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Link to original content: https://pubmed.ncbi.nlm.nih.gov/2502151/
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. 1989 Jun;3(6):373-7.
doi: 10.1097/00002030-198906000-00006.

The relationship between male circumcision and HIV infection in African populations

J Bongaarts  1 , P Reining, P Way, F Conant
Affiliations

The relationship between male circumcision and HIV infection in African populations

J Bongaarts et al. AIDS. 1989 Jun.

Abstract

The relationship between HIV seroprevalence and the proportion of uncircumcised males in African countries is examined to determine whether circumcision practices play a role in explaining the large existing variation in the sizes of African HIV epidemics. A review of the anthropological literature yielded estimates of circumcision practices for 409 African ethnic groups from which corresponding national estimates were derived. HIV seroprevalence rates in the capital cities were used as indicators of the relative level of HIV infection of countries. The correlation between these two variables in 37 African countries was high (R = 0.9; P less than 0.001). This finding is consistent with existing clinic-based studies that indicate a lower risk of HIV infection among circumcised males.

PIP: Wide variations in the HIV epidemic exist among the different countries in Africa. The relationship between HIV seroprevalence and the proportion of uncircumcised males is examined to determine whether circumcision practices play a role in explaining the variation in the sizes of the African HIV epidemics. Circumcision practices for 409 African ethnic groups were corresponded with national estimates of HIV infection levels. Although age at circumcision and other ethnic group identity characteristics were known, this information was not considered in this study. HIV seroprevalence rates in the capital cities were used to indicate the relative level of HIV infection in the countries. In 5 countries where more than 3 quarters of males were estimated to be uncircumcised, the average HIV prevalence was 16.4%. In none of the capital cities of these 5 countries was the seroprevalence less than 9.5%. Among the 20 countries where more than 90% of males were circumcised, the average seroprevalence was 0.9% and in no case did it exceed 4%. The correlation between these 2 variables was high (R=0.9%;P 0.001). Although strong population level correlation between circumcision and HIV seroprevalence exists, it does not prove a cause and effect relationship. However, the results are consistent with existing clinic-based studies that indicate a lower risk of HIV infection among circumcised males and suggest that male circumcision is a cofactor in HIV infection.

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