AEGiS-13IAC: Male circumcision and HIV spread in sub-Saharan Africa.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Male circumcision and HIV spread in sub-Saharan Africa.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC192)

Buve A, Auvert B, Lagarde E, Kahindo M, Hayes R, Carael M
A. Buve, Institute of Tropical Medicine, Nationalestraat 155, Antwerpen 2000, Belgium, Tel.: +32 3 247 6533, Fax: +32 3 247 6532, E-mail: abuve@itg.be

BACKGROUND: Results from several studies conducted since 1989 suggest that there may be an association between male circumcision (MC) and spread of HIV infection in sub-Saharan Africa. The objective of this study was to assess the importance of MC in explaining the heterogeneity of HIV prevalence in sub-Saharan Africa.

METHODS: A standardised, community based, cross-sectional study was conducted in 2 towns with high HIV prevalence (Kisumu, Kenya, and Ndola, Zambia) and 2 towns with low HIV prevalence (Yaounde, Cameroon, and Cotonou, Benin). About 2000 individuals were sampled in each town. Consenting men and women were interviewed and tested for HIV, HSV-2, syphilis, gonorrhoea, chlamydial infection and (women only) trichomoniasis.

RESULTS: In Yaounde and in Cotonou where the HIV prevalence among sexually active adult men was 3.8% and 4.4%, more than 99% of men were circumcised. Circumcision was less common in Kisumu and in Ndola (26.8% and 7.6%) where the prevalence of HIV was 21.9% and 25.9%. Analysis of risk factors found that in Kisumu MC was a strong independent protective factor for HIV infection (OR = 0.20, 95%CI 0.089-0.43) after adjustment for sexual behaviour, marital status, ethnic group, HSV-2 and syphilis. In Ndola no association was found between MC and HIV infection (OR = 1 in univariate analysis) and the possible explanations for this lack of association will be discussed.

CONCLUSIONS: MC explains at least in part the heterogeneity of HIV prevalence in sub-Saharan Africa. The evidence on the protective effect of male circumcision against HIV infection is convincing enough to start considering research on the feasibility of introducing MC as a preventive intervention against HIV infection.

Keywords: AEGIS, HIV Infections, Circumcision, Prevalence, Sex Behavior, Risk Factors, HIV Seropositivity, Cross-Sectional Studies, Herpesvirus 2, Human, Syphilis, Gonorrhea, Africa South of the Sahara, Trichomonas Infections, Interviews, Chlamydia Infections, Cameroon, Zambia, Benin, Kenya, Human, Male, Female, Adult, surgery
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MoOrC192