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Published on: October 31, 2010
Male circumcision and HIV infection in four cities in sub-Saharan Africa
1INSERM U88, AP-HP, A-Paré, France. bertran.auvert@paris-ouest.univ-paris5.fr
Insights
Male circumcision significantly reduces HIV transmission risk in sub-Saharan Africa. This study found a strong association between lack of male circumcision and higher HIV prevalence at both population and individual levels.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- HIV (Human Immunodeficiency Virus) remains a significant public health challenge in sub-Saharan Africa.
- Understanding factors influencing HIV transmission is crucial for effective prevention strategies.
Purpose of the Study:
- To investigate the association between male circumcision and HIV infection rates.
- To explore this relationship in urban populations across sub-Saharan Africa with varying HIV prevalence.
Main Methods:
- A cross-sectional, population-based study was conducted in four sub-Saharan African cities.
- Data included sociodemographic information, sexual behavior, and HIV testing for adults aged 15-49.
- Genital examinations were performed on men.
Main Results:
- In Kisumu, Kenya, HIV prevalence was 9.9% in circumcised men versus 26.6% in uncircumcised men, showing a protective effect (adjusted OR 0.26).
- In Ndola, Zambia, no significant difference in HIV prevalence was observed between circumcised (25.0%) and uncircumcised (26.0%) men.
- High circumcision rates (99%) were observed in low HIV prevalence cities (Cotonou, Benin; Yaoundé, Cameroon).
Conclusions:
- Male circumcision is a factor influencing HIV transmission during sexual intercourse.
- The study confirms a population-level association between HIV and lack of male circumcision.
- A strong individual-level association was observed in Kisumu, highlighting its protective role.
Objectives:
To explore the role of male circumcision in the spread of HIV infection in four urban populations in sub-Saharan Africa.
Design And Methods:
A cross-sectional population based study was conducted in four cities in sub-Saharan Africa with different levels of HIV infection. HIV prevalence among adults was relatively low in Cotonou (Benin) and in Yaoundé (Cameroon), and exceeded 25% in Kisumu (Kenya) and in Ndola (Zambia). In each city, a random sample was taken of men and women aged 15-49 years from the general population. Consenting study participants were interviewed about their sociodemographic characteristics and their sexual behaviour, and were tested for HIV, herpes simplex virus type 2, syphilis, gonorrhoea and chlamydial infection. Men underwent a genital examination.
Results:
In Cotonou and in Yaoundé, the two low HIV prevalence cities, 99% of men were circumcised. In Kisumu 27.5% of men were circumcised, and in Ndola this proportion was 9%. In Kisumu, the prevalence of HIV infection was 9.9% among circumcised men and 26.6% among uncircumcised men. After controlling for socio-demographic characteristics, sexual behaviour and other sexually transmitted infections, the protective effect of male circumcision remained with an adjusted odds ratio of 0.26 (95% confidence interval = 0.12-0.56). In Ndola, the prevalence of HIV infection was 25.0% in circumcised men and 26.0% in uncircumcised men. The power was insufficient to adjust for any differences in sexual behaviour.
Conclusions:
The differences in epidemic spread of HIV are likely to be due to differences in the probability of transmission of HIV during sexual exposure as well as differences in sexual behaviour. Male circumcision is one of the factors influencing the transmission of HIV during sexual intercourse, and this study confirms the population level association between HIV and lack of male circumcision, as well as a strong individual level association in Kisumu, the only city with sufficient power to analyze this association.
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