| Male
circumcision and susceptibility to HIV infection among men in Tanzania.
Urassa M, Todd J, Boerma JT, Hayes R, Isingo R.
Tanzania-Netherlands Project to Support AIDS Control in Mwanza
region, African Medical and Research Foundation, Mwanza, Tanzania.
BACKGROUND: Evidence from ecological studies and from studies of
and sexually transmitted disease (STD) patients in sub-Saharan Africa
suggests that there is a protective effect of male circumcision
against HIV infection. There are, however, few population-based
studies that have controlled adequately for potential confounding
factors. METHODS: Data from the five population-based studies in
north-western Tanzania were used to investigate the association
between male circumcision and the risk of HIV infection and STD.
The effects of circumcision on HIV prevalence, syphilis (positive
Treponema pallidum haemagglutination; TPHA) and self-reported STD
were analysed, controlling for a range of demographic and sociocultural
variables, and indicators of sexual behaviour. RESULTS: In north-western
Tanzania, circumcision was previously restricted to Muslims and
specific ethnic groups, but is now more widespread, particularly
in urban ares and among more educated men. Assessment of the reliability
and validity of self-reported circumcision status showed that these
data could be considered fairly accurate, although there was some
tendency for circumcision to be over-reported. On univariate analysis,
circumcision status was unrelated to HIV prevalence in most studies.
After controlling for confounding variables, however, there was
a modest but significant reduction of the HIV prevalence among circumcised
men [odds ratio (OR), 0.62; 95% confidence interval (CI), 0.48-.81].
This effect appeared stronger in urban areas (OR, 0.46; 95% CI,
0.32-0.68) and roadside villages (OR, 0.65; 95% CI, 0.42-1.01) than
in rural areas and islands (OR, 1.00 and 1.01 respectively). There
was no association between circumcision status and syphilis serology
(TPHA), but there was a positive association between circumcision
and self-reported STD, although this was not significant after adjustment
for confounding variables. CONCLUSION: Male circumcision has a protective
effect against HIV infection in this population, which may be stronger
in urban areas and roadside settlements than in the rural areas.
Ethnic group and religious denomination are no longer the sole determinants
of male circumcision.
|
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