       Document 0740
 DOCN  M9640740
 TI    Male circumcision, sexually transmitted disease, and risk of HIV.
 DT    9604
 AU    Seed J; Allen S; Mertens T; Hudes E; Serufilira A; Carael M; Karita E;
       Van de Perre P; Nsengumuremyi F; Projet San Francisco, California, USA.
 SO    J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Jan 1;8(1):83-90.
       Unique Identifier : AIDSLINE MED/96142205
 AB    Our objective was to describe associations among male circumcision,
       behavioral and demographic variables, ulcerative and nonulcerative
       sexually transmitted disease (STD), and human immunodeficiency virus
       (HIV) infection via a cross-sectional study in Kigali, the capital of
       Rwanda. Our subjects were 837 married men who volunteered for HIV
       testing and counselling. Uncircumcised men had a relatively low-risk
       profile in that they reported fewer lifetime sexual partners and
       prostitute contacts than circumcised men and were more likely to live in
       rural areas with lower HIV prevalence rates. Uncircumcised men were also
       less likely to report a history of sexually transmitted disease (64%
       versus 73%, p = 0.01), although they were more likely to report genital
       ulceration (GUD) (24% versus 17%, p < 0.03) and to have inguinal
       adenopathy noted on physical exam (42% versus 29%, p = 0.009). Despite
       the low-risk profile, uncircumcised men had a higher prevalence of HIV
       infection than circumcised men (29% versus 21% HIV positive, p = 0.02),
       which was most marked in men reporting five or more lifetime sex
       partners (36% versus 23% HIV positive, p = 0.005) or contact with
       prostitutes (35% versus 23% HIV positive, p = 0.009). Circumcision
       remained a predictor of HIV infection in multivariate analyses
       (multivariate odds ratio 1.69, 95% confidence interval 1.16-2.47). Lack
       of circumcision is associated with a higher risk of HIV infection in
       Rwandan men. Further research is needed to determine whether this higher
       risk is due in part to poor hygiene or to complex mechanisms operating
       through the acquisition of other sexually transmitted diseases.
       Circumcision may be an appropriate risk reduction approach for men with
       known exposures to the virus when there are constraints to alternatives,
       such as condom use.
 DE    Adult  *Circumcision  Cross-Sectional Studies  Demography  Genital
       Diseases, Male/EPIDEMIOLOGY  Human  HIV Infections/*EPIDEMIOLOGY  Male
       Multivariate Analysis  Prevalence  Prospective Studies  Risk Factors
       Rwanda/EPIDEMIOLOGY  Sex Behavior/STATISTICS & NUMER DATA  Sexually
       Transmitted Diseases/*EPIDEMIOLOGY  Support, U.S. Gov't, P.H.S.  JOURNAL
       ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

