Rapid increase in prevalence of male circumcision in rural Tanzania in the absence of a promotional campaign.
OBJECTIVE
To estimate the prevalence of circumcision among young men in rural Mwanza, North-Western Tanzania, and document trends in circumcision prevalence over time. To investigate associations of circumcision with socio-demographic characteristics, reported sexual behaviours and sexually transmitted infections (STIs).


METHODS
A cross-sectional survey in communities which had previously participated in a cluster-randomized trial of an adolescent sexual health intervention that did not include male circumcision in 20 rural communities.


METHODS
In 2007/08, 7300 young men (age 16-23 years) were interviewed and examined by a clinician. The prevalence of circumcision by age was compared with data collected during the trial in 1998-2002. Odds ratios (OR) and 95% confidence intervals (CI) for the association of circumcision with socio-demographic characteristics, reported sexual behaviours and with HIV and other STIs were estimated using multivariable conditional logistic regression.


RESULTS
The prevalence of male circumcision was 40.6%, and age-specific prevalence had more than doubled since 2001/2002. Circumcised men reported less risky sexual behaviours, being more likely to report having ever used a condom (adjusted OR = 2.62, 95%CI:2.32-2.95). Men circumcised before sexual debut were at reduced risk of being HIV seropositive compared with non-circumcised men (adjusted OR = 0.50, 95%CI:0.25-0.97), and also had reduced risks of HSV-2 infection and genital ulcer syndrome in the past 12 months compared with non-circumcised men.


CONCLUSIONS
There was a steep increase in circumcision prevalence between 2001/02 and 2007/08 in the absence of a promotional campaign. Circumcised men reported safer sexual practices than non-circumcised men and had lower prevalence of HIV and HSV-2 infection.
London School of Hygiene and Tropical Medicine, London, United Kingdom. harriet.forbes@lshtm.ac.uk
Harriet J
HJ
Forbes
Aoife M
AM
Doyle
Kaballa
K
Maganja
John
J
Changalucha
Helen A
HA
Weiss
David A
DA
Ross
Richard J
RJ
Hayes
D000293:Adolescent; D017677:Age Distribution; D002944:Circumcision, Male; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology; D006558:Herpes Genitalis / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult