Introduction: Male
circumcision (MC) reduces the risk of HIV, and this risk reduction may be modified
by socio-cultural factors such as the timing and method (medical and traditional)
of circumcision. Understanding regional variations in circumcision practices and
their relationship to HIV is crucial and can increase insight into the HIV epidemic
in Africa.
Methods: We
used data from two retrospective HIV surveys conducted in Guinea-Bissau from 1993
to 1996 (1996 cohort) and from 2004 to 2007 (2006 cohort). Multivariate logistical
models were used to investigate the relationships between HIV risk and circumcision
status, age, method of circumcision, and socio-demographic factors.
Results: MC
was protective against HIV infection in both cohorts, with adjusted odds ratios
(AORs) of 0.28 (95% CI 0.12-0.66) and 0.30 (95% CI 0.09-0.93), respectively. We
observed that post-pubertal (<13 years) circumcision provided the highest level
of HIV risk reduction in both cohorts compared to non-circumcised. However, the
difference between pre-pubertal (<13) and post-pubertal circumcision was not
significant in the multivariate analysis. Seventy-six percent (678/888) of circumcised
males in the 2006 cohort were circumcised traditionally, and 7.7% of those males
were HIV-infected compared to 1.9% of males circumcised medically, with AOR of 2.7
(95% CI 0.91-8.12).
Conclusion: MC
is highly prevalent in Guinea-Bissau, but ethnic variations in method and timing
may affect its protection against HIV. Our findings suggest that sexual risk behaviour
and traditional circumcision may increases HIV risk. The relationship between circumcision
age, sexual behaviour and HIV status remains unclear and warrants further research.
Full article at: http://goo.gl/iSGk3P
By: Dlama Nggida Rasmussen1,2,3,&, Christian
Wejse1,4,5, Olav Larsen1,2, Zacarias Da Silva1,
Peter Aaby1,6, Morten Sodemann1,2,3
1Bandim Health Project, Indepth Network, Apartado
861, 1004 Bissau Codex, Bissau, Guinea-Bissau, 2Department of Infectious Diseases,
Odense University Hospital, DK-5000 Odense, Denmark, 3Center for Global Health,
Institute of Clinical Research, University of Southern Denmark, DK-5000 Odense,
Denmark, 4Department
of Infectious Diseases, Aarhus University Hospital, DK-8200 Aarhus, Denmark, 5Center for Global Health,
Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark, 6Statens Serums Institute, DK-2300
Copenhagen, Denmark
&Corresponding author
Dlama Nggida Rasmussen, Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
Dlama Nggida Rasmussen, Department of Infectious Diseases, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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