Makatjane, T. J., T. Hlabana, and E. M. Letete. 2016. Male Circumcision and HIV in Lesotho: Is the Relationship Real or Spurious? Analysis of the 2009 Demographic and Health Survey. DHS Working Papers No. 125. Rockville, Maryland, USA: ICF International.
Background. Lesotho has the second highest prevalence of HIV in the world, estimated at 23%. Compelling evidence from ecological studies, as well as from randomized clinical trials in Africa, suggests that male circumcision reduces the risk of heterosexually-acquired HIV infection in men. However, results from DHS surveys in Lesotho present contradictory evidence of high HIV prevalence among circumcised men (21%) compared with uncircumcised men (16%). The objective of this study is to analyze the relationship between HIV and male circumcision in Lesotho. In particular, the study seeks to assess whether it makes a difference if one is medically or traditionally circumcised, and if the differences in risky sexual behaviors could explain the contradictory evidence in Lesotho.
Data and Methods. The study used data from the 2009 Lesotho Demographic and Health Survey (LDHS). A weighted sample of 2,283 sexually active males age 15-59 was used for this analysis. Descriptive univariate, bivariate, and logistic regression analyses were used.
Results. Although 57% of sexually active men in Lesotho are circumcised, HIV infection is high among all men. When controlling for background and risky sexual behaviors, the study found that medically circumcised men had significantly lower odds of HIV infection than uncircumcised men. However, the odds of HIV infection among traditionally circumcised men were similar to those of uncircumcised men. When comparing the odds of HIV infection among circumcised men only, the study found that traditionally circumcised men had significantly higher odds of being HIV-positive compared with medically circumcised men.
Conclusion and Recommendations. The previously reported, apparent non-existence of protection offered by male circumcision occurs because traditional circumcision and medical circumcision were treated like the same procedure. However, medical circumcision provides the expected protection that traditional circumcision does not. There is need to engage with gatekeepers of initiation schools to ensure that traditional circumcision is as effective as medical circumcision. It is equally important that Lesotho continues to emphasize the importance of avoiding risky sexual behaviors if the war against the AIDS epidemic is to be won. Further research is needed to understand why HIV prevalence for medically and traditionally circumcised men in Lesotho is dissimilar to what prevails in other settings.