Tram Khai Hoan, Bertrand Jane T
Stanford University School of Medicine, Stanford, California, United States of America.
Tulane University School of Public Health and Tropical Medicine, Department of Global Health Systems and Development, New Orleans, Louisiana, United States of America.
PLoS One. 2014 Jun 23;9(6):e100775. doi: 10.1371/journal.pone.0100775. eCollection 2014.
BACKGROUND: Despite the importance of male circumcision (MC) prevalence to HIV prevention efforts in Eastern and Southern Africa, there has been no systematic analysis on the correlates of male circumcision. This analysis identifies correlates of MC in 12 countries in the region with available data. METHODS: Data from the male questionnaire of DHS surveys collected between 2006-2011 in Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe were analyzed. The dependent variable was self-reported male circumcision status. Independent variables included age, education, wealth quintile, place of residence, ethnicity, religion and region. Bivariate and multivariate analyses were conducted separately for each country. RESULTS: MC prevalence ranged from 8.2 percent in Swaziland to 92.2 percent in Ethiopia. Bivariate analyses showed a consistent positive association between age (being older) and male circumcision. Education, wealth quintile, and place of residence were either not significantly related or differed in the direction of the relationship by country. Multivariate logistic regression showed three variables consistently associated with MC status: age (being older), religion (being Muslim) and ethnicity. DISCUSSION: These data were collected prior to the scale-up of voluntary medical male circumcision (VMMC) programs in 11 of the 12 countries. As the VMMC scale-up intensifies in countries across Eastern and Southern Africa, the correlates of VMMC are likely to change, with (younger) age and education emerging as key correlates of VMMC performed in medical settings. The centuries-long tradition among Muslims to circumcise should continue to favor MC among this group. Non-circumcising ethnicities may become more open to MC if promoted as a health practice for decreasing HIV risk.
背景:尽管男性包皮环切术(MC)的流行率对东部和南部非洲的艾滋病预防工作至关重要,但尚未对男性包皮环切术的相关因素进行系统分析。本分析确定了该地区12个有可用数据国家中男性包皮环切术的相关因素。 方法:对2006年至2011年期间在埃塞俄比亚、肯尼亚、莱索托、马拉维、莫桑比克、纳米比亚、卢旺达、斯威士兰、坦桑尼亚、乌干达、赞比亚和津巴布韦收集的人口与健康调查(DHS)男性问卷数据进行分析。因变量是自我报告的男性包皮环切术状况。自变量包括年龄、教育程度、财富五分位数、居住地点、种族、宗教和地区。对每个国家分别进行双变量和多变量分析。 结果:男性包皮环切术的流行率从斯威士兰的8.2%到埃塞俄比亚的92.2%不等。双变量分析显示年龄(年长)与男性包皮环切术之间存在一致的正相关。教育程度、财富五分位数和居住地点在不同国家要么无显著关联,要么在关联方向上存在差异。多变量逻辑回归显示与男性包皮环切术状况始终相关的三个变量:年龄(年长)、宗教(穆斯林)和种族。 讨论:这些数据是在12个国家中的11个国家扩大自愿医学男性包皮环切术(VMMC)项目之前收集的。随着东部和南部非洲各国VMMC扩大规模,VMMC的相关因素可能会发生变化,年龄(较年轻)和教育程度将成为在医疗机构进行VMMC的关键相关因素。穆斯林长达几个世纪的包皮环切传统应会继续使该群体更倾向于接受包皮环切术。如果将包皮环切术作为降低艾滋病病毒风险的健康做法加以推广,不进行包皮环切术的种族可能会对其更加接受。
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