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

Catherine Connolly, Leickness C Simbayi, Rebecca Shanmugam, Ayanda Nqeketo

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 populationbased
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.
Conclusion. 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.
S Afr Med J 2008; 98: 789-794
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