HIV and circumcision in South Africa

Abstract

Background: HIV infection remains highly prevalent in South Africa. Male circumcision has been shown to be protective for the acquisition of HIV in other African countries. It is important to determine if this association is evident in South Africa.

Methods: A cross-sectional, national household-based survey was conducted using second-generation surveillance procedures, weighted data adjusted for sample design was used. A total of 2585 males over the age of 15 were administered questionnaires and provided specimens for HIV testing.

Results: Circumcision was reported by 916 (35.4%) of male participants. HIV prevalence among circumcised males was 10.7% and among uncircumcised males was 12.1%, p = 0.9. Blacks were less likely to be circumcised (28.8%) compared to other racial groups, 42.6%, p = 0.002. When the data was stratified by racial group, circumcised Blacks showed similar rates of HIV as uncircumcised Blacks, (OR: 0.8, p = 0.4). however other racial groups showed a strong protective effect, (OR: 0.3, p = 0.01). The age of circumcision differed by racial group. Among Blacks, 37% were circumcised above the age of 12 compared to 6% among other racial groups. When the data are further stratified by age of circumcision, there is a slight protective effect between early circumcision and HIV among Blacks, OR: 0.7, p = 0.4.

Conclusion: In general, circumcision offers slight protection. The effect is much stronger in other racial groups than in blacks. This racial difference cannot be explained by age of circumcision.

Keywords: AEGIS, HIV Seropositivity, Acquired Immunodeficiency Syndrome, AIDS, Circumcision, HIV Infections, Prevalence, Cross-Sectional Studies, South Africa, Family Characteristics, Humans, Male, surgery