| Age
of male circumcision and risk of prevalent HIV infection in rural
Uganda.
Kelly R, Kiwanuka N, Wawer MJ, Serwadda D, Sewankambo NK, Wabwire-Mangen
F, Li C, Konde-Lule JK, Lutalo T, Makumbi F, Gray RH.
Department of Population Dynamics, Johns Hopkins University, School
of Hygiene and Public Health, Baltimore, Maryland 21205, USA.
OBJECTIVE: To assess whether circumcision performed on postpubertal
men affords the same level of protection from HIV-1 acquisition
as circumcisions earlier in childhood. DESIGN: Cross-sectional study
of a population-based cohort. SETTING: Rakai district, rural Uganda.
METHODS: A total of 6821 men aged 15-59 years were surveyed and
venous blood samples were tested for HIV-1 and syphilis. Age at
circumcision was dichotomized into men who were circumcised before
or at age 12 years (prepubertal) and men circumcised after age 12
years (postpubertal). Postpubertal circumcised men were also subdivided
into those reporting circumcision at ages 13-20 years and > or
= 21 years. RESULTS: HIV-1 prevalence was 14.1% in uncircumcised
men, compared with 16.2% for men circumcised at age > or = 21
years, 10.0% for men circumcised at age 13-20 years, and 6.9% in
men circumcised at age < or = 12 years. On bivariate analysis,
lower prevalence of HIV-1 associated with prepubertal circumcision
was observed in all age, education, ethnic and religious groups.
Multivariate adjusted odds ratio of prevalent HIV-1 infection associated
with prepubertal circumcision was 0.39 [95% confidence interval
(CI), 0.29-0.53]. In the postpubertal group, the adjusted odds ratio
for men circumcised at ages 13-20 years was 0.46 (95% CI, 0.28-0.77),
and 0.78 (95% CI, 0.43-1.43) for men circumcised after age 20 years.
CONCLUSIONS: Prepubertal circumcision is associated with reduced
HIV risk, whereas circumcision after age 20 years is not significantly
protective against HIV-1 infection. Age at circumcision and reasons
for circumcision need to be considered in future studies of circumcision
and HIV risk.
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