,946],"Prevalence/cohort: Richters et al. (2006) ASHR1 telephone survey (n=10,173 men 16-59): 59% overall, 32% among men under 20 vs ~67% over 30; men born late 1980s ~27%.","Infant rate: O'Donnell (2004) MBS claims data: 12.7% of male births nationally (2003-04); Morris et al. (2022) estimated 18.75% preschool-aged boys by 2019 (down from ~85% peak).","Policy: RACP December 2022 position statement — routine infant circumcision not warranted in Australia or NZ. Successive statements since 1983 (ACP). Public hospital ban: all states by 2007-08.","HIV: UNAIDS Australia 2023: adult HIV prevalence 0.14%, ~30,890 PLHIV; epidemic concentrated among MSM (56% of PLHIV). PrEP coverage 80.5% among gay/bisexual men. Not a VMMC priority country.",{"iso3":948,"isoNumeric":949,"name":950,"region":180,"circumcisionRatePct":936,"adultPrevalencePct":951,"plhivPer1000":952,"newInfectionsPer1000":262,"onTreatmentPct":611,"childPrevalencePct":681,"hivYear":229,"hivSource":32,"epidemicGrowthPct":953,"sexEducationGapScore":838,"preventionContextScore":523,"policyEnvironmentScore":924,"stigmaIndex":954,"legalStatus":33,"routineInfant":955,"medicalNecessity":71,"avgAge":956,"profileSources":957,"isFallback":40},"UGA","800","Uganda",5.1,28.8,-56,59,"mixed","Muslim: childhood (religious); Bagisu imbalu: adolescence ~16–25 (traditional rite); VMMC: any age 10–49 (HIV program)",[958,959,960,961],"Prevalence: 26% (UDHS 2011) → 43% (UDHS 2016–17) among men 15–49 (~38% UNAIDS 2022) — the rise driven almost entirely by the VMMC scale-up. Strong regional variation: ~69% in the Mid-Eastern region (the Bugisu/imbalu heartland + Muslim populations) vs ~14% in the Mid-Northern region. The indicator is kept near the 2011 baseline; the truer current figure is ~38–43%.","THREE CHANNELS: (1) Islamic circumcision among the ~14% Muslim minority (near-universal there — Morris cites ~99.6% of Muslim men); (2) the TRADITIONAL Bagisu/Gisu IMBALU rite — a centuries-old public manhood-initiation circumcision in the Bugisu sub-region (Mount Elgon), held every even-numbered year (inaugurated each August at Mutoto, near Mbale), candidates ~16–25 cut standing, publicly, without anaesthesia; ~6,000 initiates in 2022 — with a documented FORCED-circumcision (\"dodger\") coercion dimension; (3) the medical VMMC program (Safe Male Circumcision, adopted 2010, PEPFAR-backed) — the dominant growth driver.","THE CENTERPIECE — the Rakai RCT (Gray et al., Lancet 2007): 4,996 HIV-negative men 15–49 randomised; HIV incidence 0.66 vs 1.33 per 100 person-years (~51% ITT efficacy, up to ~60%); stopped early. One of the THREE African RCTs (with Kisumu/Kenya and Orange Farm/South Africa) behind the WHO/UNAIDS 2007 VMMC recommendation. CRITICAL CAVEAT: the companion Wawer 2009 trial (circumcising HIV-POSITIVE men) was stopped for FUTILITY — no benefit to female partners (a non-significant trend toward HIGHER female risk if sex resumed before healing). The benefit is female-to-male, heterosexual, HIV-negative ADULT men only; scale-up had documented consent/quality gaps (2012 PEPFAR assessment).","HIV: generalized epidemic, adult prevalence ~5.1% (2022; women ~6.5% vs men ~3.6%), down from a ~15% peak in the early 1990s. The famous early decline is attributed mainly to behaviour change / the \"ABC\" (Abstinence, Be faithful, Condoms) era — which PREDATES and is separate from the circumcision intervention. Key-population prevalence is far higher (sex workers ~35%, MSM ~14%, fishing communities 23–35%). VMMC is genuinely RCT-backed HIV policy here, presented accurately WITH the bodily-autonomy caveats. Sex-ed/other composite scores omitted.",{"iso3":963,"isoNumeric":964,"name":965,"region":180,"circumcisionRatePct":966,"adultPrevalencePct":967,"plhivPer1000":968,"newInfectionsPer1000":361,"onTreatmentPct":339,"childPrevalencePct":519,"hivYear":69,"hivSource":32,"epidemicGrowthPct":969,"sexEducationGapScore":523,"preventionContextScore":664,"policyEnvironmentScore":640,"stigmaIndex":712,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":970,"profileSources":971,"isFallback":40},"NAM","516","Namibia",25,12,75.6,-54,"TRADITIONAL: Owambo (OvaAmbo) people (~50% of Namibia's population, northern regions) practice male circumcision as a rite of passage — adolescent/teenage age range (background knowledge; specific initiation ceremony details [ongombo/ombwiti terms] not primary-sourced verified). Otjozondjupa Region: 72.27% overall circumcision (2017-18); 66.66% traditionally circumcised vs 33.34% medical. Non-circumcising: Herero, Nama/Damara in south and centre (background knowledge). VMMC: Khomas + Zambezi priority regions; CDC-supported procedures ended 2020 (transition to another US agency).",[972,973,974,975],"Prevalence: 21% (95% CI 19.7-22.3) in 2006-07 DHS (males, n=3,915; pre-VMMC baseline) rising to 25.5% (95% CI 24.2-26.9) in 2013 DHS (nationally representative; Morris 2016 / PMC4772313 corroborates 25.5% unchanged after erratum). The modest national increase likely understates post-VMMC uptake since 52,022+ CDC-supported VMMCs were performed after 2013. Regional variation is extreme: Otjozondjupa Region showed 72.27% overall circumcision prevalence (279/386 males, 2017-18 cross-sectional survey; MEDIUM confidence — convenience sample, 2-1 verified), with 66.66% of those circumcised having undergone traditional circumcision. The 21% figure with 'one-quarter traditional' attribution was refuted 0-3; Herero/Himba 55.56% with 'babies and small boys' was refuted 1-2 — both excluded.","Traditional practices: Owambo (OvaAmbo) people, roughly 50% of Namibia's population concentrated in northern regions (Oshana, Ohangwena, Omusati, Oshikoto), practice traditional male circumcision as a rite of passage — broadly documented in secondary and cultural sources but specific primary-sourced details for the initiation ceremony (ongombo/ombwiti terms, ages, duration, secrecy) did not survive adversarial verification. Medium confidence: treat as background knowledge. The high traditional circumcision prevalence in Otjozondjupa Region (66.66% of circumcised males traditionally circumcised) is contextually consistent with northern ethnic group practices in that region. Herero and related groups in Otjozondjupa may practice traditional circumcision; the specific Herero/Himba infant-circumcision claim was refuted 1-2.","VMMC programme: Namibia is one of the 15 WHO/UNAIDS VMMC priority countries. Under CDC/PEPFAR support 2017-2019: 52,022 procedures — 15,579 in 2017 (70.1% target attainment), 19,384 in 2018 (82.7%), 17,059 in 2019 (73.3%). CDC support transitioned to another US government agency beginning 2020, resulting in zero CDC-reported procedures in 2020-2021. Priority regions include Khomas (Windhoek) and Zambezi. Post-2020 programme data is unavailable in the verified evidence base.","Adverse events and legal context: Namibia VMMC AE data from Oshana and Zambezi regions (PMC8528325, Jan 2015-Aug 2018, 28,990 total VMMCs): 498 moderate/severe AEs, overall rate 1.7%; severity 77% moderate / 23% severe; AE type: infections and wound disruption 80%, bleeding 8%, other 12%; bleeding predominated early (≤day 2), infections dominated after day 7. Legal: no Namibia statute specifically regulating non-therapeutic male circumcision — UNREGULATED (absence of evidence). VMMC = programme framework, not statute. FGM is a completely separate female issue, strictly separate, never conflated. HIV adult prevalence ~12% (UNAIDS 2024). No traditional-setting circumcision harm cases specifically verified for Namibia — honest evidence gap.",{"iso3":977,"isoNumeric":978,"name":979,"region":180,"circumcisionRatePct":980,"adultPrevalencePct":228,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":981,"profileSources":982,"isFallback":40},"SSD","728","South Sudan",24,"ETHNIC DIVIDE: Western Nilotic groups (Dinka [largest, ~35-40%] / Nuer [2nd largest] / Luo) traditionally do NOT circumcise — Agar Dinka non-circumcision confirmed (3-0). Broader pattern consistent across Western Nilotic ethnographic literature. NOTE: the precise 0%/100% Nilotic/Equatoria split REFUTED 0-3. Equatoria region and Muslim/Arabised communities: higher circumcision prevalence likely but not specifically quantified in verified claims. VMMC: added as 15th priority country 2018; pilot programme 2018; PEPFAR 2018-2021. Juba university students 2024 (n=390, urban, non-representative): 83.8% overall / 41.8% VMMC-specific.",[983,984,985,986],"Prevalence: South Sudan is estimated at 23.6% (Morris 2016, PMC4772313, Table 1; MODELED from religious-composition proxies; no direct DHS or nationally representative survey). South Sudan is THE ONLY ONE of the 15 WHO VMMC priority countries with no nationally representative prevalence data — the 2024 systematic review (PMC10936832) covering all 15 priority countries explicitly states 'There were no data sources from South Sudan.' The 23.6% figure is a modeled estimate; a 2010 IGAD/UNHCR survey found 9.4%; a 2024 Juba University convenience sample (n=390 students) found 83.8% overall / 41.8% VMMC-specific. These figures are not comparable due to methodology and sampling differences. MEDIUM confidence for any national estimate. Erratum PMC4820865 did not revise South Sudan.","Cultural practices: Western Nilotic non-circumcision tradition. The Agar Dinka (a major Dinka subgroup; Dinka = largest ethnic group in South Sudan, ~35-40%) do not practice male circumcision — confirmed (3-0). This is consistent with the broader Western Nilotic ethnographic pattern: Dinka, Nuer, and Luo peoples are historically non-circumcising groups. Historical records document that forced circumcision of Dinka boys occurred during the slave trade and northern conflict, which confirms the Dinka as a non-circumcising group subject to external coercive pressure. The 0%/100% precise Nilotic/Equatoria regional split (i.e. 'all Nilotic = 0%, all Equatoria = 100%') was REFUTED 0-3 — too precise for available evidence. Equatoria and Muslim/Arabised communities likely have higher circumcision rates but specific ethnic-group data was not confirmed in verified claims. The 2024 Juba University student sample (83.8%) reflects urbanisation, education, VMMC exposure, and the mixed-ethnic Juba population — not national patterns.","VMMC programme: South Sudan was added as the 15th and final WHO/UNAIDS VMMC priority country in 2018 (3-0 verified, PMC7339571 verbatim: 'in 2018 South Sudan was included, bringing the total priority countries to 15'). A pilot VMMC programme was initiated in South Sudan in 2018. PEPFAR VMMC support covered South Sudan from 2018 through at least 2021 (PMC11002756). South Sudan was NOT among the original 12 CDC-supported countries listed in the 2017 MMWR report (mm6647a2), which covered Botswana, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. The country's ongoing civil conflict (2013-2018, ongoing instability), mass displacement (~4 million displaced), and weak health infrastructure create major barriers to VMMC delivery.","Legal context and HIV: No South Sudan statute or constitutional provision addresses non-therapeutic male circumcision. The Transitional Constitution of South Sudan 2011 (rev. 2013) — reviewed via Constitute Project — contains no provision specifically addressing male circumcision. Related articles (Art. 11: right to bodily integrity; Art. 17: children's rights; Art. 33: cultural community rights) are general and do not name male circumcision. UNREGULATED (absence-of-evidence). HIV: ~2.2% adult prevalence per UNAIDS/WHO data; WHO supports the Ministry of Health to maintain prevalence below 2%, suggesting a generalized epidemic slightly above the 2% threshold. Not a concentrated epidemic. FGM in South Sudan: ~23% prevalence (UNICEF est.), primarily in specific communities — STRICTLY SEPARATE from male circumcision. No circumcision harm cases verified — honest gap.",{"iso3":988,"isoNumeric":989,"name":990,"region":180,"circumcisionRatePct":980,"adultPrevalencePct":991,"plhivPer1000":992,"newInfectionsPer1000":710,"onTreatmentPct":339,"childPrevalencePct":194,"hivYear":69,"hivSource":32,"epidemicGrowthPct":993,"sexEducationGapScore":523,"preventionContextScore":994,"policyEnvironmentScore":554,"stigmaIndex":639,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":995,"profileSources":996,"isFallback":40},"BWA","072","Botswana",20,142.8,-58,64,"TRADITIONAL: Bakgatla (Mochudi), Balete, Batlokwa practice initiation including circumcision — ages/duration not independently primary-sourced for Botswana; bogwera is the pan-Tswana initiation