Comparison of the prevalence of HIV infection in circumcised and uncircumcised men from Salima District in Malawi

• Main Author: Kankuwe, Hector Master
• Format: Others
• Language: English
• Published: University of Fort Hare 2012
• Subjects: HIV infections > Malawi; Initiation rites > Malawi
• Online Access: http://hdl.handle.net/10353/462

The overall objective of the study was to investigate the relationship between male circumcision status and HIV infection in men from Salima district in Malawi. A cross-sectional survey-based study of men aged 15 years or more was conducted at three sites in Salima district, each of which targeted 90 participants, half of whom were circumcised and the other half uncircumcised. These participants had already decided on their own to visit HIV Testing and Counseling centres at these sites to know their HIV serostatus. Consenting men were drawn into the study using quota sampling, interviewed through a structured questionnaire in local language and tested for HIV during January and March 2011. Measures of association were performed using analysis of contingency tables and Pearson’s chi-square tests or Fisher’s exact tests for comparison of proportions in STATA version 11.0 and PASW Statistics 18.0 software. Unadjusted odds ratios were used to approximate the direction and strength of association. Further, a multivariable logistic regression model was fit to determine which other variables were significantly associated with HIV infection. The study was approved by University of Fort Hare Interim Research Ethics Committee and National Health Sciences Research Committee in Malawi. The overall prevalence of HIV infection was 11.5 percent. However, it was less than half in circumcised males (7.4 percent) compared with uncircumcised counterparts (15.6 vi percent). While Fisher’s exact test revealed a borderline statistically significant association between male circumcision status and HIV infection (p 0.055), Pearson’s chi-square test showed a stronger significant association between the two variables ( p 0.036). The strength of the association was manifested by the odds of HIV infection being roughly 0.43 times lower for circumcised males than their uncircumcised counterparts with a 95 percent confidence interval of (0.20 0.96). Although the association was maintained after controlling for some variables, it lost statistical significance when adjusted for other variables. A multivariable logistic regression revealed that three other variables had significant associations with HIV infection and these were: falling in the age group of 25 years or more (OR 4.69; p 0.020), having had sex with an HIV positive partner (OR 12.15; p 0.000) and having contracted a sexually transmitted infection (OR 3.25; p 0.032). Male circumcision status is significantly related to HIV infection. Although the study involved a small sample size and undertaken in one district in Malawi, the finding is consistent with existing clinic-based findings in literature that indicate a lower risk of HIV infection in circumcised males than in uncircumcised males. Consequently, male circumcision could be considered if it can prove to be a public health intervention in the Malawi context aimed at reducing the risk of uncircumcised males becoming infected by HIV.