Male circumcision and hiv

S Afr Med J. 2008 Oct;98(10):789-94.

Male circumcision and its relationship to HIV infection in South Africa: results of a national survey.

Connolly C¹, Simbayi LC, Shanmugam R, Nqeketo A.

Author information

• ¹Medical Research Council, Durban. cconnolly@mrc.ac.za

Abstract

OBJECTIVE:

To investigate the nature of male circumcision and its relationship to HIV infection.

METHODS:

Analysis of a sub-sample of 3 025 men aged 15 years and older who participated in the first national population-based survey on HIV/AIDS in 2002. Chi-square tests and Wilcoxon rank sum tests were used to identify factors associated with circumcision and HIV status, followed by a logistic regression model.

RESULTS:

One-third of the men (35.3%) were circumcised. The factors strongly associated with circumcision were age > 50, black living in rural areas and speaking SePedi (71.2%) or IsiXhosa (64.3%). The median age was significantly older for blacks (18 years) compared with other racial groups (3.5 years), p < 0.001. Among blacks, circumcisions were mainly conducted outside hospital settings. In 40.5% of subjects, circumcision took place after sexual debut; two-thirds of the men circumcised after their 17th birthday were already sexually active. HIV and circumcision were not associated (12.3% HIV positive in the circumcised group v. 12% HIV positive in the uncircumcised group). HIV was, however, significantly lower in men circumcised before 12 years of age (6.8%) than in those circumcised after 12 years of age (13.5%, p = 0.02). When restricted to sexually active men, the difference that remained did not reach statistical significance (8.9% v. 13.6%, p = 0.08.). There was no effect when adjusted for possible confounding.

CONCLUSION:

Circumcision had no protective effect in the prevention of HIV transmission. This is a concern, and has implications for the possible adoption of the mass male circumcision strategy both as a public health policy and an HIV prevention strategy.