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Male circumcision and HIV infection in four cities in sub-Saharan
Africa
Auvert, B | Buve, A | Lagarde, E | Kahindo, M | Chege, J | Rutenberg,
N | Musonda, R | Laourou, M | Akam, E | Weiss, HA
AIDS [AIDS]. Vol. 15, suppl. 4, pp. S31-S40. Aug 2001.
To explore the role of male circumcision in the spread of HIV
infection in four urban populations in sub-Saharan Africa. 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 Yaounde (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 socio-demographic 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. In Cotonou and in Yaounde, 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. 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.
 Descriptors: Article Subject Terms Acquired immune deficiency syndrome | Disease
transmission | Transmission (sexual) | Urban areas | Article Taxonomic Terms Human immunodeficiency virus | Article Geographic Terms Africa | Benin | Cameroon | Kenya | Zambia
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