rite but its circumcision relationship varies by sub-group (incompletely characterised). Bakgalagadi (Hukuntsi) explicitly does NOT practice initiation or circumcision. VMMC programme (SMC): targets males aged 10+ (both boys and adults); predominantly surgical modality.",[997,998,999,1000],"Prevalence: 24% (BAIS IV 2013, males 10-64) is the pre-VMMC nationally representative baseline most cited in the programme literature. The Botswana Combination Prevention Project (BCPP, ~2016, males 16-49) found ~50% circumcised at baseline — a higher figure attributed to VMMC uptake in the 2013-BCPP period, peri-urban community composition with higher traditional circumcision, and social desirability bias given BCPP's association with MC promotion. These two figures are not contradictory but reflect different time-points, age ranges, and sampling contexts. By 2016, estimated VMMC coverage was 43% against the 80% WHO/national target. Refuted figures: 15.1% (BAIS III 2008, 0-3 refuted) and the claimed 12.5%→25.2%→50.1% trajectory (0-3 refuted).","Ethnic circumcision practices: peer-reviewed qualitative ethnography (PMC4487566, Mavhu et al. 2015, Global Public Health, purposive qualitative design contrasting circumcising vs non-circumcising communities) confirms: Bakgatla (Mochudi) practice 'initiation and MC'; Batlokwa and Balete are named by national programme officials as circumcising tribes; Bakgalagadi (Hukuntsi) 'does not practice initiation or MC' (verbatim, confirmed by a Bakgalagadi traditional leader). The bogwera initiation rite spans multiple Tswana sub-groups and includes circumcision in some; the specific detail that bogwera involves simultaneous circumcision with one knife was refuted 1-2 in adversarial verification and is not asserted. The Bakwena-as-non-circumcising claim was refuted 0-3. The bogwera/circumcision relationship for broader Tswana groups (Bakwena, Bangwaketse, Ngwato) remains an open question in the verified record.","VMMC programme (Safe Male Circumcision, SMC): Launched 2009, funded by MoH, CDC, and ACHAP (Gates Foundation). 241,539 cumulative medical circumcisions 2008-2020, peaking in 2013 and stagnating thereafter. Under CDC/PEPFAR support 2017-2021: 58,798 procedures (67.4% overall target attainment; 117.0% in 2017, 28.0% in 2020 due to COVID-19 disruption). 2015-2019 interrupted time-series (PMC12700458): 68,301 males aged 10+ circumcised; less than 50% of 2018 national target achieved. Early programme: only 39% of 2012 annual target achieved (PMC4487566). One of 15 WHO/UNAIDS VMMC priority countries.","Adverse events and legal context: Gaborone clinic cohort (Spees 2017, PMC5675416, 427 enrolled, 97% follow-up): 6.7% moderate/severe AE rate (28 events among 415 follow-up completers); hematoma 2.7%, infection 2.2%, bleeding 1.2%. Programme-wide 2015-2019 (27 districts, PMC12700458): 1,175 total AEs; mild 73.8% (868/1,175); infections most common 45.1% (530/1,175). The 6.7% rate is approximately twice that observed in RCTs but consistent with other real-world evaluations with high follow-up retention. Legal: no Botswana statute specifically regulating non-therapeutic male circumcision — UNREGULATED (SMC strategy = programme framework, not statute). FGM is a completely separate female issue — STRICTLY SEPARATE, never conflated. HIV adult prevalence ~20% (UNAIDS 2024). No traditional-setting circumcision harm cases specifically verified for Botswana — honest evidence gap.",{"iso3":1002,"isoNumeric":1003,"name":1004,"region":1005,"circumcisionRatePct":1006,"adultPrevalencePct":169,"plhivPer1000":361,"newInfectionsPer1000":521,"onTreatmentPct":636,"childPrevalencePct":30,"hivYear":69,"hivSource":725,"epidemicGrowthPct":1007,"sexEducationGapScore":922,"preventionContextScore":624,"policyEnvironmentScore":553,"stigmaIndex":878,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":1008,"profileSources":1009,"isFallback":40},"BEL","056","Belgium","Western & Central Europe",22,-30,"Infancy/childhood (religious)",[1010,1011,1012],"Legal & unregulated; doctor-only requirement: Belgian Advisory Committee on Bioethics, Opinion no. 70 (8 May 2017); Wikipedia, \"Circumcision and law\".","Not medically necessary: KNMG viewpoint (2010), \"not justifiable except on medical/therapeutic grounds\"; CoE PACE Resolution 1952 (2013).","Concentrated in religious minorities; prevalence ~22% (contested): Morris et al., Popul Health Metr 2016 (from Bronselaer et al., BJU Int 2013, railway-station cohort).",{"iso3":1014,"isoNumeric":1015,"name":1016,"region":92,"circumcisionRatePct":991,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"MNE","499","Montenegro",{"iso3":1018,"isoNumeric":1019,"name":1020,"region":284,"circumcisionRatePct":991,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"SLB","090","Solomon Is.",{"iso3":1022,"isoNumeric":1023,"name":1024,"region":1005,"circumcisionRatePct":991,"adultPrevalencePct":169,"plhivPer1000":361,"newInfectionsPer1000":30,"onTreatmentPct":391,"childPrevalencePct":14,"hivYear":69,"hivSource":725,"epidemicGrowthPct":1025,"sexEducationGapScore":966,"preventionContextScore":15,"policyEnvironmentScore":624,"stigmaIndex":289,"legalStatus":1026,"routineInfant":115,"medicalNecessity":71,"avgAge":1008,"profileSources":1027,"isFallback":40},"GBR","826","United Kingdom",-33,"REGULATED",[1028],"Routine infant circumcision largely abandoned after the NHS stopped funding it in 1948; now mostly limited to specific religious communities.",{"iso3":1030,"isoNumeric":1031,"name":1032,"region":284,"circumcisionRatePct":1033,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"NCL","540","New Caledonia",15,{"iso3":1035,"isoNumeric":1036,"name":1037,"region":1005,"circumcisionRatePct":1033,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"CYP","196","Cyprus",{"iso3":1039,"isoNumeric":1040,"name":1041,"region":767,"circumcisionRatePct":1033,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"GUY","328","Guyana",{"iso3":1043,"isoNumeric":1044,"name":1045,"region":767,"circumcisionRatePct":1033,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"SUR","740","Suriname",{"iso3":1047,"isoNumeric":1048,"name":1049,"region":767,"circumcisionRatePct":1033,"adultPrevalencePct":56,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":1050,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1051,"profileSources":1052,"isFallback":40},"MEX","484","Mexico","UNAIDS / CENSIDA","Elective/medical (phimosis) at varying ages, private clinics; tiny Jewish minority: 8th day (brit milah). Majority: not practised (intact norm)",[1053,1054,1055,1056],"Prevalence: best figure ~15.4% (Morris et al. 2016) — the HIGHEST in Latin America, yet still meaning ~85% of Mexican men are intact (regional context: Brazil ~1.3%, Argentina ~2.9%, Chile ~0.2%). This is a MODELED estimate; there is NO national Mexican circumcision survey (ENSANUT/CENSIDA do not measure it). Older estimates are wide (10–31%) and a 2020 Mexico City HIV cohort was ~23% (convenience sample); the HIM/HPV study (Cuernavaca arm) confirmed a majority-uncircumcised cohort. Treat any single number cautiously. Revised the indicator up from 10 to ~15.","Cultural: circumcision is foreign to the Roman-Catholic mestizo majority — the intact penis is the default. A qualitative study of Mexican men (Parrini-Roses 2013) found widespread unfamiliarity, fear and distrust, with men willing to consider it only on a doctor's recommendation, concluding \"there are no cultural interpretations that would effectively facilitate the promotion of male circumcision.\" It is NOT religious and NOT a routine-neonatal practice.","Where circumcision occurs it is overwhelmingly ELECTIVE/MEDICAL — for phimosis, paraphimosis or recurrent balanitis — done in private clinics; Mexican pediatric/urology guidance (Anales de Pediatría 2003; Hospital General de México \"Fimosis\" doc) treats it as indication-only and notes most childhood phimosis is physiological and reversible (conservative topical-steroid management first). A CLASS/aspirational \"más higiénico\" coding (middle/upper-class, urban) and possible US/northern-border influence are SUGGESTIVE (tertiary/anecdotal), not established. The public system does not perform routine neonatal circumcision.","Minorities (qualitative only): a Jewish community of ~40,000–50,000 (>95% in Mexico City) for whom brit milah is normative, and a very small Muslim community — neither is quantified as a share of national prevalence. HIV: low general prevalence (~0.3%, CENSIDA/UNAIDS), a concentrated epidemic in MSM (~17%), male sex workers (~24%) and trans women (~15–20%); circumcision/VMMC plays no role and Mexico is not a WHO VMMC-priority country. Sex-ed/other composite scores omitted.",{"iso3":1058,"isoNumeric":1059,"name":1060,"region":767,"circumcisionRatePct":1033,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"BHS","044","Bahamas",{"iso3":1062,"isoNumeric":1063,"name":1064,"region":284,"circumcisionRatePct":8,"adultPrevalencePct":169,"plhivPer1000":422,"newInfectionsPer1000":896,"onTreatmentPct":126,"childPrevalencePct":286,"hivYear":31,"hivSource":32,"epidemicGrowthPct":1065,"sexEducationGapScore":554,"preventionContextScore":524,"policyEnvironmentScore":816,"stigmaIndex":805,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":1066,"profileSources":1067,"isFallback":40},"IND","356","India",-44,"Childhood (Muslim minority; khatna/sunnat)",[1068,1069,1070,1071,1072],"Prevalence: low — ~13.5% (Morris et al. 2016, Population Health Metrics; a MODELLED estimate partly derived from religious demographics) and 16% (NFHS-4, Government of India 2015–16, n~122,051 men). Report as two separate estimates. Low across states (Mizoram 2.5% → UP 19.1%) except Muslim-majority Lakshadweep (94.5%) — confirming a religious-minority practice.","Demographics/religion: practised almost entirely by the Muslim minority (khatna/sunnat) on boys in childhood; the Hindu majority does not circumcise and Sikhism prohibits it (Sahay et al., PLoS One 2014). India's Jewish minority is doctrinally circumcising but numerically negligible (~4,429, 2011 census).","Identity: circumcision functions as a marker of Muslim religious identity, explicitly distinguishing Muslims from Hindus (\"without khatna he is considered a Hindu\"; Sahay 2014) — a function tragically weaponised in communal violence from Partition (1947) to the April 2025 Pahalgam attack.","Sex-education-gap score (M9 = 62, editorial composite, 0–100 where higher = larger gap): India has limited, uneven, often-contested formal sex education and strong taboo; a sizeable information gap.","HIV context: low adult prevalence (~0.2%) but a large epidemic by absolute numbers. VMMC is NOT part of national strategy (NACO declined trials in 2009 as \"a sensitive matter\"; India is not a WHO VMMC priority country); circumcision carries religious-identity charge, not a prevention rationale. (Specific prevalence/PLHIV figures beyond the indicator were not re-verified in this pass.)",{"iso3":1074,"isoNumeric":1075,"name":1076,"region":1005,"circumcisionRatePct":8,"adultPrevalencePct":56,"plhivPer1000":1077,"newInfectionsPer1000":896,"onTreatmentPct":1078,"childPrevalencePct":250,"hivYear":31,"hivSource":725,"epidemicGrowthPct":1079,"sexEducationGapScore":19,"preventionContextScore":553,"policyEnvironmentScore":700,"stigmaIndex":1080,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":1081,"profileSources":1082,"isFallback":40},"FRA","250","France",2.6,91,-10,36,"Infancy/childhood (religious minorities); uncommon in the majority",[1083,1084,1085,1086],"Prevalence: ~14% of French men circumcised (2008 TNS Sofres national survey, reproduced in Morris et al. 2016, Population Health Metrics) — the highest in continental Western Europe (the UK ~21% is higher), driven by near-universal circumcision in France's Muslim (Maghrebi-origin) and Jewish communities, Western Europe's largest. A self-reported survey estimate, not a registry.","Legal: de-facto tolerated, not affirmatively authorised — the Conseil d'État's 2004 laïcité report deemed ritual circumcision \"admise\" yet \"dépourvue de tout fondement légal\"; no specific statute (except the Alsace-Moselle mohel-certification regime); no penal complaint has ever been filed. See the legislation entry + write-up.","Sex-education-gap score (M9 = 30, editorial composite, 0–100 where higher = larger gap): France has comprehensive, secular school sex education and high health literacy; a small information gap.","HIV context: low-incidence — ~0.17 per 1,000 adults / ~6,607 new infections in 2014 (Marty