title: Increased risk of infection with human immunodeficiency virus type 1 among uncircumcised men presenting with genital ulcer disease in Kenya.
abstract: The factors responsible for the explosive spread of human immunodeficiency virus type 1 (HIV-1) in sub-Saharan Africa continue to be identified and debated. One of the most controversial factors has been male circumcision. This cross-sectional study was conducted to measure the association between circumcision status and infection with HIV-1 among men with genital ulcer disease. Eight hundred and ten men participated in the study, of whom 190 (23%) were HIV-1-positive. A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised (adjusted odds ratio [OR], 4.8; 95% confidence interval [CI], 3.3-7.2) and with a history of urethral discharge (adjusted OR, 2.0; 95% CI, 1.4-2.8). This association could not be explained by measures of sexual exposure to HIV-1 among this population. Male circumcision should be considered as an intervention strategy for AIDS control.
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Kenya.
authors.forename: M W
authors.initials: MW
authors.lastname: Tyndall
authors.forename: A R
authors.initials: AR
authors.lastname: Ronald
authors.forename: E
authors.initials: E
authors.lastname: Agoki
authors.forename: W
authors.initials: W
authors.lastname: Malisa
authors.forename: J J
authors.initials: JJ
authors.lastname: Bwayo
authors.forename: J O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: S
authors.initials: S
authors.lastname: Moses
authors.forename: F A
authors.initials: FA
authors.lastname: Plummer
mesh_terms: D000293:Adolescent; D000328:Adult; D002602:Chancroid / Q000150:complications; D002944:Circumcision, Male / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005832:Genital Diseases, Male / Q000150:complications* / Q000382:microbiology; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1; D006191:Haemophilus ducreyi / Q000302:isolation & purification; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012883:Skin Ulcer / Q000150:complications* / Q000382:microbiology