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Abstract
Male circumcision and HIV infection risk among tea plantation residents in Kericho, Kenya: incidence results after 1.5 years of follow-up
W.B. Sateren1, C.T. Bautista1, D.N. Shaffer2, G. Foglia3, M. Wassuna4, S. Kiplangat5, F. Sawe5, D.E. Singer1, M. Robb1, N. Michael1, D.L. Birx6
1U.S. Military HIV Research Program at the Walter Reed Army Institute of Research and the Henry M. Jackson Foundation, Inc., Rockville, United States, 2United States Army Medical Research Unit-Kenya, Kericho, Kenya, 3U.S. Army Medical Research Unit - Kenya (formerly), Nairobi, Kenya, 4Kenya Medical Research Institute - KEMRI, Nairobi, Kenya, 5U.S. Army Medical Research Unit - Kenya, Nairobi, Kenya, 6U.S. Military HIV Research Program at the Walter Reed Army Institute of Research and the Henry M. Jackson Foundation, Inc., (formerly), Rockville, United States
Background: To determine the association between male circumcision and risk of HIV infection at baseline and after 1.5 years of follow-up in an HIV prospective cohort study.
Methods: As part of an ongoing 3-year study of HIV incidence, a total of 1,719 men were enrolled at a tea plantation in Kericho, Kenya, between June and December 2003. Following written informed consent volunteers were administered a sociodemographic and behavioral questionnaire and screened for HIV infection. Circumcision status was self-determined. HIV testing was done by ELISA and confirmed by Western blot assay. Participants returned for follow-up HIV screening and additional questionnaires at 6, 12 and 18 months. Incidence rates (IR) were expressed as the number of seroconverters per 100 person-years of follow-up.
Results: At baseline a high HIV prevalence was found in this study population, 11.3% (95% CI 9.8–12.8). A strong statistically significant difference in HIV prevalence (p<0.01) was observed between the 398 uncircumcised men (24.9%, 95% CI: 20.6–29.1) and the 1,321 circumcised men (7.3%, 95% CI 5.9–8.7). Circumcision was found to be a protective predictor of HIV infection (odds ratio = 0.24, 95%: CI 0.17–0.32). This protective effect was also observed for circumcised men compared to uncircumcised men across all strata of age groups, education, marital status, history of sexually transmitted infection(s), and syphilis infection status. After 1.5 years of follow-up, the overall HIV incidence rate was statistically significantly lower among circumcised men (0.84/100 person-years, 95% CI: 0.38–1.29) compared to uncircumcised men (2.98/100 person-years, 95% CI: 1.25-4.72), yielding an HIV incidence rate ratio of 0.28 (95% CI: 0.13-0.63, p<0.001).
Conclusions: Circumcision plays an important role in a reduced risk of HIV infection among men.
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