Assessment of the protective effect of male circumcisioin from HIV infection and sexually transmitted diseases: evidence from 18 demographic and health surveys in Sub-Saharan Africa.

A cross-sectional comparative study based on secondary data of 18 Demographic Health Surveys (DHS) carried out in Sub-Saharan Africa starting from 2003 was conducted to assess the protective effect of male circumcision from HIV infection and STDs. From all surveys, information on 70,554 males aged 15-59 years was extracted. The association between male circumcision and HIV infection and STD symptoms (Genital discharge or genital ulcer/sore) was assessed using binary logistic regression. Adjustment was made for sexual history and basic sociodemographic variables. The weighted prevalence of HIV among men 15-59 years was 3.1%. In the bivairate analysis being uncircumcised was significantly associated with risk of HIV with Odds Ratio (OR) of 4.12 aged (95% CI: 3.85-4.42). The association was even more significant, 4.95 (95% CI: 4.57-5.36), after adjustment for number of lifetime sexual partners and socio-demographic variables. The risk associated with uncircumcision is significantly lower among younger men aged 15-29 years than those in 30-59 years age category. About 5.5% of the study subjects reported either genital discharge or genital sore/ulcer in the preceding 12 months of the surveys. Circumcision was not significantly associated with either of the symptoms of STD with adjusted OR of 1.07 (95% CI: 0.99-1.15). The study concludes that male circumcision provides a strong protection against acquisition of HIV infection. Hence, it can be considered as a possible way of reducing the spread of HIV infection in areas where the practice is rare. A comprehensive study to assess the association between circumcision and different types STDs is recommended.