et al., J Int AIDS Soc 2018). Circumcision is not promoted for HIV prevention in France (a low-prevalence high-income setting; WHO scopes VMMC to high-prevalence sub-Saharan settings).",{"iso3":1088,"isoNumeric":1089,"name":1090,"region":284,"circumcisionRatePct":8,"adultPrevalencePct":169,"plhivPer1000":519,"newInfectionsPer1000":1091,"onTreatmentPct":624,"childPrevalencePct":14,"hivYear":31,"hivSource":32,"epidemicGrowthPct":967,"sexEducationGapScore":838,"preventionContextScore":523,"policyEnvironmentScore":306,"stigmaIndex":522,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1092,"profileSources":1093,"isFallback":40},"CHN","156","China",0.08,"Han: childhood/adult (medical only); Muslim minorities: childhood (Islamic rite)",[1094,1095,1096,1097,1098],"Prevalence: ~14% national (Morris et al. 2016, Population Health Metrics — a \"soft\" estimate from only 9 studies) but this MASKS a sharp split: only ~5% of the general/Han population is circumcised (Yang et al., PLoS One 2012), while it is near-universal among the Muslim Hui/Uyghur minorities. Keep the two figures distinct — the 14% is not a Han figure.","Han majority: the intact penis is the norm; circumcision is uncommon and overwhelmingly MEDICAL (most for phimosis/tight foreskin — 81.6% in one Beijing MSM sample; Ruan et al. 2009), not ritual. Ritual/infant circumcision \"is not traditional in China except among Muslims (\u003C3% of population)\".","Muslim minorities / Xinjiang: circumcision is a long-standing Islamic religious practice among the Hui and Uyghur; residence in Xinjiang is an independent predictor of circumcision willingness (OR 3.69; Yang 2012). (The Muslim-influence mechanism is the authors' hypothesis, framed neutrally and factually.)","Device export: China invented the Shang Ring (Shang Jianzhong / Wuhu Snnda), WHO-prequalified in June 2015 and adopted into African VMMC/HIV-prevention programmes (~2M procedures worldwide by 2022). Sex-education-gap score M9 = 65 (editorial composite, 0–100, higher = larger gap): conservative, uneven formal sex education.","HIV context: low prevalence (~0.2%) but a large-absolute-numbers epidemic now dominated by sexual transmission (China CDC Weekly 2024, four-phase evolution). China ran domestic VMMC research — the 2024 CoM Study RCT found efficacy among predominantly-insertive MSM — but VMMC is not a general-population programme. Exact UNAIDS % not pinned in this pass.",{"iso3":1100,"isoNumeric":1101,"name":1102,"region":767,"circumcisionRatePct":1103,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"DOM","214","Dominican Rep.",13,{"iso3":1105,"isoNumeric":1106,"name":1107,"region":284,"circumcisionRatePct":1103,"adultPrevalencePct":592,"plhivPer1000":1108,"newInfectionsPer1000":1109,"onTreatmentPct":15,"childPrevalencePct":286,"hivYear":69,"hivSource":32,"epidemicGrowthPct":993,"sexEducationGapScore":524,"preventionContextScore":680,"policyEnvironmentScore":398,"stigmaIndex":10,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1110,"profileSources":1111,"isFallback":40},"THA","764","Thailand",7.8,0.23,"Childhood (Muslim minority)",[1112,1113],"Most Thai men are intact; circumcision largely confined to the Muslim minority in the south as a religious practice (\"sunat\").","Not medically necessary: no national medical recommendation for routine circumcision.",{"iso3":1115,"isoNumeric":1116,"name":1117,"region":92,"circumcisionRatePct":967,"adultPrevalencePct":592,"plhivPer1000":1118,"newInfectionsPer1000":1119,"onTreatmentPct":523,"childPrevalencePct":896,"hivYear":69,"hivSource":32,"epidemicGrowthPct":666,"sexEducationGapScore":553,"preventionContextScore":19,"policyEnvironmentScore":922,"stigmaIndex":126,"legalStatus":33,"routineInfant":115,"medicalNecessity":71,"avgAge":1120,"profileSources":1121,"isFallback":40},"RUS","643","Russia",8.2,0.36,"Muslim minorities: childhood (Islamic rite); Jewish: 8th day (brit milah); ethnic-Russian majority: rare/intact-norm",[1122,1123,1124,1125,1126],"Prevalence: ~11.8% national (Morris et al. 2016) — but this is a MODELED ESTIMATE, not a survey: the method sums Jewish + Muslim males assuming ~99.9% circumcision where direct data are absent. So the national figure literally IS the minority-community aggregate; it is NOT evidence of any general-population norm. No peer-reviewed Russia-specific survey of male circumcision appears to exist.","Distribution: effectively rare among the ethnic-Russian Orthodox/secular majority — the Russian Orthodox Church neither requires nor practises circumcision; the intact penis is the cultural norm. Regional Orthodox-majority neighbours are far lower in the same study (Ukraine ~2.3%, Belarus ~0.32%), underscoring that Russia's 11.8% is driven by its specific Muslim and Jewish populations.","Muslim minorities: near-universal as the Islamic rite (sünnet / khitan) among the North Caucasus peoples (Chechnya, Dagestan, Ingushetia) and the Volga-Ural Tatars (~6.6M) and Bashkirs (~1.57M); \"strictly observed\", persisting through Soviet state atheism as an ethnic-identity marker. Russia's Muslim share is contested (~7% to ~14%+; ~15–25M at maximalist counts). Region-level rates are qualitative, not quantified.","Jewish community (~250,000): brit milah on the 8th day, near-universal among the observant. Soviet policy suppressed ritual circumcision (medical-grounds only), creating a post-1990 adult-circumcision backlog. (Treated strictly as established religious custom; framed neutrally.)","HIV counterpoint: Russia has one of the world's fastest-growing HIV epidemics (IDU- then heterosexual-driven, low ART coverage) yet has REJECTED harm reduction (OST illegal, needle exchange rejected) and assigns NO role to VMMC — Russia is not a WHO VMMC-priority country. Circumcision is absent from Russian HIV policy; NO causal link between low circ and the epidemic is claimed.",{"iso3":1128,"isoNumeric":1129,"name":1130,"region":767,"circumcisionRatePct":967,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"TTO","780","Trinidad and Tobago",{"iso3":1132,"isoNumeric":1133,"name":1134,"region":767,"circumcisionRatePct":1135,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"JAM","388","Jamaica",10,{"iso3":1137,"isoNumeric":1138,"name":1139,"region":284,"circumcisionRatePct":1135,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"TLS","626","Timor-Leste",{"iso3":1141,"isoNumeric":1142,"name":1143,"region":284,"circumcisionRatePct":1135,"adultPrevalencePct":1144,"plhivPer1000":1145,"newInfectionsPer1000":1146,"onTreatmentPct":625,"childPrevalencePct":169,"hivYear":69,"hivSource":32,"epidemicGrowthPct":922,"sexEducationGapScore":486,"preventionContextScore":727,"policyEnvironmentScore":306,"stigmaIndex":522,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"PNG","598","Papua New Guinea",1.5,11.3,1.05,{"iso3":1148,"isoNumeric":1149,"name":1150,"region":284,"circumcisionRatePct":1135,"adultPrevalencePct":29,"plhivPer1000":262,"newInfectionsPer1000":29,"onTreatmentPct":1151,"childPrevalencePct":286,"hivYear":69,"hivSource":32,"epidemicGrowthPct":682,"sexEducationGapScore":554,"preventionContextScore":523,"policyEnvironmentScore":523,"stigmaIndex":524,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"NPL","524","Nepal",77,{"iso3":1153,"isoNumeric":1154,"name":1155,"region":767,"circumcisionRatePct":1135,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"BLZ","084","Belize",{"iso3":1157,"isoNumeric":1158,"name":1159,"region":180,"circumcisionRatePct":1135,"adultPrevalencePct":1160,"plhivPer1000":1161,"newInfectionsPer1000":275,"onTreatmentPct":474,"childPrevalencePct":651,"hivYear":69,"hivSource":32,"epidemicGrowthPct":1162,"sexEducationGapScore":523,"preventionContextScore":805,"policyEnvironmentScore":523,"stigmaIndex":805,"legalStatus":33,"routineInfant":955,"medicalNecessity":71,"avgAge":1163,"profileSources":1164,"isFallback":40},"ZWE","716","Zimbabwe",9.8,78.3,-66,"VMMC: adolescents/adults (HIV program; age drift to boys 10–14); VaRemba/Shangaan minorities: adolescence (traditional rite); Shona/Ndebele majority: not practised",[1165,1166,1167,1168],"Baseline: Zimbabwe is a traditionally NON-circumcising country — only ~9–10% of men were circumcised pre-program (2010–11 DHS), among the lowest in East/Southern Africa. The Shona majority (~70%) and the Ndebele have no general circumcision tradition; only small minorities did. So the WHO VMMC program had a large \"gap\" to fill and had to CREATE demand in a non-circumcising society — and it repeatedly fell short of targets. Prevalence rose only modestly (e.g. ~9%→~14% in one district); cumulative VMMC volume is a better measure of reach than a recomputed national rate (no current ZIMPHIA MC% located).","THE CENTERPIECE — the VMMC program: adopted as a key HIV strategy in 2009 (after the WHO/UNAIDS 2007 recommendation), PEPFAR/Global-Fund-backed. Its rationale is the three African RCTs (Kenya/Uganda/South Africa, ~60% female-to-male reduction) — genuine, RCT-backed evidence in a severe generalized epidemic. TARGET SHORTFALL: the goal was ~1.3 million (80% of males 13–29) by 2017, but only ~204,000 were reached by end-2013 (~16% of target) and ~1.14 million by mid-2018 (years late); COVID cut 2020 volume ~80%. Zimbabwe was a major adopter of the PrePex device (discontinued Dec 2016 over rare fatal tetanus) and ran an early-infant-MC (EIMC) component (AccuCirc/Mogen, not PrePex).","BODILY-AUTONOMY LENS (load-bearing): the proven VMMC benefit is adult, female-to-male, heterosexual ONLY — it does not protect women or men in male-to-male transmission, and the RCT evidence is for voluntary ADULT uptake, not infants/minors. Yet the program substantially targeted adolescents/minors (by end-2013, 29% of VMMCs were boys aged 10–14), and demand-creation used outreach/school campaigns and incentives — raising consent/voluntariness concerns; EIMC extends the rationale to neonates who cannot consent. THE KEY HARM SIGNAL: AGE-GRADED adverse events — boys 10–14 had ~double the AE rate of adult men (18.00 vs 9.03 per 10,000) and were most prone to rare severe outcomes (fistula, glans injury) — the safety basis for PEPFAR's 2019 shift toward restricting VMMC to ages 15+.","Traditional/religious circumcision is confined to minorities: the VaRemba (Remba/Lemba, ~80,000, claimed Judaic heritage; secretive mountain initiation camps in Mberengwa/Midlands) and the Shangaan/Tsonga (Chiredzi/Mwenezi). HIV: a severe GENERALIZED epidemic — adult prevalence peaked ~26.5–29% around 1997 and fell to ~9.8% now, but the major decline was BEHAVIOUR-driven and PRE-DATES VMMC (the program began only in 2009). VMMC is genuine RCT-backed adult HIV-prevention policy here, presented with the autonomy caveats. FGM is not part of Zimbabwe's circumcision picture. Sex-ed/other composite scores omitted.",{"iso3":1170,"isoNumeric":1171,"name":1172,"region":284,"circumcisionRatePct":1135,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"LKA","144","Sri Lanka",{"iso3":1174,"isoNumeric":1175,"name":1176,"region":284,"circumcisionRatePct":1177,"adultPrevalencePct":29,"plhivPer1000":1178,"newInfectionsPer1000":1179,"onTreatmentPct":680,"childPrevalencePct":14,"hivYear":31,"hivSource":725,"epidemicGrowthPct":1180,"sexEducationGapScore":524,"preventionContextScore":707,"policyEnvironmentScore":126,"stigmaIndex":10,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1181,"profileSources":1182,"isFallback":40},"JPN","392","Japan",9,0.24,0.008,-18,"Adulthood (elective cosmetic); no infant/rite tradition",[1183,1184,1185,1186,1187],"Prevalence: ~9% (Morris et al. 2016, Population Health Metrics) — derived from Yamagishi et al. 2012 (Sex Transm Infect; 9.0%, 17 of 188 adult men, Kanagawa), NOT a religious extrapolation. A modelled estimate from a single self-report survey, not a national census. Low-prevalence.","No tradition: Japan has no routine infant, religious or rite-of-passage circumcision — \"neonatal circumcision has never been mandatory and no official records are provided\" (Castro-Vázquez, Sociology 2013). The intact penis is the cultural norm.","Cosmetic framing: where adult men are circumcised it is overwhelmingly elective surgery at private beauty/aesthetic clinics, framed around masculinity and self-confidence, not disease prevention — \"references to circumcision as a procedure for disease prevention were almost completely absent\" (Castro-Vázquez, Cult Health Sex 2013, n=26 qualitative).","Conservative pediatric norm: Japanese pediatric urology favours nonoperative foreskin care — physiological non-retractability resolves by adolescence (retractable