Male circumcision and its relationship to HIV infection in South Africa: results of a national survey in 2002.
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.


CONCLUSIONS
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.
Connolly
Catherine
C
Medical Research Council, Durban. cconnolly@mrc.ac.za
Simbayi
Leickness C
LC
Shanmugam
Rebecca
R
Nqeketo
Ayanda
A
D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D002944:Circumcision, Male / Q000208:ethnology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult