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Circumcised vs intact men living with HIV infection

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If mass circumcision is a good way to slow HIV epidemics in Africa, then one would expect that country-by-country circumcised men would be less likely to be HIV-positive compared to intact men (ie, men with foreskins).

Twenty-four national surveys in 16 countries in Africa (eight countries had two surveys) report the percentages of circumcised men and intact men who are HIV-positive by age. From these surveys, the table below shows the percentages of men aged 20 years and above who are HIV-positive (because many men are circumcised in their late teens, these calculations exclude teenagers). In 7 of 16 countries, circumcised men are more likely to be HIV-positive compared to intact men, while the median (middle) ratio of the percentages of circumcised vs. intact men who are HIV-positive is 0.93 (taking the latest survey results for 16 countries).

From these data, circumcision seems, for example, to raise men’s risk for HIV in Burundi, Rwanda, and Malawi, but to lower their risk in Kenya and Tanzania. Because that doesn’t make much sense, it’s reasonable to conclude that other factors have a much bigger influence on men’s risk to get HIV than whether they are circumcised or intact.

Table: HIV infections in circumcised and intact men (if you know any data we’ve missed, please bring it to our attention)

Country,   year %   HIV+ among: Ratio   of %’s of circ’d vs intact men who are HIV+
Circ’d   men Intact   men
Cameroon,   2004 5.1 1.5 3.5
Malawi,   2010 14 10 1.4
Rwanda, 2005 3.8 2.7 1.4
Burundi,   2010 1.6 1.3 1.3
Ethiopia,   2011 1.2 1.1 1.1
Ghana,   2003 2.0 1.8 1.1
Rwanda,   2010 3.4 3.1 1.1
Zimbabwe, 2005-06 20 19 1.1
Lesotho, 2004 26 24 1.0
Zimbabwe,   2010-11 16.1 15.5 1.0
Tanzania, 2003-04 7.5 7.4 1.0
Lesotho,   2009 23 25 0.94
Ethiopia, 2005 1.2 1.3 0.93
Swaziland,   2006-07 26 29 0.91
Zambia,   2007 13 15 0.87
Uganda,   2011 5.3 8.0 0.67
Cote   d’Ivoire, 2005 3.4 5.2 0.64
Uganda, 2004-05 4.7 7.3 0.64
Mozambique,   2009 7.8 15 0.52
Tanzania,   2007-08 4.6 9.0 0.51
Burkina Faso, 2003 2.1 4.2 0.50
Burkina   Faso, 2010 0.9 1.9 0.47
Kenya,   2008-09 3.9 21 0.17
Kenya, 2003 3.6 22 0.16

Sources: Demographic and Health Surveys and AIDS Indicators Surveys. When you get to the link, click on the country and then the survey.

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