rose 0%→62.9% by ages 11–15; Kayaba et al., J Urol 1996), making circumcision for it unnecessary (Hayashi et al., Urology 2010).","Sex-education-gap score (M9 = 55, editorial composite, 0–100 where higher = larger gap): Japan has limited formal sex education and a documented phimosis-misinformation problem (~80% of men worry about phimosis while \u003C0.1% need surgery) exploited by cosmetic clinics — a real information gap. HIV very low (0.006–0.115%); circumcision is not part of any health strategy.",{"iso3":1189,"isoNumeric":1190,"name":1191,"region":284,"circumcisionRatePct":1177,"adultPrevalencePct":1192,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":217,"hivSource":1193,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1194,"profileSources":1195,"isFallback":40},"TWN","158","Taiwan",0.15,"Taiwan CDC","Older boys / adults (medical — phimosis, balanitis, redundant prepuce); NOT neonatal/ritual; tiny Muslim minority childhood",[1196,1197,1198,1199,1200],"Prevalence: ~7–9% in school-age boys — DIRECTLY MEASURED (Ko et al. 2007: 7.2% at age 7 to 8.7% at age 13, in 1,145 boys). The dataset's 9% sits at the top of that range and is sound. Neonatal/ritual circumcision is essentially negligible. NB: do NOT attribute a Taiwan figure to \"Morris 2016\" — no such citation was verified; Taiwan is often absent from or folded into \"East Asia \u003C20%\" in global models. A secondary adult ~10–15% projection exists but is weak — treat as approximate.","Medical-not-ritual (the decisive feature): as in mainland China and the wider Sinitic sphere, circumcision is foreign to the Han majority (~95% of Taiwan) — the intact penis is the norm — and what circumcision occurs is overwhelmingly THERAPEUTIC (phimosis, recurrent balanitis/balanoposthitis, redundant prepuce), typically performed on older boys or adults rather than as neonatal ritual. Taiwan's NHI research database tracks circumcision as a phimosis-coded procedure (a nationwide study found elevated circumcision risk in diabetic men).","Conservative-management note: Taiwan's pediatric-urology literature documents that non-retractable foreskin (physiologic phimosis) is near-universal at birth and self-resolves with age (full retractability ~84% by age 13), so true pathologic phimosis needing surgery is uncommon — an implicit caution against over-treating physiologic phimosis. (This is an inference from the clinical literature, not a documented named public controversy.)","Minority: the only group with a religious circumcision tradition is a tiny Muslim minority (~0.2–0.3% of Taiwan — roughly 60,000 local Hui/mainlander-descendant Muslims plus 250,000+ foreign Muslim workers, mostly Indonesian). No circumcision rate for that minority is documented; treated neutrally and qualitatively; not generalised to the national picture.","HIV (Taiwan CDC — Taiwan is EXCLUDED from UNAIDS/UN datasets for political reasons): a LOW, CONCENTRATED, MSM-dominated epidemic — population prevalence ~0.13–0.16% (Taiwanese back-calculation, ~158/100,000 in 2019), with MSM ~82% of 2024 diagnoses and MSM-subpopulation prevalence ~4.3% (2013–15, declining). New diagnoses have fallen for years. The response is PrEP + treatment-as-prevention/U=U + testing (90-90-90 met ~2020; elimination modelled by 2030 via PrEP); circumcision/VMMC plays NO role. Sex-ed/other composite scores omitted.",{"iso3":1202,"isoNumeric":1203,"name":1204,"region":767,"circumcisionRatePct":923,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"PAN","591","Panama",{"iso3":1206,"isoNumeric":1207,"name":1208,"region":92,"circumcisionRatePct":923,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"BGR","100","Bulgaria",{"iso3":1210,"isoNumeric":1211,"name":1212,"region":180,"circumcisionRatePct":923,"adultPrevalencePct":1213,"plhivPer1000":1214,"newInfectionsPer1000":1215,"onTreatmentPct":474,"childPrevalencePct":9,"hivYear":69,"hivSource":32,"epidemicGrowthPct":969,"sexEducationGapScore":524,"preventionContextScore":522,"policyEnvironmentScore":664,"stigmaIndex":664,"legalStatus":33,"routineInfant":263,"medicalNecessity":71,"avgAge":1216,"profileSources":1217,"isFallback":40},"SWZ","748","Eswatini",26,177,3.9,"VMMC programme (Soka Uncobe ASI 2011): adult-focused, 15-49; earlier 2009-2013 strategy also targeted 111,688 aged 15-24 and 33,000 neonates. Traditional: variable clan-based practices — no nationally uniform male initiation rite (in contrast to Lesotho lebollo or Malawi jando). Post-VMMC nationally representative prevalence not verified (SHIMS data gap).",[1218,1219,1220,1221],"Prevalence: 8.2% (95% CI 7.4-9.1) nationally representative 2006-07 DHS (PMC4067410; confirmed PMC10936832 systematic review 2024). This is the pre-VMMC baseline. The 9.60% EDHS 2006 figure (PMC10911536) is a minor weighting variation on the same dataset — not contradictory. Regional post-VMMC gain: Shiselweni region 49.4% (95% CI 44.6-54.2) by 2018 — NOT nationally representative. The claim that national prevalence rose to 27.82% by 2016 was refuted (0-3) in adversarial verification. SHIMS survey circumcision data (2011, 2016-17) was specifically sought but no verified figure emerged — honest gap.","VMMC programme — Soka Uncobe ASI: Eswatini launched the Accelerated Saturation Initiative (ASI, branded 'Soka Uncobe') in 2011, targeting 80% of males aged 15-49 within one year — the most aggressive VMMC saturation target in Africa. This followed the 2009-2013 national Strategy and Implementation Plan (target: 144,688 HIV-negative males: 111,688 aged 15-24 plus 33,000 neonates). Soka Uncobe 2011 campaign: 9,862 circumcisions at 29 clinics; 84.2% (8,306) returned for follow-up within 7 days; overall AE rate 4.1% (341/8,306 follow-up returners); severity: mild 46.0% (157 cases), moderate 47.8% (163 cases), severe 6.2% (21 cases). Rural Luke Commission NGO programme: 2.1% AE (31/1,500; forceps-guided, local block anesthesia; infection, bleeding, dehiscence). Eswatini is one of 15 WHO/UNAIDS VMMC priority countries (South Sudan joined in 2018).","Traditional context: Swazi culture historically had variable, clan-based circumcision practices — no nationally uniform male initiation ceremony comparable to Lesotho's lebollo or Malawi's Yao jando. The very low 8.2% pre-VMMC baseline reflects this cultural non-uniformity. No traditional-setting circumcision harm cases specifically attributed to Eswatini were verified in indexed literature — honest evidence gap. The regional comparator for severe traditional circumcision harm in southern Africa is Eastern Cape (South Africa): OR Tambo district, June 2013 season: 26 deaths, 24 amputations, 259 hospital admissions.","Legal and HIV: No Eswatini statute specifically regulates or prohibits non-therapeutic male circumcision — UNREGULATED (absence of evidence; national VMMC strategy = programme framework, not statute). FGM in Eswatini is a completely separate female issue — strictly separate, never conflated. HIV adult prevalence ~26% (UNAIDS 2024), the highest in the world. Eswatini is one of 15 WHO/UNAIDS VMMC priority countries. VMMC is one component of combination HIV prevention — no circ↔HIV causal claim. PHIA pooled data (2015-17, 8 countries including Eswatini): statistically significant incidence difference in medically circumcised vs uncircumcised men aged 15-34 (0.04% vs 0.34%, P=0.01); no protective association in men aged 35-59 (reversed, P=0.14, nonsignificant).",{"iso3":1223,"isoNumeric":1224,"name":1225,"region":92,"circumcisionRatePct":923,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"SRB","688","Serbia",{"iso3":1227,"isoNumeric":1228,"name":1229,"region":1005,"circumcisionRatePct":923,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"LUX","442","Luxembourg",{"iso3":1231,"isoNumeric":1232,"name":1233,"region":1005,"circumcisionRatePct":1234,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1235,"profileSources":1236,"isFallback":40},"NLD","528","Netherlands",7,"Muslim minority (Turkish/Moroccan): childhood ~5–7; Jewish: 8th day (brit milah, ~50/yr); secular majority: not practised (intact norm)",[1237,1238,1239,1240],"Prevalence is low — ~5.7% national (Morris et al. 2016, modeled; the dataset's ~7% is compatible) — present as ~6% / low single digits, consistent with Western European norms. The intact penis is the secular-majority norm. KEY DISTINCTION: low national prevalence ≠ near-universal minority practice — the Amsterdam HELIUS study reportedly found ~9% circumcision among Dutch men without a migration background versus >95% among men of Moroccan, Turkish or Ghanaian background (split is via a tertiary table — flag).","THE CENTERPIECE — the KNMG 2010 viewpoint: the Royal Dutch Medical Association (KNMG) adopted \"Non-therapeutic circumcision of male minors\" (27 May 2010), condemning the practice as conflicting with the child's rights to autonomy and physical (bodily) integrity — \"a violation of the integrity of the body\" — finding no convincing medical justification, citing real complication risks, and recommending the procedure be deferred until the boy can decide for himself. Coalition-endorsed by Dutch specialist colleges (urology NVU, GPs NHG, paediatrics NVK, surgeons NVvH, paediatric & plastic surgery). One of the strongest medical-association stances in the world.","THE CRUCIAL NUANCE: the KNMG said there are \"good reasons for a legal prohibition\" in principle (an ethical-consistency comparison with the existing FGM ban) BUT deliberately recommended AGAINST an actual ban — judging prohibition counterproductive (it would drive the practice underground into unqualified settings, causing more serious harm) — opting instead for strong discouragement + dialogue, performed only by qualified doctors. Circumcision therefore remains LEGAL in the Netherlands; the KNMG stance is professional/ethical, NOT law. (Contrast: Germany legislated §1631d in 2012 to PERMIT it; the Dutch route was professional discouragement, no legislation.)","Religious/minority context: circumcision is concentrated in the Muslim (Turkish/Moroccan-origin, boys ~5–7) and Jewish (brit milah, infants, ~50/yr) communities plus some African-Christian migrant groups — established religious custom there. The KNMG's children's-rights position is in live tension with religious-freedom claims; periodic Dutch POLITICAL ban proposals (e.g. a 2014 party-youth-division push to ban brit milah) are distinct from the KNMG stance. HIV: low (~0.2%), concentrated in MSM (~8.3% of MSM HIV-positive in 2012 vs ~0.06% in pregnant women); circumcision/VMMC plays no role and the Netherlands is not a VMMC country. Sex-ed/other composite scores omitted.",{"iso3":1242,"isoNumeric":1243,"name":1244,"region":767,"circumcisionRatePct":1234,"adultPrevalencePct":1245,"plhivPer1000":1246,"newInfectionsPer1000":1247,"onTreatmentPct":1248,"childPrevalencePct":939,"hivYear":69,"hivSource":32,"epidemicGrowthPct":1177,"sexEducationGapScore":523,"preventionContextScore":291,"policyEnvironmentScore":994,"stigmaIndex":666,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1249,"profileSources":1250,"isFallback":40},"BRA","076","Brazil",0.7,5.2,0.47,73,"Childhood (medical, phimosis) + secondary peak after age 60; no infant/rite tradition",[1251,1252,1253,1254,1255],"Prevalence: low and contested. ~7% (UNAIDS JC1360, from Castellsague et al., Am J Epidemiol 2005 — a small non-representative sample of male partners in a cervical-cancer study) is the most-cited figure; a separate SUS administrative figure is ~1.3% MEDICALLY-indicated circumcision over 1984–2010 (Korkes et al., Einstein 2012) — a public-system medical figure, NOT overall prevalence. No Latin American country exceeds 20%.","No tradition: the intact penis is the cultural norm; there is no continuing religious/cultural mass-circumcision tradition (pre-Columbian Aztec/Maya practice largely disappeared after the conquest). Religious/prophylactic circumcision \"is not widely performed, and never in the public health system for these indications\" (Korkes 2012).","Medical/SUS: where it happens it is therapeutic — phimosis, paraphimosis, balanoposthitis, balanitis xerotica obliterans, preputial neoplasia, frenulum lacerations. SUS performed 668,818 medical circumcisions over 1984–2010 (47.8/100,000 men/yr; Korkes 2012), funding it ONLY for medical indications. Bimodal age (childhood + post-60).","Sex-education-gap score (M9 = 50, editorial composite, 0–100 where higher = larger gap): Brazil has formal but uneven, politically-contested sex education; a mid-range gap.","HIV context: low (~0.4% general population, MoH 