Male Circumcision and HIV Infection among Sexually Active Men in Malawi

The HIV epidemic remains a major health challenge all over the world. In 2013, an estimated 35million people were living with HIV globally. Male circumcision is increasingly being adopted as a method of HIV prevention. WHO and UNAIDS have advised that male circumcision be added to current HIV interventions. Malawi is one of the countries hardest hit by HIV/AIDS with a prevalence rate of 11 % and male circumcision prevalence of 21.6 % in 2010. Prior to 2011, traditional male circumcision in Malawi was the dominant form of male circumcision, mainly for cultural and religious reasons. This paper looks at male circumcision as a prevention method against HIV by examining the relationship between male circumcision and HIV status among Malawian men.

The data used were collected as part of the 2010 Malawi Demographic and Health Survey. The methodology used in the 2010 MDHS has been comprehensively described by the National Statistical Office of Malawi and ICF Macro. Our analysis is based on men aged 15–54 years who were tested for HIV and responded to questions on circumcision during the survey. Sixty one percent of the 7175 men interviewed in the MDHS, qualified for this analysis. The sample was weighted to ensure representativeness. Frequencies, cross-tabulations, univariate and multivariate logistic regressions were conducted. Differences in the prevalence of HIV infection among circumcised and uncircumcised men were determined with Chi-squared tests.

There is no significant difference in HIV prevalence between circumcised (12 %) and uncircumcised men (10 %). Among circumcised men, age and number of lifetime partners are the dominant correlates of HIV status. Additionally, circumcised men who have had ritual sex are two times more likely (OR = 2.399) to be HIV+ compared to circumcised men who have never had ritual sex.

This study has demonstrated that traditional male circumcision was not associated with HIV infection in pre-2010 Malawi. Among circumcised men, age and number of lifetime partners are correlates to HIV status while circumcised men who have had ritual sex are more likely to be diagnosed with HIV than circumcised men who have not had ritual sex.

Table 2
Percent distribution of respondents by HIV status and selected background characteristics
Background characteristics	HIV status		Sample size
	Negative	Positive
Age***
15–24	97.8	2.2	1533
25–39	87.5	12.5	1911
40+	81.1	18.9	914
Marital status***
Never married	94.0	6.0	1778
Currently married	87.8	12.2	2410
Formerly married	76.3	23.7	170
Age at sexual debut**
< 15	92.7	7.3	915
15-24	89.2	10.8	3294
25 +  †	87.7	12.3	149
Ever had ritual sex
Yes	86.4	13.6	159
No	90.1	9.9	4199
Number of life time partners***
1	98.0	2.0	750
2	92.7	7.3	1082
3	89.3	10.7	921
4	91.6	8.4	486
5	85.2	14.8	371
6-9	80.7	19.3	394
10+	79.7	20.3	354
Type of residence***
Urban	84.8	15.2	647
Rural	91.4	8.6	3711
Region***
Northern	93.2	6.8	750
Central	91.9	8.1	1592
Southern	87.2	12.8	2016
Religion
Catholic	89.9	8.4	984
Other Christian	89.8	8.6	2930
Muslim	90.4	7.7	444
Level of education
None	87.5	12.5	253
Primary	90.3	9.7	2669
Secondary+	89.7	10.3	1436
Wealth index***
Poor	92.2	7.8	1496
Medium	91.7	8.3	903
Rich	87.7	12.3	1959
Circumcision status*
Circumcised	87.9	12.1	831
Not circumcised	90.5	9.5	3,527
Total	89.9	10.1	4,358

*p < 0.050; **p < 0.01; ***p < 0.001

Mutombo et al.

Mutombo et al. BMC Public Health 2015 15:1051   doi:10.1186/s12889-015-2384-z

Full article at: http://goo.gl/Vhv8qx

By: Namuunda Mutombo^1*, Beatrice Maina² and Monica Jamali³

¹African Population and Health Research Center (APHRC), Nairobi, 00100, Kenya

²APHRC, Nairobi, Kenya

³Chancellor College, University of Malawi, Zomba, Malawi

   

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