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

S Afr Med J. 2008 Oct;98(10):789-94.

Abstract

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 population-based 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group / statistics & numerical data
  • Circumcision, Male / ethnology
  • Circumcision, Male / statistics & numerical data*
  • Cross-Sectional Studies
  • HIV Infections / epidemiology*
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Rural Health / statistics & numerical data
  • Socioeconomic Factors
  • South Africa / epidemiology
  • Urban Health / statistics & numerical data
  • Young Adult