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Voluntary medical male circumcision and HIV in Zambia: expectations and observations

  • Michel Garenne (a1) (a2) (a3) (a4) and Alan Matthews (a5)

Abstract

The study analysed the HIV/AIDS situation in Zambia six years after the onset of mass campaigns of Voluntary Medical Male Circumcision (VMMC). The analysis was based on data from Demographic and Health Surveys (DHS) conducted in 2001, 2007 and 2013. Results show that HIV prevalence among men aged 15–29 (the target group for VMMC) did not decrease over the period, despite a decline in HIV prevalence among women of the same age group (most of their partners). Correlations between male circumcision and HIV prevalence were positive for a variety of socioeconomic groups (urban residence, province of residence, level of education, ethnicity). In a multivariate analysis, based on the 2013 DHS survey, circumcised men were found to have the same level of infection as uncircumcised men, after controlling for age, sexual behaviour and socioeconomic status. Lastly, circumcised men tended to have somewhat riskier sexual behaviour than uncircumcised men. This study, based on large representative samples of the Zambian population, questions the current strategy of mass circumcision campaigns in southern and eastern Africa.

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Corresponding author

*Corresponding author. Email: Michel.Garenne@pasteur.fr

References

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Abbott, SA, Haberland, NA, Mulenga, DM and Hewett, PC (2013) Female sex workers, male circumcision and HIV: a qualitative study of their understanding, experience, and HIV risk in Zambia. PLoS One 8(1), e53809.
Auvert, B, Taljaard, D, Lagarde, E, Sobngwi-Tambekou, J, Sitta, R and Puren, A (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Medicine 2, e298.
Bailey, RC, Moses, S, Parker, CB, Agot, K, Maclean, I, Krieger, JN et al. (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet 369, 643656.
Bloom, SS, Banda, C, Songolo, G et al. (2000) Looking for change in response to the AIDS epidemic: trends in AIDS knowledge and sexual behavior in Zambia, 1990 through 1998. Journal of AIDS 25, 7785.
Central Statistical Office of Zambia (2011) AIDS and HIV Statistics. Central Statistical Office, Lusaka, Zambia.
Central Statistical Office of Zambia (2017) AIDS and HIV Statistics: Estimated Number of Persons Living With HIV/AIDS. Central Statistical Office, Lusaka, Zambia.
Central Statistical Office of Zambia , Central Board of Health, Zambia and ORC Macro (2003) Zambia Demographic and Health Survey 2001–2002. Central Statistical Office, Central Board of Health and ORC Macro Calverton, MD.
Central Statistical Office of Zambia, Central Board of Health, Zambia, University of North Carolina and Measure Evaluation (2004) Zambia Sexual Behaviour Survey, 2003. Central Statistical Office, Lusaka, Zambia, and University of North Carolina.
Central Statistical Office of Zambia, Ministry of Health of Zambia and ICF International (2014) Zambia Demographic and Health Survey 2013–14. Central Statistical Office, Ministry of Health, Lusaka, Zambia, and ICF International, Rockville, MD.
Central Statistical Office of Zambia, Ministry of Health of Zambia and Macro International (1997) Zambia Demographic and Health Survey, 1996. Central Statistical Office, Lusaka, Zambia and Macro International Inc., Calverton, MD.
Central Statistical Office of Zambia, Ministry of Health of Zambia, Project Concern International, Zambia and Measure Evaluation (1999) Zambia Sexual Behaviour Survey, 1998. Central Statistical Office, Lusaka, Zambia, and Measure Evaluation, University of North Carolina.
Central Statistical Office of Zambia, Ministry of Health of Zambia, University of Zambia and Measure Evaluation (2010) Zambia Sexual Behavior Survey, 2009. Central Statistical Office, Lusaka, Zambia, and Measure Evaluation, University of North Carolina.
Central Statistical Office of Zambia, Ministry of Health of Zambia, Tropical Diseases Research Centre, University of Zambia and Macro International (2009) Zambia Demographic and Health Survey 2007. Central Statistical Office, Lusaka, Zambia, and Macro International Inc., Calverton, MD.
Central Statistical Office of Zambia, University of Zambia and Macro International (1993) Zambia Demographic and Health Survey, 1992. Central Statistical Office, Lusaka, Zambia, and Macro International Inc., Columbia, MD.
Fylkesnes, K, Musonda, RM, Kasumba, K, Ndhlovu, Z, Mluanda, F, Kaetano, L and Chipaila, CC (1997) The HIV epidemic in Zambia: socio-demographic prevalence patterns and indications of trends among childbearing women. AIDS 11, 339345.
Fylkesnes, K, Musonda, RM, Sichone, M, Ndhlovu, Z, Tembo, F and Monze, M (2001) Declining HIV prevalence and risk behaviours in Zambia: evidence from surveillance and population-based surveys. AIDS 15, 907916.
Garenne, M (2006) Male circumcision and HIV control in Africa. PLoS Medicine 3(1), e78.
Garenne, M (2007) Male circumcision as a public health policy: ethical challenges. Journal of Medical Ethics 33(6), 357361.
Garenne, M (2008) Long-term population effect of male circumcision in generalized HIV epidemics in sub-Saharan Africa. African Journal of AIDS Research 7(1), 18.
Garenne, M (2010) Mass campaigns of male circumcision for HIV control in Africa: In Denniston, GC, Hodges, FM and Milos, MF (eds) Genital Autonomy. Protecting Personal Choice. Springer Science+Business Media B, Dordrecht, pp. 4960.
Garenne, M, Giami, A and Perrey, C (2013) Male circumcision and HIV control in Africa: questioning scientific evidence and decision making process. In Giles-Vernick, T and Webb, J (eds) Global Health in Africa. Ohio Press University.
Gray, RH, Kigozi, G, Serwadda, D, Makumbi, F, Watya, S, Nalugoda, F et al. (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet 369, 657666.
Hargreaves, JR and Glynn, JR (2002) Educational attainment and HIV-1 infection in developing countries: a systematic review. Tropical Medicine and International Health 7, 489498.
Kripke, K, Njeuhmeli, E, Samuelson, J, Schnure, M, Dalal, S and Farley, T (2014) Assessing progress, impact, and next steps in rolling out voluntary medical male circumcision for HIV prevention in 14 priority countries in Eastern and Southern Africa through 2014. PLoS One 11(7), e0158767.
Kripke, K, Opuni, M, Schnure, M, Sgaier, S, Castor, D and Reed, J (2016) Age targeting of voluntary medical male circumcision programs using the Decision Makers’ Program Planning Toolkit (DMPPT) 2.0. PLoS One 11(7), e0156909.
Leclerc, P and Garenne, M (2008) Clients of commercial sex workers in Zambia: prevalence, frequency and risk factors. Open Journal of Demography 1(1), 110.
Leclerc, P, Matthews, A and Garenne, M (2009) Fitting the HIV/AIDS epidemic in Zambia: a two-sex micro-simulation model. PLoS One 4(5), e5439.
Michelo, C, Sandøy, IF, Dzekedzeke, K, Siziya, S and Fylkesnes, K (2006a) Steep HIV prevalence declines among young people in selected Zambian communities: population-based observations (1995–2003). BMC Public Health 6, 279290.
Michelo, C, Sandøy, I and Fylkesnes, K (2006b) Marked HIV prevalence declines in higher educated young people: evidence from population based surveys (1995–2003) in Zambia. AIDS 20, 10311038.
Ministry of Health of Zambia (2012) Zambia National Voluntary Medical Male Circumcision (VMMC) Communication and Advocacy Strategy 2012–2015. Ministry of Health, Lusaka, Zambia.
Njeuhmeli, E, Forsythe, S, Reed, J, Opuni, M, Bollinger, L, Heard, N et al. (2011) Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS Medicine 8(11), e1001132.
Prodger, JL, Gray, RH, Shannon, B, Shahabi, K, Kong, X, Grabowski, K et al. (2016) Chemokine levels in the penile coronal sulcus correlate with HIV-1 acquisition and are reduced by male circumcision in Rakai, Uganda. PLoS Pathogens 12(11), e1006025.
Prodger, JL and Kaul, R (2017) The biology of how circumcision reduces HIV susceptibility: broader implications for the prevention field. AIDS Research and Therapy 14(1), 4953.
Sandøy, IF, Kvåle, G, Michelo, C and Fylkesnes, K (2006) Antenatal clinic-based HIV prevalence in Zambia: declining trends but sharp local contrasts in young women. Tropical Medicine and International Health 11(6), 917928.
Sandøy, IF, Michelo, C, Siziya, S and Fylkesnes, K (2007) Associations between sexual behaviour change in young people and decline in HIV prevalence in Zambia. BMC Public Health 7, 6074.
Shi, CF, Li, M and Dushoff, J (2017) Evidence that promotion of male circumcision did not lead to sexual risk compensation in prioritized Sub-Saharan countries. PLoS One 12(4), e0175928.
UNAIDS (2017) UNAIDS Data Book 2017. World Health Organization, Geneva.
UNAIDS/WHO (2007) Technical Consultation on Male Circumcision and HIV Prevention: Research Implications for Policy and Programming. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. World Health Organization, Geneva.
UNAIDS/WHO (2011) Joint Strategic Action Framework to Accelerate the Scale-Up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa. World Health Organization, Geneva.
UNAIDS/WHO/UNICEF (2017) Global AIDS Monitoring Report. World Health Organization, Geneva.
United Nations Population Division (2016) World Population Prospects: The 2015 Revision. United Nations, New York.
Van Binsbergen, W (1993) ‘Mukanda’: towards a history of circumcision rites in Western Zambia, 18th–20th century. In Chrétien, JP, Perrot, CH, Prunier, G and Raison-Jourde, F (eds) L’invention religieuse en Afrique: histoire et religion en Afrique noire. Agence de Culture et de Coopération Technique & Editions Karthala, Paris, Chapter 2, pp. 49103.
Van Howe, RS (1999) Circumcision and HIV infection: review of the literature and meta-analysis. International Journal of STD and AIDS 10(1), 816.
Van Howe, RS (2015) Circumcision as a primary HIV preventive: extrapolating from the available data. Global Public Health 10(5-6), 607625.
Van Howe, RS and Storms, MR (2011) How the circumcision solution in Africa will increase HIV infections. Journal of Public Health in Africa 2(1), e4.
Westercamp, N, Agot, K, Jaoko, W and Bailey, RC (2014) Risk compensation following male circumcision: results from a two-year prospective cohort study of recently circumcised and uncircumcised men in Nyanza Province, Kenya. AIDS Behavior 18(9), 17641775.
World Health Organization (2016) Progress Brief: Voluntary Medical Male Circumcision for HIV Prevention in 14 Priority Countries in East and Southern Africa. World Health Organization, Geneva.
Zhou, Z, Barry de Longchamps, N, Schmitt, A, Zerbib, M, Vacher-Lavenu, MC, Bomsel, M and Ganor, Y (2011) HIV-1 efficient entry in inner foreskin is mediated by elevated CCL5/RANTES that recruits T cells and fuels conjugate formation with Langerhans cells. PLoS Pathogens 7(6), e1002100.

Keywords

Voluntary medical male circumcision and HIV in Zambia: expectations and observations

  • Michel Garenne (a1) (a2) (a3) (a4) and Alan Matthews (a5)

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