School of Public Health, Makerere University, Kampala, Uganda.
Reprod Health. 2014 Mar 24;11(1):25. doi: 10.1186/1742-4755-11-25.
Safe male circumcision (SMC) is a known efficacious intervention in the prevention of heterosexual HIV acquisition. However, there are perceptions that SMC may lead to behavior disinhibition towards risky sexual behaviors. We assessed the association between male circumcision, risky sexual behaviors and HIV prevalence among men in a nationally representative sample.
Data was extracted from the Uganda AIDS Indicator Survey (2011), a stratified two-stage cluster sample, with a total of 7,969 ever sexually active men aged 15-59 years. The association between risky sexual behaviors (non- marital/non-cohabiting sexual relations, non-use of condoms, transactional sex, multiple (4+) lifetime partners) and male circumcision status were determined using odds ratios (OR) and their 95% confidence intervals, through logistic regression models. All analyses were conducted in Stata version 12.
Overall, the prevalence of male circumcision was 28%; higher among men aged 25-34 years, 32%, and lowest among those aged 45-59 years, 18%. HIV prevalence was significantly lower among the circumcised, 4.8% compared to the uncircumcised men, 7.8% (p < 0.001). The commonest risky sexual behaviors were multiple life-time sexual partners (4+), 59%; non-use of condoms with non-marital sexual partners, 55%; and having non-marital sex, 33%. In comparison with the uncircumcised, circumcised men had higher odds of engaging in non-marital sex AOR = 1.26 (95% CI: 1.05-1.52), reporting multiple (4+) life-time partners, AOR = 1.46 (95% CI: 1.27-1.67). The odds of non-use of condoms with a non-marital partner were also significantly lower among the circumcised compared to the uncircumcised men, AOR = 0.79 (95% CI: 0.63-0.98).
Although risky sexual behaviors were more common among circumcised men, HIV prevalence was lower among the circumcised men relative to the uncircumcised. These observations suggest a need to promote the already known HIV intervention strategies especially among the circumcised men.
安全男性割礼（SMC）是预防异性恋人群中 HIV 获得的一种有效的干预措施。然而，有人认为 SMC 可能导致性行为对风险性行为的抑制作用丧失。我们评估了男性割礼、风险性行为与男性 HIV 流行率之间的关系，研究对象是全国代表性样本中的男性。
数据取自乌干达艾滋病指标调查（2011 年），这是一个分层两阶段的聚类样本，共有 7969 名 15-59 岁曾有过性行为的男性。使用逻辑回归模型，通过比值比（OR）及其 95%置信区间来确定风险性行为（非婚姻/非同居性关系、不使用安全套、性交易、多个（4+）终身伴侣）与男性割礼状况之间的关联。所有分析均在 Stata 版本 12 中进行。
总体而言，男性割礼的流行率为 28%；25-34 岁的男性割礼率较高，为 32%，而 45-59 岁的男性割礼率最低，为 18%。与未割礼的男性相比，HIV 流行率在割礼的男性中明显较低，分别为 4.8%和 7.8%（p<0.001）。最常见的风险性行为是多个（4+）终身性伴侣，占 59%；不与非婚姻伴侣使用安全套，占 55%；有非婚姻性行为，占 33%。与未割礼的男性相比，割礼的男性发生非婚姻性行为的可能性更高，比值比（OR）为 1.26（95%可信区间：1.05-1.52），报告多个（4+）终身伴侣的可能性更高，OR 为 1.46（95%可信区间：1.27-1.67）。与未割礼的男性相比，割礼的男性与非婚姻伴侣发生性行为时不使用安全套的可能性也显著降低，比值比（OR）为 0.79（95%可信区间：0.63-0.98）。
尽管割礼男性中风险性行为更为常见，但与未割礼男性相比，HIV 流行率在割礼男性中较低。这些观察结果表明，需要特别针对割礼男性促进已有的 HIV 干预策略。
