Are circumcised men safer sex partners? Findings from the HAALSI cohort in rural South Africa
Year: 2018
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: The real-world association between male circumcision and HIV status has important implications for policy and intervention practice. For instance, women may assume that circumcised men are safer sex partners than non-circumcised men and adjust sexual partnering and behavior according to these beliefs. Voluntary medical male circumcision (VMMC) is highly efficacious in preventing HIV acquisition in men and this biological efficacy should lead to a negative association between circumcision and HIV. However, behavioral factors such as differential selection into circumcision based on current HIV status or factors associated with future HIV status could reverse the association. Here, we examine how HIV prevalence differs by circumcision status in older adult men in a rural South African community, a non-experimental setting in a time of expanding VMMC access. METHODS: We analyzed data collected from a population-based sample of 2345 men aged 40 years and older in a rural community served by the Agincourt Health and socio-Demographic Surveillance System site in Mpumalanga province, South Africa. We describe circumcision prevalence and estimate the association between circumcision and laboratory-confirmed HIV status with log-binomial regression models. RESULTS: One quarter of older men reported circumcision, with slightly more initiation-based circumcisions (56%) than hospital-based circumcisions (44%). Overall, the evidence did not suggest differences in HIV prevalence between circumcised and uncircumcised men; however, those who reported hospital-based circumcision were more likely to test HIV-positive [PR (95% CI): 1.28 (1.03, 1.59)] while those who reported initiation-based circumcision were less likely to test HIV-positive [PR (95% CI): 0.68 (0.51, 0.90)]. Effects were attenuated, but not reversed after adjustment for key covariates. CONCLUSIONS: Medically circumcised older men in a rural South African community had higher HIV prevalence than uncircumcised men, suggesting that the effect of selection into circumcision may be stronger than the biological efficacy of circumcision in preventing HIV acquisition. The impression given from circumcision policy and dissemination of prior trial findings that those who are circumcised are safer sex partners may be incorrect in this age group and needs to be countered by interventions, such as educational campaigns.
Source: PLoS ONE
Language: English
Topic: Genital Health and Disease
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,641
Funders: Alexander von Humboldt-Stiftung, Wellcome Trust, European Commission, Bundesministerium für Bildung und Forschung, National Institutes of Health, Medical Research Council, National Institute on Aging, National Institute of Allergy and Infectious Diseases, Fogarty International Center, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Strengthening and stabilising a demographic and health surveillance in Agincourt: foundation for a health and population research programme in South Africa's rural northeast, G1112674395, G1119205115, G1279806978, G2563538044, Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions., Preventing cardiometabolic diseases in Africa: life-course and multi-sector approaches., G3479276667, G4029150292, G4469057728, Investigating and responding to health, population and social transitions in rural Southern Africa., Causal Pathways to population health impact of HIV antiretroviral treatment, G5311169479, Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions., New Methods for the design and evaluation of large HIV prevention interventions, G7923275117, G8021174655, G8186070293, G8276714428, Can HIV Hot-Spots be eradicated? An intervention to decrease HIV transmission to young women in rural KwaZulu-Natal South Africa, Health, Aging and Dementia in South Africa: A Longitudinal Study (HAALSI), HIS : Training Tanzanian Researchers for HIV/AIDS Implementation Science (Renewal)
OpenAlex ID: W2886850079