2020; ~0.6–0.7% adult 15–49, UNAIDS), nationally stable, concentrated epidemic. Brazil's celebrated response centres on ART + PrEP (in SUS since Jan 2018) + condoms + harm-reduction; VMMC is NOT part of it — WHO scopes VMMC to 15 generalized-epidemic priority countries in East/Southern Africa, not Brazil.",{"iso3":1257,"isoNumeric":1258,"name":1259,"region":1005,"circumcisionRatePct":1260,"adultPrevalencePct":937,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":725,"epidemicGrowthPct":30,"sexEducationGapScore":966,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":1026,"routineInfant":115,"medicalNecessity":71,"avgAge":1261,"profileSources":1262,"isFallback":40},"DEU","276","Germany",6.7,"Infancy/childhood (religious minorities); rare among the secular majority",[1263,1264,1265,1266],"Prevalence: best estimate ~6.7% of German males circumcised — Morris et al. ERRATUM (Population Health Metrics, PMC4820865) correcting the originally-published 10.9%/~11% figure, which was a known error drawn from a survey of males aged 1–17; the 6.7% comes from a survey of 2,490 men aged 30–61. Concentrated in Muslim and Jewish minorities; rare among the secular Christian-heritage majority. (Single general-population survey estimate, not a German census.)","Legal context: the 2012 Cologne ruling (Landgericht Köln, 7 May 2012, 151 Ns 169/11) held non-therapeutic minor circumcision is criminal bodily harm; the Bundestag responded with §1631d BGB (in force 28 Dec 2012) explicitly permitting it under conditions. See the de write-up + legal entry.","Sex-education-gap score (M9 = 25, editorial composite, 0–100 where higher = larger gap): Germany has comprehensive, mandatory, secular school sex education and high health literacy; the low score reflects a small information gap.","HIV context: low-prevalence country — the Robert Koch Institut estimated ~96,700 people living with HIV at end-2023 and ~2,200 new infections, a concentrated (mainly MSM) epidemic. Circumcision is not promoted for HIV prevention; prevention is PrEP, condoms, testing and treatment-as-prevention. adultPrevalencePct ~0.14% is a national estimate, not a UNAIDS model.",{"iso3":1268,"isoNumeric":1269,"name":1270,"region":1005,"circumcisionRatePct":898,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"CHE","756","Switzerland",{"iso3":1272,"isoNumeric":1273,"name":1274,"region":1005,"circumcisionRatePct":898,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"AUT","040","Austria",{"iso3":1276,"isoNumeric":1277,"name":1278,"region":1005,"circumcisionRatePct":1279,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":1026,"routineInfant":773,"medicalNecessity":71,"avgAge":1280,"profileSources":1281,"isFallback":40},"SWE","752","Sweden",5,"Muslim minority: childhood ~\u003C10; Jewish: 8th day (brit milah, ~40/yr); secular majority: not practised (intact norm)",[1282,1283,1284,1285],"Prevalence: low (~5%; Morris 2016 low-European band) — circumcision is not a Swedish cultural/national norm and is concentrated in religious minorities. The often-cited volume is ~3,000 non-therapeutic circumcisions per year, overwhelmingly on Muslim boys, versus only ~40 Jewish boys/yr (brit milah on the 8th day) — figures from The Lancet (2002), restated in the US State Dept 2023 religious-freedom report. Distinguish the low NATIONAL rate from the near-universal practice within these minorities.","THE CENTERPIECE — the 2001 Circumcision Act (Lag (2001:499) om omskärelse av pojkar, in force 1 Oct 2001): Sweden was the FIRST Western country to pass a law specifically REGULATING non-therapeutic male circumcision — it REGULATES, it does NOT ban. Core provisions: (1) a two-tier provider rule by age — for a boy UNDER 2 MONTHS a Socialstyrelsen-certified non-medical person (e.g. a mohel) may perform it (or a doctor), but for a boy OVER 2 MONTHS only a licensed physician may; (2) MANDATORY anaesthesia/pain relief in ALL cases, administered by a physician or nurse; (3) hygienic conditions + the child's best interest; (4) the boy's own view must be ascertained and the procedure may not be done against his will if he is mature enough; (5) penalty of fine or up to 6 months' imprisonment for unauthorised performance. Passed to make ritual circumcision SAFER — regulating rather than banning. (Threshold is 2 MONTHS — the \"2 years\" figure in some mirrors is wrong.)","THE BAN DEBATE — proposals, NOT law: Sweden has repeatedly debated restricting/banning non-therapeutic circumcision of minors, but NONE has been enacted (the 2001 Act remains the only operative law). The Swedish Medical Association ethics council recommended a minimum age ~12 with the boy's consent (~2014); the Children's Ombudsman called for a ban pending the boy's consent (2013); Sweden Democrats + the Left Party backed an under-18 age limit (2018); a Centre Party congress voted 314–166 to work toward a ban (Oct 2019, over the leader's objection; reportedly reversed ~2021). Strong Jewish/Muslim opposition (religious-continuity/emigration concerns). The religious-freedom-vs-children's-rights tension is presented neutrally; a proposed ban is not a ban.","HIV: very low prevalence (~0.1%), a concentrated epidemic among MSM and migrants (~80% of those diagnosed acquired HIV abroad); Sweden meets/surpasses the UNAIDS 95-95-95 targets with low, declining incidence. Circumcision/VMMC plays no role (a sub-Saharan strategy irrelevant to a low-prevalence high-income country) — no circ↔HIV claim. FGM is separately criminalised (Sweden's 1982 FGM-prohibition law) and kept strictly separate. Sex-ed/other composite scores omitted.",{"iso3":1287,"isoNumeric":1288,"name":1289,"region":92,"circumcisionRatePct":1279,"adultPrevalencePct":519,"plhivPer1000":1290,"newInfectionsPer1000":30,"onTreatmentPct":522,"childPrevalencePct":1091,"hivYear":31,"hivSource":32,"epidemicGrowthPct":726,"sexEducationGapScore":522,"preventionContextScore":625,"policyEnvironmentScore":924,"stigmaIndex":664,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"UKR","804","Ukraine",6.4,{"iso3":1292,"isoNumeric":1293,"name":1294,"region":1005,"circumcisionRatePct":1279,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":725,"epidemicGrowthPct":30,"sexEducationGapScore":991,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":1295,"routineInfant":773,"medicalNecessity":71,"avgAge":1296,"profileSources":1297,"isFallback":40},"DNK","208","Denmark","REFORM_PROPOSED","Infancy/childhood (religious minorities); rare among ethnic Danes",[1298,1299,1300,1301],"Prevalence: ~5% of Danish men circumcised overall, only 4.5% among Lutheran/non-religious (ethnic-Danish) men — Frisch, Lindholm & Grønbæk, \"Male circumcision and sexual function in men and women,\" International Journal of Epidemiology 2011;40(5):1367–81 (n=5,552); the 4.5% ethnic-Danish figure is also cited in Morris et al. 2016 (Population Health Metrics). Non-medical circumcision is concentrated in Muslim and Jewish minorities.","Boys/age: Frisch & Simonsen 2015 (J R Soc Med) found 3,347 of 342,877 boys (0.98%) ritually circumcised — 10.9% in Muslim families vs 0.14% in non-Muslim families. The 0.98% is a registered-procedure floor for under-10s, not adult-male prevalence, and may undercount procedures done outside the medical system.","Sex-education-gap score (M9 = 20, editorial composite, 0–100 where higher = larger gap): Denmark has long-established, comprehensive, secular school sex education and high health literacy; the low score reflects a small information gap. Circumcision is rare and not a routine medical default here.","HIV context: low-incidence country — Statens Serum Institut reported 110 newly diagnosed domestic HIV cases in 2023 and 103 in 2024 (~1.7–1.9 per 100,000 in a ~6M population). SSI lists PrEP, condoms, testing, TasP and PEP as prevention; circumcision is not mentioned. adultPrevalencePct ~0.1% is a small national estimate, not a UNAIDS model.",{"iso3":1303,"isoNumeric":1304,"name":1305,"region":284,"circumcisionRatePct":1279,"adultPrevalencePct":56,"plhivPer1000":1306,"newInfectionsPer1000":521,"onTreatmentPct":1307,"childPrevalencePct":250,"hivYear":229,"hivSource":32,"epidemicGrowthPct":1308,"sexEducationGapScore":664,"preventionContextScore":664,"policyEnvironmentScore":524,"stigmaIndex":639,"legalStatus":1026,"routineInfant":773,"medicalNecessity":71,"avgAge":1309,"profileSources":1310,"isFallback":40},"VNM","704","Vietnam",2.5,54.1,-42,"N/A (medical only)",[1311,1312],"Rare (~5.6% clinical study / ~0.2% modelled); no cultural or religious tradition. Done only for a medical reason (e.g. phimosis).","Hospital-only by regulation (MOH Circular 50/2014/TT-BYT, applied as a Type-3 surgery).",{"iso3":1314,"isoNumeric":1315,"name":1316,"region":1005,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"GRC","300","Greece",{"iso3":1318,"isoNumeric":1319,"name":1320,"region":92,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"GEO","268","Georgia",{"iso3":1322,"isoNumeric":1323,"name":1324,"region":284,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"MNG","496","Mongolia",{"iso3":1326,"isoNumeric":1327,"name":1328,"region":767,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"HND","340","Honduras",{"iso3":1330,"isoNumeric":1331,"name":1332,"region":284,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"BTN","064","Bhutan",{"iso3":1334,"isoNumeric":1335,"name":1336,"region":767,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"SLV","222","El Salvador",{"iso3":1338,"isoNumeric":1339,"name":1340,"region":850,"circumcisionRatePct":1279,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":1341,"hivSource":1342,"epidemicGrowthPct":30,"sexEducationGapScore":1033,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":1026,"routineInfant":773,"medicalNecessity":71,"avgAge":1343,"profileSources":1344,"isFallback":40},"NOR","578","Norway","2025","FHI/NIPH","No statutory minimum; hospitals imposed informal 1-2 year minimums despite the 2014 Act; Muslim community primarily early childhood; Jewish community ~7 per year",[1345,1346,1347,1348],"Prevalence: ~5% population-level estimate reflecting almost exclusively the Muslim minority (~3-5% of population). ~2,000 ritual circumcisions/year (pre-2015 Directorate of Health estimate); ~7/year in Jewish community in Oslo (~700 members). No tradition among Lutheran majority.","Legal: 2014 Circumcision Act (Omskjaering av gutter, in force 1 January 2015): licensed physician must be present and take medical responsibility; trained non-physician (e.g. mohel) may physically perform; mandatory anaesthesia before/during/after; both parents with parental responsibility must consent; prohibited against the boy's expressed will; boys 12+ must be informed; boys 18+ decide independently.","Implementation resistance: Despite the Act obligating all health regions to provide the service, hospitals imposed de facto age minimums of 1-2 years (some up to 3 years) and majorities of urologists at some hospitals filed written objections (e.g. 13 of 15 urologists at Akershus University Hospital). No conscience clause exists in the statute.","HIV: FHI (Norwegian Institute of Public Health) 2025: ~5,500 PLHIV; 96.5% diagnosed; 13 new domestic infections in 2023; MSM 58% of new domestic cases. Norway achieved UNAIDS 95-95-95 targets. Epidemic not related to circumcision.",{"iso3":1350,"isoNumeric":1351,"name":1352,"region":1005,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"HRV","191","Croatia",{"iso3":1354,"isoNumeric":1355,"name":1356,"region":767,"circumcisionRatePct":1279,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"CRI","188","Costa Rica",{"iso3":1358,"isoNumeric":1359,"name":1360,"region":284,"circumcisionRatePct":1279,"adultPrevalencePct":169,"plhivPer1000":678,"newInfectionsPer1000":1091,"onTreatmentPct":288,"childPrevalencePct":286,"hivYear":229,"hivSource":32,"epidemicGrowthPct":1361,"sexEducationGapScore":522,"preventionContextScore":994,"policyEnvironmentScore":522,"stigmaIndex":666,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1362,"profileSources":1363,"isFallback":40},"KHM","116","Cambodia",-62,"Cham Muslim minority: childhood–adolescence (~age 6–15, Islamic rite); Khmer Buddhist majority: not practised (intact norm)",[1364,1365,1366,1367],"Prevalence: ~3–5% national (Morris et al. 2016 models ~3.5%) — a MODELED estimate from an advocacy-leaning author, not a survey; treat as a range. Cambodia is an intact-norm country: the ~97% Theravada Buddhist Khmer majority does not circumcise, and the small national figure essentially IS the Cham Muslim minority