Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries

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Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries

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dc.contributor.author Drain, Paul K. en_US
dc.contributor.author Halperin, Daniel T. en_US
dc.contributor.author Hughes, James P. en_US
dc.contributor.author Klausner, Jeffrey D. en_US
dc.contributor.author Bailey, Robert C. en_US
dc.date.accessioned 2010-04-21T15:54:40Z
dc.date.available 2010-04-21T15:54:40Z
dc.date.issued 2006 en_US
dc.identifier.citation Drain 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.other 10.1186/1471-2334-6-172 en_US
dc.identifier.uri http://www.biomedcentral.com/1471-2334/6/172 en_US
dc.identifier.uri http://hdl.handle.net/1773/15763
dc.description.abstract Background: 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.sponsorship Supported 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.iso en_US en_US
dc.title Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries en_US
dc.type Article en_US


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