Abstract:
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.
Male Circumcision and HIV in Lesotho: Is the Relationship Real or Spurious? Analysis of the 2009 Demographic and Health Survey (PDF, 568K)