rite plus a little medical circumcision. Do not generalise circumcision to the Cambodian population.","Cham Muslim minority: circumcision (khitan) is a Sunni Shafi'i religious rite (treated as obligatory in that school), performed roughly age 6–15. Muslims — overwhelmingly ethnic Cham — are a small minority (~1–2%; ~236,000 in 2009 / ~311,045 in the 2019 census; concentrations up to ~11.8% in Tboung Khmum). Intra-Cham practice varies — the syncretic \"Cham Sot\" reportedly perform a symbolic foreskin incision rather than full circumcision (moderate confidence).","Cham history (neutral context): the Cham descend from the kingdom of Champa and follow a partly syncretic Sunni Islam. Under the Khmer Rouge (1975–79) they suffered severe targeted persecution (mosques destroyed, religion forbidden) — a contested death-toll range of 90,000–500,000 — followed by a post-1979/1990s Islamic revival. Treated strictly as established religious custom; no political statement.","HIV — THE KEY CONTEXT: Cambodia is one of the world's most celebrated HIV SUCCESS STORIES, reversing one of Asia's worst 1990s epidemics (peak ~1.7% adult, 1998) to well under 1% today and becoming the first Asia-Pacific country to reach the 95-95-95 targets — achieved WITHOUT male circumcision/VMMC, through the 100% Condom Use Programme, testing (VCCT), ART scale-up and later PrEP. Cambodia is NOT a WHO VMMC-priority country. Sex-education-gap score is an editorial composite.",{"iso3":1369,"isoNumeric":1370,"name":1371,"region":1005,"circumcisionRatePct":1372,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"SVK","703","Slovakia",4,{"iso3":1374,"isoNumeric":1375,"name":1376,"region":1005,"circumcisionRatePct":1372,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"PRT","620","Portugal",{"iso3":1378,"isoNumeric":1379,"name":1380,"region":1005,"circumcisionRatePct":1372,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"ESP","724","Spain",{"iso3":1382,"isoNumeric":1383,"name":1384,"region":1005,"circumcisionRatePct":1372,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"HUN","348","Hungary",{"iso3":1386,"isoNumeric":1387,"name":1388,"region":1005,"circumcisionRatePct":1372,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"SVN","705","Slovenia",{"iso3":1390,"isoNumeric":1391,"name":1392,"region":1005,"circumcisionRatePct":1372,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"CZE","203","Czechia",{"iso3":1394,"isoNumeric":1395,"name":1396,"region":284,"circumcisionRatePct":1372,"adultPrevalencePct":1245,"plhivPer1000":951,"newInfectionsPer1000":169,"onTreatmentPct":1151,"childPrevalencePct":896,"hivYear":31,"hivSource":32,"epidemicGrowthPct":1308,"sexEducationGapScore":126,"preventionContextScore":625,"policyEnvironmentScore":306,"stigmaIndex":664,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1397,"profileSources":1398,"isFallback":40},"MMR","104","Myanmar","Muslim minority: childhood (Islamic rite khitan/khatna); Burman Buddhist majority: not practised (intact norm)",[1399,1400,1401,1402],"Prevalence (CORRECTED): ~3.5% (Morris et al. 2016) — the previously-stored 80% figure was a DATA ERROR (likely a row-swap with a Muslim-majority neighbour, or confusion with the WHO 80% VMMC COVERAGE TARGET used in African programmes). Myanmar is a Theravada-Buddhist-mainland country with an \"almost total absence\" of circumcision (Hull & Budiharsana 2001; WHO/UNAIDS 2007 lists it as \"uncommon\"), sitting in the global \"\u003C20%\" lowest band alongside Thailand, Cambodia, Laos, Vietnam, China and Japan. The ~3.5% is a MODELED estimate (≈ the Muslim-minority share), not a survey — the robust conclusion is simply \"LOW/uncommon\". Myanmar is data-poor (no DHS/MICS circumcision survey).","Cultural status: for the Burman Buddhist majority (~88%, 2014 census) — and for the Christian (~6%), animist and Hindu minorities — circumcision is foreign to the culture; the intact body is the norm. No circumcision tradition is attributed to any non-Muslim group.","The only circumcising community is the Muslim minority (~4% of the population, realistically ~5–6% once the largely-uncounted Rohingya are included), for whom circumcision (khitan/khatna) is the Islamic rite. Subgroups: the Rohingya (the largest Muslim community, concentrated in Rakhine State — a persecuted, genocide-affected minority, esp. the 2017 military \"clearance operations\"); the Kaman/Kamein (the only officially recognised indigenous Muslim group); the Panthay (Chinese Hui Muslims); and Indian/South Asian Burmese Muslims. Treated neutrally as established religious custom; within-minority practice ≈ the national share, so the two figures are effectively the same.","HIV: Myanmar has a LOW, declining, CONCENTRATED epidemic (national adult prevalence ~0.5–0.7%) with the burden on key populations — people who inject drugs (~19–35%; PWID-driven, hotspots in Kachin), MSM/transgender women (higher in Yangon/Mandalay), and female sex workers. Prevention is harm-reduction (needle/syringe, opioid substitution), condoms, testing and ART; circumcision/VMMC plays NO role and Myanmar is not a WHO VMMC-priority country. The Feb-2021 coup (and COVID) disrupted the HIV programme. Sex-ed-gap score is an editorial composite.",{"iso3":1404,"isoNumeric":1405,"name":1406,"region":1407,"circumcisionRatePct":1372,"adultPrevalencePct":571,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":1408,"profileSources":1409,"isFallback":40},"COL","170","Colombia","Latin America & Caribbean","No routine or religious circumcision; intact is the overwhelming norm. What circumcision exists is therapeutic (phimosis/recurrent balanitis/hygiene) at any age, or private elective; religious cutting confined to tiny Jewish/Muslim minorities",[1410,1411,1412,1413],"Prevalence: LOW — ~4.2% (Morris et al. 2016, Table 1), consistently below 20% (\"fewer than 20% of all men are circumcised\" — Gonzales et al. 2012), with cervical-cancer-study convenience samples as low as 7–11%. Best framed as \"low, single-digit to low-teens, well under 20%\" (the 4.2% is likely a method-inferred estimate, not a measured Colombian survey value). Circumcision is culturally foreign to the Catholic-heritage majority — there is no Catholic infant-circumcision tradition, and the intact penis is the overwhelming norm, consistent with the wider low-rate Latin-American region.","THE DISTINCTIVE ANGLE — intact-norm / elective-medical, with a CONSTITUTIONAL touchpoint + the Emberá-FGM disambiguation: what circumcision exists in Colombia is largely ELECTIVE/MEDICAL (phimosis, hygiene, sexual-function, recurrent balanitis) rather than a religious or infant tradition — in a Bogotá sample of 100 men who have sex with men (2010), only 15 were circumcised, of whom 6 were circumcised as ADULTS for health reasons. Religious circumcision is confined to tiny Jewish/Muslim minorities.","LAW / CONSTITUTIONAL touchpoint: Colombia has no statute mandating or banning non-therapeutic male circumcision. The one place it surfaced in constitutional review — Sentencia C-246/17, the Constitutional Court's review of Law 1799 of 2016 (which bans COSMETIC/aesthetic surgery on minors under 18) — circumcision appeared only as a religious-liberty OBJECTION raised by an intervenor (Universidad del Rosario), not as legislation on circumcision; the Court's modulated ruling (allowing procedures for adolescents 14+ with informed consent) did not address circumcision. Public-system (SGSSS/EPS) coverage being medical-indication-only is inferred, not a located policy text.","HIV: a CONCENTRATED epidemic (general adult prevalence ~0.5–0.7%) that is MSM-driven — HIV prevalence among men who have sex with men is ~15.1% across Colombia's seven largest cities (range 5.8% Cúcuta to 23.7% Cali; Bogotá ~12–16%), spanning the Andean, Pacific and Caribbean regions, vs ~0.45% in the general adult population. Circumcision plays NO role: Colombia is not a VMMC country, the epidemic is not generalised, and primary studies + UNAIDS regional reports recommend PrEP/PEP/self-testing/condoms while mentioning circumcision/VMMC ZERO times — no circ↔HIV protective claim applies. Sex-ed/other composite scores omitted.",{"iso3":1415,"isoNumeric":1416,"name":1417,"region":1407,"circumcisionRatePct":1372,"adultPrevalencePct":304,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":1418,"profileSources":1419,"isFallback":40},"PER","604","Peru","No routine or religious circumcision; intact is the overwhelming norm. What circumcision exists is therapeutic (phimosis/paraphimosis/recurrent infection) at any age, or private elective; religious cutting confined to tiny Jewish/Muslim minorities",[1420,1421,1422,1423],"Prevalence: LOW — ~3.7% (Morris et al. 2016, Table 1), far below the ~37–39% global average and fitting the Latin-American intact-norm pattern (Brazil 1.3%, Colombia 4.2%, Mexico 15.4%). Circumcision is culturally foreign to Peru's Catholic-heritage majority — there is no infant or religious circumcision tradition, and the intact penis is the overwhelming norm. (The 3.7% is a modelled estimate; notably, a LOW figure runs AGAINST the circumcision-advocacy-aligned lead author's bias and is independently corroborated.) Religious circumcision is confined to tiny Jewish and Muslim minorities.","THE DISTINCTIVE ANGLE — intact-norm + elective-medical, against the set's MOST CONCENTRATED HIV epidemic: what circumcision exists in Peru is framed clinically as a THERAPEUTIC surgical treatment for phimosis (plus paraphimosis and recurrent foreskin infections), not a routine or religious practice — within MINSA/EsSalud it is \"not part of routine protocol except for medical problems like phimosis or recurrent infections.\" Private clinics additionally offer it as ELECTIVE (personal/family preference), a small private/cosmetic dimension distinct from any tradition. (Private-clinic pages also carry an HIV-protection marketing line — that is unsupported and is NOT endorsed here.)","CLINICAL/MEDICAL practice: the therapeutic indication triad (phimosis / paraphimosis / recurrent infection) is the universal urological standard and is how Peruvian public (MINSA/EsSalud) and private providers describe circumcision. No religious/infant routine; uptake is medical or elective-private, with no quantified national procedure counts located (the rural-vs-urban split is undocumented in the verified sources).","HIV: Peru has a sharply CONCENTRATED epidemic — general-population prevalence is \u003C1%, but it is driven almost entirely by men who have sex with men (~10–22%) and TRANSGENDER WOMEN (~20–30%, reaching ~29.6%, and 41.5% among young trans women aged 16–24 in Lima), who together account for >50–60% of cases / new diagnoses (cisgender male partners of trans women form a partly separate transmission network). Circumcision plays NO role: Peru is a low-circumcision, non-VMMC country whose epidemic is anal-sex / key-population-driven, where the heterosexual VMMC evidence base does not apply — no circ↔HIV protective claim is made or implied. Sex-ed/other composite scores omitted.",{"iso3":1425,"isoNumeric":1426,"name":1427,"region":92,"circumcisionRatePct":1372,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"ROU","642","Romania",{"iso3":1429,"isoNumeric":1430,"name":1431,"region":767,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"URY","858","Uruguay",{"iso3":1433,"isoNumeric":1434,"name":1435,"region":92,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"MDA","498","Moldova",{"iso3":1437,"isoNumeric":1438,"name":1439,"region":92,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"LTU","440","Lithuania",{"iso3":1441,"isoNumeric":1442,"name":1443,"region":92,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"LVA","428","Latvia",{"iso3":1445,"isoNumeric":1446,"name":1447,"region":1005,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"ITA","380","Italy",{"iso3":1449,"isoNumeric":1450,"name":1451,"region":1005,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"IRL","372","Ireland",{"iso3":1453,"isoNumeric":1454,"name":1455,"region":767,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"NIC","558","Nicaragua",{"iso3":1457,"isoNumeric":1458,"name":1459,"region":767,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"HTI","332","Haiti",{"iso3":1461,"isoNumeric":1462,"name":1463,"region":92,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"EST","233","Estonia",{"iso3":1465,"isoNumeric":1466,"name":1467,"region":92,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"BLR","112","Belarus",{"iso3":1469,"isoNumeric":1470,"name":1471,"region":767,"circumcisionRatePct":13,"adultPrevalencePct":304,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1472,"profileSources":1473,"isFallback":40},"ARG","032","Argentina","Jewish minority: 8th day (brit milah, Buenos Aires); elective/medical (phimosis) at varying ages. Majority: not practised (intact norm)",[1474,1475,1476,1477],"Prevalence: ~2.9% (Morris et al. 2016) — among the LOWEST in the world; Argentina is one of the least-circumcised countries on Earth. A MODELED estimate (no national circumcision survey exists). Regional context confirms an intact-norm cluster: Brazil ~1.3%, Chile ~0.21%, Uruguay ~0.62% (vs Mexico ~15%). The only MEASURED Argentine number is 13% among Buenos Aires MSM (Pando et al. 2013) — a non-representative urban key-population subgroup, NOT the national rate; do not conflate.","Cultural: Argentina is a secular, Catholic-heritage Southern-Cone society where circumcision is culturally foreign and the intact penis is the overwhelming norm. Direct evidence of the entrenched intact norm: in the Pando 2013 MSM study, ~70.4% of uncircumcised men said they would NOT get circumcised even to reduce HIV risk — citing aesthetics, doubts about effectiveness, fear of surgery, and the feeling that it is \"a mutilation of the body.\"","What little non-religious circumcision occurs is ELECTIVE/MEDICAL (chiefly pathological phimosis), not routine/neonatal; the public health system does not perform routine neonatal circumcision, and the regional pediatric-urology view is that physiologic phimosis self-resolves with conservative management (no Argentine-specific guideline was surfaced — flagged). The principal circumcising minority is the JEWISH community — Latin America's LARGEST (~180,000–230,000, concentrated in Buenos Aires; infrastructure incl. AMIA and the Seminario Rabínico Latinoamericano) — for whom brit milah (8th-day circumcision) is the norm (the rate within the community is unquantified). A small Muslim minority also circumcises (no Argentine figure).","HIV: low general prevalence (~0.4%, ~140,000 people living with HIV), a CONCENTRATED epidemic — burden in MSM (~12–17%), transgender women (~34%) and sex workers, ~70% clustered in Buenos Aires/Santa Fe/Córdoba. Circumcision/VMMC plays NO role: the epidemic is MSM/trans-driven (where the heterosexual circ–HIV effect does not translate; Pando found no overall circ–HIV/STI association in its MSM sample), and Argentina is not a WHO VMMC country — prevention is testing, condoms, treatment-as-prevention and PrEP. Sex-ed/other composite scores omitted.",{"iso3":1479,"isoNumeric":1480,"name":1481,"region":767,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"CUB","192","Cuba",{"iso3":1483,"isoNumeric":1484,"name":1485,"region":1005,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"POL","616","Poland",{"iso3":1487,"isoNumeric":1488,"name":1489,"region":767,"circumcisionRatePct":13,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"PRY","600","Paraguay",{"iso3":1491,"isoNumeric":1492,"name":1493,"region":850,"circumcisionRatePct":13,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":217,"hivSource":1494,"epidemicGrowthPct":30,"sexEducationGapScore":991,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":1026,"routineInfant":773,"medicalNecessity":71,"avgAge":1495,"profileSources":1496,"isFallback":40},"FIN","246","Finland","FINHIV Register","No statutory minimum; physician-supervised, typically performed in early childhood for Muslim/Jewish communities",[1497,1498,1499,1500],"Prevalence: Finnish Health Ministry publication (via WHO/Wikipedia aggregator): overall male circumcision prevalence 2-4%. Practice almost entirely confined to the Muslim minority (~130,000-170,000 people, ~2.5-3% of population) and Jewish community (~1,500-2,000 in Helsinki). Approx. 200 boys circumcised for non-medical reasons annually.","Legal framework: KKO:2008:93 (Finnish Supreme Court, 2008) — non-medical circumcision of a Muslim boy by a licensed doctor for religious reasons not criminal. Ministry of Social Affairs and Health guidelines (STM/242/2015): licensed physician, anaesthesia, sterile conditions, dual parental consent required.","Medical ethics: Finnish Medical Association opposes non-therapeutic circumcision as contrary to medical ethics; Helsinki University Central Hospital stated it would refuse even if legislation required it. ETENE 1999: ethically acceptable only for Jewish and Muslim communities if performed safely.","HIV: FINHIV Register (PMC 2022): ~2,931 PLHIV as of end-2019, ~150 new diagnoses/year; heterosexual transmission 45.5%, MSM 31.9%. Finland achieved UNAIDS 90-90-90 targets. HIV unrelated to circumcision practice.",{"iso3":1502,"isoNumeric":1503,"name":1504,"region":850,"circumcisionRatePct":9,"adultPrevalencePct":29,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":195,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":1135,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":1295,"routineInfant":773,"medicalNecessity":71,"avgAge":1505,"profileSources":1506,"isFallback":40},"ISL","352","Iceland","Vanishingly rare practice; no pattern (21 minors circumcised in hospitals/clinics in 12 years 2006-2018)",[1507,1508,1509,1510],"Prevalence: Extremely low. Iceland's Directorate of Health recorded only 21 boys under 18 circumcised at hospitals or private clinics in the 12-year period 2006-2018 (Reykjavik Grapevine, 2018). The Children's Hospital performed just one circumcision (for medical reasons) between 2013 and 2016. The ~2% estimate likely reflects adult male immigrants. Records acknowledged incomplete by Directorate of Health.","Religious demographics: Jewish community ~100-200 persons; Muslim community ~1,100 (total population ~370,000; overwhelmingly Lutheran or non-religious). Both communities account for virtually all demand for religious circumcision.","2018 bill: MP Silja Dogg Gunnarsdottir (Progressive Party) + 8 co-sponsors from 4 parties introduced a bill amending General Penal Code Article 218a (FGM statute) to gender-neutral terms, effectively extending the prohibition to male circumcision of minors. Penalties up to 6 years imprisonment (16 years for serious injury). Shelved by Judicial Affairs and Educational Committee April-May 2018.","HIV: UNAIDS/World Bank (2020): adult HIV prevalence ~0.1%; geographic isolation and small population have historically limited epidemic spread. Entirely unrelated to circumcision rates.",{"iso3":1512,"isoNumeric":1513,"name":1514,"region":284,"circumcisionRatePct":9,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"PRK","408","North Korea",{"iso3":1516,"isoNumeric":1517,"name":1518,"region":723,"circumcisionRatePct":9,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"GRL","304","Greenland",{"iso3":1520,"isoNumeric":1521,"name":1522,"region":92,"circumcisionRatePct":9,"adultPrevalencePct":30,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":30,"hivSource":30,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":30,"medicalNecessity":30,"avgAge":30,"profileSources":30,"isFallback":40},"ARM","051","Armenia",{"iso3":1524,"isoNumeric":1525,"name":1526,"region":1407,"circumcisionRatePct":592,"adultPrevalencePct":571,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":475,"medicalNecessity":71,"avgAge":1527,"profileSources":1528,"isFallback":40},"CHL","152","Chile","No routine or religious circumcision; intact is the overwhelming norm. Phimosis is managed conservatively (topical corticosteroids first-line); circumcision is \"absolutely elective\" / last-resort for specific pathologies, or among tiny Jewish/Muslim minorities",[1529,1530,1531,1532],"Prevalence: among the WORLD'S LOWEST — ~0.21% (Morris et al. 2016, Table 1; Chile was not corrected in the erratum, so 0.21% stands). A MODELLED estimate (built from Chile's tiny Jewish/Muslim-minority proportions plus a 0.1% uniform medical floor — no Chilean survey data), but correctly labelled an estimate. Circumcision is culturally foreign to the Catholic-heritage majority; the intact penis is the overwhelming norm, and neonatal circumcision \"is only recently being clinically introduced\" (Letelier et al. 2016 — a case series that was 100% religious/sociocultural, by parental request, framed as emerging from globalisation/immigration/returning expatriate families — explicitly NOT a traditional Chilean practice). What circumcision exists is elective/medical or confined to tiny Jewish/Muslim minorities.","THE DISTINCTIVE ANGLE — the region's most developed health system guiding AWAY from circumcision: Chilean clinical guidance manages phimosis CONSERVATIVELY. Physiological phimosis (≈95% of newborns) is normal, asymptomatic and resolves spontaneously (≈90% by ages 2–4); topical corticosteroids for 4–8 weeks are first-line (per a 2024 Cochrane review by Chilean authors); forced retraction/massage is explicitly advised AGAINST (it causes fissures, scarring, fibrosis); and circumcision is \"absolutely elective\" / a last resort reserved for specific pathologies (pathological phimosis, recurrent balanoposthitis, recurrent UTI, paraphimosis, suspected BXO). Both FONASA-adjacent public (PUC 2024; Servicio de Salud Aconcagua) and ISAPRE-private (Clínica Dávila) institutions frame circumcision as non-routine.","PRACTICE: circumcision in Chile is ELECTIVE or THERAPEUTIC (for the specific pathologies above), performed within the modern health system (FONASA public / ISAPRE private), with a small private/cosmetic and religious-minority component. There is no infant or religious routine; uptake is low, and the clinical default is intact-preserving (conservative phimosis management).","HIV: a sharply RISING, concentrated, MSM-driven epidemic — among the fastest-growing in Latin America. HIV prevalence among men who have sex with men in metropolitan Santiago measured 17.6% (a \"re-emerging\" problem); new HIV cases among those aged 15–39 rose ~133% from 2010 to 2019, and Chile is among the ~10 countries worldwide with a >50% increase in new cases over a decade (other windows cite ~34–35% over the decade — directionally consistent, magnitude window-dependent). Circumcision/VMMC plays NO role: Chile is a low-circumcision, non-VMMC country, peer-reviewed Chilean HIV reviews do not mention circumcision, and treatment investment dwarfs prevention with no biomedical circumcision strategy — no circ↔HIV protective claim is warranted. Sex-ed/other composite scores omitted.",{"iso3":1534,"isoNumeric":1535,"name":1536,"region":284,"circumcisionRatePct":592,"adultPrevalencePct":304,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":773,"medicalNecessity":71,"avgAge":1537,"profileSources":1538,"isFallback":40},"LAO","418","Laos","Tiny Muslim minority: childhood (Islamic rite, qualitative only); Lao Buddhist/animist majority: not practised (intact norm)",[1539,1540,1541,1542],"Prevalence is DATA-POOR: there is NO Lao national survey of male circumcision. The only quantitative figure is a single MODELED estimate of ~0.1% (Morris et al. 2016), built from religious demography rather than field data — so the honest statement is \"no reliable prevalence data; the best estimate is very low / effectively negligible.\" (The indicator stores a rounded integer; treat it as near-zero.) Discard the spurious \"35%\" figure that appeared in one aggregator snippet — it is a confirmed error.","Circumcision is FOREIGN to the Lao majority: Laos is ~64.7% Theravada Buddhist and ~31% animist/folk (\"no religion\"), and none of these groups have a circumcision norm. Peer-reviewed regional scholarship (Newell & Brundage 2001) describes an \"almost total absence\" of male circumcision across the Theravada-Buddhist mainland (Laos, Cambodia, Thailand, Burma); WHO/UNAIDS (2007) explicitly names Lao PDR among countries where circumcision is \"uncommon\". The intact penis is the cultural norm.","The only circumcising community is an EXTREMELY SMALL Muslim minority (well under 1% — roughly 500–1,650 people across sources, some estimates ~0.01–0.02%), mostly foreign-origin permanent residents in Vientiane: Chin Haw (Yunnanese Chinese), Tamil/South Asian, Cham (Cambodian-origin) and some Pashtun Muslims, for whom circumcision (khitan) is the Islamic rite. Treated neutrally as established religious custom, and only qualitatively — no figure for circumcision within the minority exists. No Hmong/animist/highland circumcision tradition is sourced; none is asserted.","HIV: Laos has a LOW-level, CONCENTRATED epidemic — national adult (15–49) prevalence roughly 0.3–0.42% (UNAIDS-aligned; ~0.42% cited for 2024), with the burden on key populations (men who have sex with men — ~5.6% in a 2007 Vientiane study; people who inject drugs; sex workers; mobile/migrant populations tied to Thailand — the \"three Ms\"). Prevention is condom-, testing- and ART-based; circumcision/VMMC plays NO role and Laos is not a WHO VMMC-priority country. Keep key-population rates distinct from the low national rate.",{"iso3":1544,"isoNumeric":1545,"name":1546,"region":1407,"circumcisionRatePct":14,"adultPrevalencePct":571,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":229,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":498,"medicalNecessity":71,"avgAge":1547,"profileSources":1548,"isFallback":40},"VEN","862","Venezuela","No ritual age — circumcision is rare and, when done, therapeutic/elective (phimosis, balanitis); urban/private",[1549,1550,1551,1552],"Prevalence: ~0.33% (Morris et al. 2016, Table 1, erratum-confirmed) — among the very lowest in the world (~100× below the ~37-39% global mean), squarely within the Latin-American Catholic-heritage, mestizo/indigenous intact-norm pattern. NB: a MODELED estimate (minority share + a 0.1% medical floor; partly imputed) — read as 'near-zero / extremely low', the order of magnitude robust even if the exact 0.33% is soft. Fits the uniform LatAm cluster (Bolivia 0.11, Ecuador 0.11, Guatemala 0.11, Chile 0.21, Brazil 1.3, Argentina 2.9, Peru 3.7, Colombia 4.2; Mexico 15.4 outlier). FGM is not a documented Venezuelan practice and is never conflated here.","THE DISTINCTIVE ANGLE — the Caribbean-coast/Andean intact-norm case set against a HUMANITARIAN-CRISIS HIV collapse. There is no circumcision tradition; the intact penis is the norm, and any circumcision is therapeutic or private elective (phimosis, balanitis), skewing urban/higher-income (Caracas). Religious circumcision is confined to a tiny Jewish community (historically notable, much reduced by post-2015 emigration — though a specific '\u003C6,000 by 2020' figure could not be verified and is not asserted) and a negligible Muslim minority.","Practice / harm: very low and medical. No verified Venezuela-specific male-circumcision harm case or series was located (an honest gap — likely-low given near-zero circumcision; not evidence of safety, only an unfilled gap in the surfaced literature).","HIV: a CONCENTRATED epidemic (~0.5-0.9% adult; ~0.6% generalized per peer-reviewed data, ~0.5% UNAIDS) driven by key populations — men who have sex with men ~7.8% (about 13× the general rate; ~60% of cases), female sex workers, with a diaspora study of Venezuelan migrants showing MSM 9.5% / trans 8.5%. CRUCIAL CONTEXT (HIV-response only, NOT a circumcision link): the post-2015 humanitarian/economic collapse broke HIV diagnosis and treatment — the state bought no antiretrovirals in 2017-2018 and ART coverage fell to ~16% by April 2018, the highest ART-interruption rate in Latin America (later coverage figures conflict: ~10% per crisis-reporting papers vs ~58-67% per UNAIDS-derived estimates). Because circumcision is near-zero and Venezuela is not a WHO voluntary-medical-male-circumcision priority country — and the crisis HIV literature makes zero mention of circumcision — Venezuela is another Latin-American natural rebuttal to circumcision-as-HIV-shield. No circumcision↔HIV protective claim is made or implied.",{"iso3":1554,"isoNumeric":1555,"name":1556,"region":1407,"circumcisionRatePct":14,"adultPrevalencePct":304,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":498,"medicalNecessity":71,"avgAge":1557,"profileSources":1558,"isFallback":40},"ECU","218","Ecuador","No ritual age — circumcision is rare and, when done, therapeutic/elective (phimosis, recurrent infections, urinary obstruction); skews urban/private",[1559,1560,1561,1562],"Prevalence: ~0.11% (Morris et al. 2016, Table 1, erratum-confirmed; identical to Bolivia) — among the lowest in the world, a Catholic-heritage, mestizo + indigenous (Kichwa/Quechua) intact norm with no circumcision tradition. NB: a MODEL ESTIMATE (Jewish+Muslim share + a small medical floor; ~5-10% stated uncertainty; small-country estimates 'less precise') — read as 'extremely low / near-zero', not a precise count. Fits the uniform LatAm cluster (Bolivia 0.11, Chile 0.21, Brazil 1.3, Argentina 2.9, Peru 3.7, Colombia 4.2; Mexico 15.4 outlier). FGM is essentially absent and is never conflated here.","THE DISTINCTIVE ANGLE — the Pacific-coast/Andean intact-norm case, a companion to Bolivia/Peru/Colombia. There is no Kichwa/Quechua or Catholic-mestizo circumcision tradition; the intact penis is the norm. Where circumcision occurs it is therapeutic/elective — Ecuadorian urologists state plainly 'nadie lo hace por prevención profiláctica; se realizan cuando existen muchas infecciones, tienen fimosis o no pueden orinar' and that patients are 'not motivated by Islamic or Jewish rituals'.","Practice / volume: very low and medical. Ecuadorian urologists report tiny annual caseloads (one ~20 adult interventions/year, another 5 pediatric phimosis cases in 2018), skewing urban/private (Quito/Guayaquil). MEDIUM confidence — the only Ecuador-specific practice source is a tabloid (extra.ec) quoting two clinicians' anecdotal figures, not a national registry; the directional conclusion (rare, medical/elective, not ritual) is robust and convergent with the Morris prevalence, but the specific figures are illustrative, not generalizable. Religious circumcision is confined to statistically negligible Jewish and Muslim minorities. No verified Ecuador-specific harm series was located (an honest gap).","HIV: a CONCENTRATED epidemic (not generalized) — general adult (15-49) prevalence ~0.3-0.4% versus 7.3-16.5% among men who have sex with men in Guayaquil and Quito and roughly 20-35% among trans women — geographically centred on the Pacific coast, where Guayaquil/Guayas province accounts for over a third (~32.5% in 2022) of new national notifications. Ecuador is NOT a WHO voluntary-medical-male-circumcision priority country (those 15 are in eastern/southern Africa), and the UNAIDS 2024 Latin-America profile and Ecuadorian MSM studies make zero mention of circumcision — so near-zero circumcision coexisting with a concentrated epidemic makes Ecuador a natural rebuttal to circumcision-as-HIV-shield arguments. No circumcision↔HIV protective claim is made or implied.",{"iso3":1564,"isoNumeric":1565,"name":1566,"region":1407,"circumcisionRatePct":14,"adultPrevalencePct":169,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":31,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":498,"medicalNecessity":71,"avgAge":1547,"profileSources":1567,"isFallback":40},"GTM","320","Guatemala",[1568,1569,1570,1571],"Prevalence: ~0.11% (Morris et al. 2016, Table 1, erratum-confirmed; tied near the world's lowest with Bolivia and Ecuador) — a Catholic-and-evangelical, Maya-indigenous + mestizo (ladino) intact norm with no circumcision tradition. The Roman Catholic Church formally denounced religious circumcision for its members (the 1442 Council of Florence, Cantate Domino), making circumcision culturally and doctrinally foreign. NB: a MODEL ESTIMATE (minority share + a small medical floor) — read as 'near-zero', not a precise count. Fits the uniform LatAm cluster (Bolivia 0.11, Ecuador 0.11, Chile 0.21, Brazil 1.3, Argentina 2.9, Peru 3.7, Colombia 4.2; Mexico 15.4 outlier). FGM is essentially absent and is never conflated here.","THE DISTINCTIVE ANGLE — the Central-American Maya-indigenous case, opening Central America in the LatAm intact-norm cluster. There is no Maya or ladino circumcision tradition; the intact penis is the norm. Where circumcision occurs it is therapeutic or private elective (phimosis, balanitis), skewing urban/higher-income (Guatemala City private clinics). Religious circumcision is confined to a tiny Jewish community (~900-1,000, almost entirely in Guatemala City, brit milah) and a negligible Muslim minority — statistically negligible at the national level.","Practice / providers: very low and medical. No Guatemala-specific clinician-volume source surfaced, so the practice profile is inferred from the near-zero prevalence and the consistent regional pattern rather than from local caseload data. No verified Guatemala-specific male-circumcision harm series was located (an honest gap — likely-low given near-zero circumcision).","HIV: a CONCENTRATED epidemic (not generalized) — general adult prevalence ~0.2% (Wikipedia/World Bank/CDC 2023; ~35,000 people living with HIV; an older UNGASS-2010/antenatal-surveillance figure put general prevalence at ~0.79-0.8%) versus much higher among key populations: men who have sex with men ~10% nationally (18% in Guatemala City, 2006) and transgender women ~22.2% (2022); the afro-descendant Garifuna at ~1% (about 5× the general rate) and some indigenous communities elevated. The epidemic is geographically concentrated (about 78% of reported cases in 7 of 22 departments, ~70% in Guatemala City). Guatemala is NOT a WHO voluntary-medical-male-circumcision priority country (those 15 are in eastern/southern Africa), and the WHO VMMC framework, the UNAIDS 2024 Latin-America profile and the Guatemalan HIV literature make zero mention of circumcision — so near-zero circumcision coexisting with a concentrated epidemic makes Guatemala a natural rebuttal to circumcision-as-HIV-shield arguments. No circumcision↔HIV protective claim is made or implied.",{"iso3":1573,"isoNumeric":1574,"name":1575,"region":1407,"circumcisionRatePct":14,"adultPrevalencePct":56,"plhivPer1000":30,"newInfectionsPer1000":30,"onTreatmentPct":30,"childPrevalencePct":30,"hivYear":69,"hivSource":32,"epidemicGrowthPct":30,"sexEducationGapScore":30,"preventionContextScore":30,"policyEnvironmentScore":30,"stigmaIndex":30,"legalStatus":33,"routineInfant":498,"medicalNecessity":71,"avgAge":1576,"profileSources":1577,"isFallback":40},"BOL","068","Bolivia","No ritual age — circumcision is rare and, when done, therapeutic/elective (refractory phimosis) and skews adult; pediatric phimosis managed conservatively",[1578,1579,1580,1581],"Prevalence: ~0.11% (Morris et al. 2016, Table 1, erratum-unchanged; reproduced by World Population Review and Visual Capitalist) — among the lowest in the world, a near-total intact norm. There is NO cultural or religious circumcision tradition in Bolivia's Catholic-heritage, indigenous-majority (Quechua/Aymara) society. NB: a MODELED estimate (Muslim+Jewish minority size + a 0.1% medical floor; no national survey) — read as 'near-zero / among the world's lowest', not a precise measured value (the paper itself flags small-country estimates as 'less precise'). FGM is essentially absent and is never conflated here.","THE DISTINCTIVE ANGLE — the Andean highland intact-norm case. Bolivia extends the consistent Latin-American intact-norm pattern (Chile 0.21%, Brazil 1.3%, Argentina 2.9%, Peru 3.7%, Colombia 4.2%; Mexico the outlier at 15.4%) into the Quechua/Aymara-majority highlands, where circumcision is culturally foreign. The intact penis is simply the norm; the few circumcisions that occur are therapeutic or private elective.","Practice / medicalisation: circumcision in Bolivia is therapeutic/elective — performed surgically for refractory phimosis (when topical creams fail) — and the treated cases skew ADULT rather than infant-ritual (a credentialed La Paz urologist, ex-president of the Bolivian Society of Urology, notes most phimosis cases operated in clinic are adults; pediatric phimosis usually resolves conservatively). MEDIUM confidence — a single-clinician practice description, not a national statistic. Religious circumcision is confined to statistically negligible Jewish and Muslim minorities (brit milah / khitan). No Bolivia-specific male-circumcision harm series was located (an honest gap — likely a genuine absence given near-zero circumcision).","HIV: low and concentrated — general-population prevalence ~0.3% (UNAIDS 2024 adult 15-49 ~0.5%, comfortably under 1%), centred on men who have sex with men (~15% in La Paz, ~21-24% in Santa Cruz) and trans women (~19.7%), with over 80% of diagnoses registered in La Paz, Cochabamba and Santa Cruz. Bolivia is NOT a WHO/UNAIDS voluntary-medical-male-circumcision target country (those 13/14 are exclusively sub-Saharan African). Near-zero circumcision coexisting with a low epidemic makes Bolivia a natural rebuttal to circumcision-as-HIV-shield arguments — no circumcision↔HIV protective claim is made or implied.",{"sortBy":1583,"order":1584,"limit":1315},"circumcisionRatePct","desc",1782740981722]