title: Effects of household shocks and poverty on the timing of traditional male circumcision and HIV risk in South Africa.
abstract: Poverty may influence HIV risk by increasing vulnerability to economic shocks and thereby preventing key health investments. We explored this possibility by examining the relationship between household shocks and the timing of traditional male circumcision, a practice associated with considerable expense and whose HIV-prevention benefits are larger when done earlier, even within young adulthood. Using unique data on a sample of Xhosa men, a group that almost universally practices traditional circumcision, we found that respondents in the poorest households delayed circumcision by 2 years if a household member experienced loss of income or death and/or illness. The impact of these shocks declined with increasing household income. Our findings suggest that interventions that work to mitigate the impact of shocks among the poor may be useful in HIV prevention efforts. More generally, they illustrate that the relationship between HIV and wealth may be more nuanced than assumed in previous work.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard University, Cambridge, MA, USA.
authors.forename: Atheendar S
authors.initials: AS
authors.lastname: Venkataramani
authors.forename: Brendan
authors.initials: B
authors.lastname: Maughan-Brown
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D003625:Data Collection; D005191:Family Characteristics; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult