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A Cut Above the Rest: Traditional Male Circumcision and HIV Risk Among Xhosa Men in Cape Town, South Africa

Maughan-Brown, Brendan PhD*; Venkataramani, Atheendar S. MD, PhD; Nattrass, Nicoli DPhil; Seekings, Jeremy DPhil§; Whiteside, Alan W. PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2011 - Volume 58 - Issue 5 - p 499–505
doi: 10.1097/QAI.0b013e31823584c1
Epidemiology and Prevention

Background Randomized clinical trials have shown that medical male circumcision substantially reduces the risk of contracting HIV. However, relatively little is known about the relationship between traditional male circumcision and HIV risk. This article examines variations in traditional circumcision practices and their relationship to HIV status.

Methods We used data from the fifth wave of the Cape Area Panel Study (n = 473) of young adults in Cape Town, South Africa, to determine attitudes towards circumcision, whether men were circumcised, at what age, and whether their foreskin had been fully or partially removed. Probit models were estimated to determine the association between extent and age of circumcision and HIV status.

Results There was strong support for traditional male circumcision. 92.5% of the men reported being circumcised, with 10.5% partially circumcised. Partially circumcised men had a 7% point greater risk of being HIV positive than fully circumcised men (P < 0.05) and equal risk compared with uncircumcised men. Most (91%) men were circumcised between the ages of 17 and 22 years (mean 19.2 years), and HIV risk increased with age of circumcision (P < 0.10).

Conclusions Efforts should be made to encourage earlier circumcisions and to work with traditional surgeons to reduce the number of partial circumcisions. Data on the extent and age of circumcision are necessary for meaningful conclusions to be drawn from survey data about the relationship between circumcision and HIV status.

*Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa

Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

AIDS and Society Research Unit and Department of Economics

§Centre for Social Science Research and Department of Sociology, University of Cape Town, Cape Town, South Africa

Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, Durban, South Africa

The CAPS is a joint project of the universities of Cape Town and Michigan.

Supported by the US National Institute for Child Health and Human Development, the Andrew W. Mellon Foundation, the National Institute on Aging, the Health Economics & HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal, and the European Union. Further information is available from

The authors have no conflicts of interest to disclose.

Correspondence to: Brendan Maughan-Brown, PhD, Southern Africa Labour and Development Research Unit (SALDRU), University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa (e-mail:

Received May 18, 2011

Accepted August 26, 2011

© 2011 Lippincott Williams & Wilkins, Inc.