Connolly Catherine, Simbayi Leickness C, Shanmugam Rebecca, Nqeketo Ayanda
Medical Research Council, Durban.
S Afr Med J. 2008 Oct;98(10):789-94.
To investigate the nature of male circumcision and its relationship to HIV infection.
Analysis of a sub-sample of 3 025 men aged 15 years and older who participated in the first national population-based survey on HIV/AIDS in 2002. Chi-square tests and Wilcoxon rank sum tests were used to identify factors associated with circumcision and HIV status, followed by a logistic regression model.
One-third of the men (35.3%) were circumcised. The factors strongly associated with circumcision were age > 50, black living in rural areas and speaking SePedi (71.2%) or IsiXhosa (64.3%). The median age was significantly older for blacks (18 years) compared with other racial groups (3.5 years), p < 0.001. Among blacks, circumcisions were mainly conducted outside hospital settings. In 40.5% of subjects, circumcision took place after sexual debut; two-thirds of the men circumcised after their 17th birthday were already sexually active. HIV and circumcision were not associated (12.3% HIV positive in the circumcised group v. 12% HIV positive in the uncircumcised group). HIV was, however, significantly lower in men circumcised before 12 years of age (6.8%) than in those circumcised after 12 years of age (13.5%, p = 0.02). When restricted to sexually active men, the difference that remained did not reach statistical significance (8.9% v. 13.6%, p = 0.08.). There was no effect when adjusted for possible confounding.
Circumcision had no protective effect in the prevention of HIV transmission. This is a concern, and has implications for the possible adoption of the mass male circumcision strategy both as a public health policy and an HIV prevention strategy.
探讨男性包皮环切术的性质及其与艾滋病毒感染的关系。
对2002年参与首次全国基于人群的艾滋病毒/艾滋病调查的3025名15岁及以上男性的子样本进行分析。采用卡方检验和威尔科克森秩和检验来确定与包皮环切术和艾滋病毒感染状况相关的因素，随后建立逻辑回归模型。
三分之一的男性（35.3%）接受了包皮环切术。与包皮环切术密切相关的因素包括年龄>50岁、居住在农村地区且讲塞佩迪语（71.2%）或科萨语（64.3%）的黑人。黑人的中位年龄（18岁）明显高于其他种族群体（3.5岁），p<0.001。在黑人中，包皮环切术主要在医院外进行。40.5%的受试者在首次性行为后进行了包皮环切术；17岁生日后接受包皮环切术的男性中有三分之二已经有性行为。艾滋病毒感染与包皮环切术无关（包皮环切组的艾滋病毒阳性率为12.3%，未包皮环切组为12%）。然而，12岁之前接受包皮环切术的男性中的艾滋病毒感染率（6.8%）明显低于12岁之后接受包皮环切术的男性（13.5%，p=0.02）。当仅限于有性行为的男性时，这种差异不再具有统计学意义（8.9%对13.6%，p=0.08）。调整可能的混杂因素后没有影响。
包皮环切术在预防艾滋病毒传播方面没有保护作用。这令人担忧，并且对作为公共卫生政策和艾滋病毒预防策略而可能采用的大规模男性包皮环切术策略具有影响。
