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Intact vs. circumcised men have less HIV in many African countries

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National surveys in 27 countries report the percentages of intact and circ’d men who are HIV-positive. Intact men are LESS LIKELY to be HIV-positive in 15 of 27 countries (see Table below), and the median (middle) ratio of the percentages of HIV-infected intact vs circ’d men is 0.89 — intact men are 11% less likely to be HIV-positive.

In nine countries only very small numbers of surveyed men were intact, so the ratios are less reliable (see countries in bold and italics in the Table below). Considering only the 18 countries in which at least 5% of surveyed men are intact, intact men are less likely to be HIV-positive in six countries. In these 18 countries, ratios of HIV in intact vs. circ’d men range from 0.23 in Cameroon to 4.4 in Kenya, and the median (middle) ratio is 1.3 — intact men are 30% more likely to be HIV-positive (see Table).

Survey data are available for 13 of the 14 countries where the US and partners target men for circ’ing (see starred countries in the Table). In 3 of these 13 countries, intact men have less HIV than circ’d men, and the median (middle) ratio is 1.4.

The wide range of ratios of HIV prevalence in intact vs. circ’d men leaves us with a puzzle: why do intact men have less HIV in some communities, but more in others?

Table: HIV infections in circumcised vs. intact men in countries in Africa

Country, year Ratio of intact vs. circ’d men who are HIV-positive %s of intact vs. circ’d men who are HIV-positive
Liberia, 2013 0 0 vs. 1.8
Chad, 2014-15 0 0 vs. 1.4
Dem Rep Congo, 2007 0 0 vs. 1.0
Mali, 2012-13 0 0 vs. 0.9
Sierra Leone, 2013 <0.08 <0.1 vs. 1.3
Ghana, 2014 0.08 0.2 vs. 1.2
Cameroon, 2011 0.23 0.7 vs. 3.0
Cote d’Ivoire, 2011-12 0.39 1.1 vs. 2.8
Togo, 2013-14 0.47 0.8 vs. 1.7
Benin, 2011-12 0.50 0.5 vs. 1.0
Gabon, 2012 0.55 1.2 vs. 2.2
Burundi, 2016-17 0.67 0.6 vs. 0.9
Ethiopia, 2011* 0.80 0.8 vs. 1.0
Swaziland, 2006-7* [this is the median for all 27 countries] 0.89 19.5 vs. 21.8
Malawi, 2015-16*  0.95 7.0 vs. 7.4
Rwanda, 2014-15* 1.09 2.5 vs. 2.3
Zambia, 2013-14 *   1.2 12.2 vs. 10.5
Lesotho, 2014* 1.2 21.8 vs. 18.7
[this is the median for 18 countries with ≥5% of sampled men intact; this median ignores nine italicized countries] 1.3
Zimbabwe, 2015* [this is the median for 13 starred countries, where WHO targets men for circ’ing] 1.4 11.8 vs. 8.2
Uganda, 2004-5* 1.5 5.6 vs. 3.8
Namibia, 2013* 1.5 11.9 vs. 8.0
Tanzania, 2011-12* 1.6 5.2 vs. 3.3
South Africa, 2016* 1.6 18.4 vs. 11.3
Mozambique, 2015* 1.7 13.7 vs. 8.1
Burkina Faso, 2010 1.9 1.5 vs. 0.8
Equatorial Guinea, 2011 2.2 7.4 vs. 3.3
Kenya, 2008-9* 4.4 13.6 vs. 3.1

Sources: Data for all countries are from the latest Demographic and Health Surveys and AIDS Information Surveys for each country, available at: http://www.dhsprogram.com/Where-We-Work/Country-List.cfm (from this link, click on the country and then the survey, and then go to the chapter that reports HIV prevalence).

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