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dc.contributor.authorDrain, Paul K.en_US
dc.contributor.authorHalperin, Daniel T.en_US
dc.contributor.authorHughes, James P.en_US
dc.contributor.authorKlausner, Jeffrey D.en_US
dc.contributor.authorBailey, Robert C.en_US
dc.date.accessioned2010-04-21T15:54:40Z
dc.date.available2010-04-21T15:54:40Z
dc.date.issued2006en_US
dc.identifier.citationDrain P, Halperin D, Hughes J, Klausner J, Bailey R. Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries. BMC Infectious Diseases. 2006;6(1):172.en_US
dc.identifier.other10.1186/1471-2334-6-172en_US
dc.identifier.urihttp://www.biomedcentral.com/1471-2334/6/172en_US
dc.identifier.urihttp://hdl.handle.net/1773/15763
dc.description.abstractBackground: Both religious practices and male circumcision (MC) have been associated with HIV and other sexually-transmitted infectious diseases. Most studies have been limited in size and have not adequately controlled for religion, so these relationships remain unclear. Methods: We evaluated relationships between MC prevalence, Muslim and Christian religion, and 7 infectious diseases using country-specific data among 118 developing countries. We used multivariate linear regression to describe associations between MC and cervical cancer incidence, and between MC and HIV prevalence among countries with primarily sexual HIV transmission. Results: Fifty-three, 14, and 51 developing countries had a high (>80%), intermediate (20-80%), and low ( less than 20%) MC prevalence, respectively. In univariate analyses, MC was associated with lower HIV prevalence and lower cervical cancer incidence, but not with HSV-2, syphilis, nor, as expected, with Hepatitis C, tuberculosis, or malaria. In multivariate analysis after stratifying the countries by religious groups, each categorical increase of MC prevalence was associated with a 3.65/100,000 women (95% CI 0.54-6.76, p = 0.02) decrease in annual cervical cancer incidence, and a 1.84-fold (95% CI 1.36-2.48, p less than 0.001) decrease in the adult HIV prevalence among sub-Saharan African countries. In separate multivariate analyses among non-sub-Saharan African countries controlling for religion, higher MC prevalence was associated with a 8.94-fold (95% CI 4.30-18.60) decrease in the adult HIV prevalence among countries with primarily heterosexual HIV transmission, but not, as expected, among countries with primarily homosexual or injection drug use HIV transmission (p = 0.35). Conclusion: Male circumcision was significantly associated with lower cervical cancer incidence and lower HIV prevalence in sub-Saharan Africa, independent of Muslim and Christian religion. As predicted, male circumcision was also strongly associated with lower HIV prevalence among countries with primarily heterosexual HIV transmission, but not among countries with primarily homosexual or injection drug use HIV transmission. These findings strengthen the reported biological link between MC and some sexually transmitted infectious diseases, including HIV and cervical cancer.en_US
dc.description.sponsorshipSupported by the University of Washington Center for AIDS Research Grant AI 27757 and University of Washington STD Cooperative Research Center Grant AI 31448.en_US
dc.language.isoen_USen_US
dc.titleMale circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countriesen_US
dc.typeArticleen_US


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