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

Published online by Cambridge University Press:  14 October 2019

Michel Garenne*
Affiliation:
MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa Institut Pasteur, Epidémiologie des Maladies Emergentes, Paris, France Institut de Recherche pour le Développement (IRD), UMI Résiliences, Bondy, France FERDI, Université d’Auvergne, Clermont-Ferrand, France
Alan Matthews
Affiliation:
School of Chemistry and Physics, University of KwaZulu-Natal, Durban, South Africa
*
*Corresponding author. Email: Michel.Garenne@pasteur.fr

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.

Type
Research Article
Copyright
© Cambridge University Press 2019

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References

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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Bailey, RC, Moses, S, Parker, CB, Agot, K, Maclean, I, Krieger, JNet al. (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. The Lancet 369, 643656.CrossRefGoogle ScholarPubMed
Bloom, SS, Banda, C, Songolo, Get 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.Google ScholarPubMed
Central Statistical Office of Zambia (2011) AIDS and HIV Statistics. Central Statistical Office, Lusaka, Zambia.Google Scholar
Central Statistical Office of Zambia (2017) AIDS and HIV Statistics: Estimated Number of Persons Living With HIV/AIDS. Central Statistical Office, Lusaka, Zambia.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Garenne, M (2006) Male circumcision and HIV control in Africa. PLoS Medicine 3(1), e78.CrossRefGoogle ScholarPubMed
Garenne, M (2007) Male circumcision as a public health policy: ethical challenges. Journal of Medical Ethics 33(6), 357361.Google Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.Google Scholar
Gray, RH, Kigozi, G, Serwadda, D, Makumbi, F, Watya, S, Nalugoda, Fet al. (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. The Lancet 369, 657666.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
Ministry of Health of Zambia (2012) Zambia National Voluntary Medical Male Circumcision (VMMC) Communication and Advocacy Strategy 2012–2015. Ministry of Health, Lusaka, Zambia.Google Scholar
Njeuhmeli, E, Forsythe, S, Reed, J, Opuni, M, Bollinger, L, Heard, Net 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.CrossRefGoogle ScholarPubMed
Prodger, JL, Gray, RH, Shannon, B, Shahabi, K, Kong, X, Grabowski, Ket 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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle Scholar
UNAIDS (2017) UNAIDS Data Book 2017. World Health Organization, Geneva.Google Scholar
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.Google Scholar
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.Google Scholar
UNAIDS/WHO/UNICEF (2017) Global AIDS Monitoring Report. World Health Organization, Geneva.Google Scholar
United Nations Population Division (2016) World Population Prospects: The 2015 Revision. United Nations, New York.Google Scholar
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.Google Scholar
Van Howe, RS (1999) Circumcision and HIV infection: review of the literature and meta-analysis. International Journal of STD and AIDS 10(1), 816.CrossRefGoogle ScholarPubMed
Van Howe, RS (2015) Circumcision as a primary HIV preventive: extrapolating from the available data. Global Public Health 10(5-6), 607625.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed