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

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, 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 men (35.3%) were circumcised. Being over 50, African, living in rural areas and speaking SePedi (71.2%), IsiXhosa (64.3%) were strongly associated with circumcision. The median age was significantly older for Africans (18 yr) compared to other racial groups (3.5 yr), p < 0.001. Among Africans, circumcisions were mainly conducted outside hospital setting. In 40.5%, circumcision took place after sexual debut; Two thirds of men were circumcised after their 17th birthday were already sexually active. HIV and circumcision were not associated (12.3% vs 12%). HIV was, however, significantly lower in men circumcised before 12 yrs (6.8%) compared to over 12 yrs of age (13.5%), p = 0.02. When restricted to sexually active men, the difference that remained did not reach statistical significance (8.9% vs 13.6%, p = 0.08.)

Conclusions: The high percentage of circumcision taking place after sexual debut 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.