Association between HIV/AIDS, Medical Male Circumcision and Traditional Circumcision in Mozambique, 2015

BackgroundThe WHO AFRO region continues to be severely impacted by HIV and a global public health problem. In Mozambique, as of 2015, HIV prevalence was estimated to be 12.5% among adults. Medical male circumcision (MMC) has been promoted as a national prevention strategy to reduce the risk of HIV in men. We aimed to analyze the association between HIV infection, medical male circumcision and traditional male circumcision among men in Mozambique. MethodsCross-sectional data from the 2015 Mozambican National and Demographic Health Survey of Immunization, Malaria, and HIV/AIDS (IMASIDA) were used in this analysis. In this study, considered medical male circumcision (MMC) and medical circumcision (MC). Participants were asked about their circumcision status and where the circumcision was performed. In addition, blood samples were collected from participants and tested for HIV antibodies. All analyses were weighted and adjusted for the complex survey design to ensure results and approximate population parameters of interest. Chi-square tests and multiple logistic regression were used in the analyses to assess the associations between male circumcision and HIV infection. ResultsA total unweighted sample of 4733 men aged 15-49 consented to the survey and were interviewed. Of those who participated, 4236 consented to an HIV test. Nationally, 62.6% (95% CI 59.6-65.6) of men aged 15-49 years were circumcised. Traditional circumcision was the most common form of circumcision at 32.9% (95% CI 30.1-35.8), followed by MMC at 21.7% (95% CI 19.6-24.1), 8.0% (95% CI 6.5-9.9) did not know whether it was traditional or medical. The prevalence of HIV was highest at 13.4% among uncircumcised men (13.4%, 95% CI 11.3-15.7), and significantly lower among traditionally circumcised men (8.5%, 95% CI 6.8-10.6) and among medically circumcised men (7.5%, 95% CI 5.7-9.6). In multivariable analysis, men circumcised by a medical practitioner had almost 50% reduced odds of infection with HIV compared to uncircumcised men (aOR=0.52; 95% [CI=0.34-0.78], p=0.002), whereas men who were circumcised by traditional methods had a 29% reduced risk, but not significantly different than uncircumcised men (aOR=0.71; 95% [CI=0.47-1.07], p=0.098). ConclusionWe found that HIV prevalence was lower among men aged 15-49 years who were circumcised, and the odds of being HIV positive was about 50% lower among men who were circumcised by a medical practitioner, suggesting a reduced risk of HIV infection. Although Mozambique has not achieved the UNAIDS goal of 80% men circumcised at the time of the IMASIDA 2015 survey, we encourage the continued expansion of voluntary medical male circumcision.