IJE Advance Access published online on October 9, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl217
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1 Gender & Health Research Unit, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa
* To whom correspondence should be addressed. Objective To describe factors associated with HIV infection in men aged 15-26 years. Setting Rural Eastern Cape Province, South Africa. Sample A total of 1277 sexually experienced Xhosa male volunteers from 70 villages participating in a cluster randomized controlled trial of an HIV behavioural intervention. Xhosas circumcise during manhood initiation rituals. Design Cross-sectional, analysis of the study's baseline interviews. Main measure HIV sero-status, sexual practices measured with an interviewer-administered questionnaire. Results About 2% of the men were HIV positive. A logistic regression model showed HIV positivity to be associated with age (OR 1.55; 95%CI 1.22-1.95), having made a woman pregnant (OR 2.93; 95% CI 1.28-6.68), having been circumcised (OR 0.40; 95% CI 0.16-0.98), and having had sex with a man (OR 3.61; 95% CI 1.0-13.0). Conclusions Our findings provide further evidence to suggest that circumcision is protective. There was much heterosexual risk taking among men but only pregnancy (with its association with sexual frequency) predicted HIV sero-positivity. Although relatively rare, same-sex sexual experiences were a risk factor. Male-male sexual contact is rarely assessed in HIV research in Africa and almost never addressed in general HIV prevention programming. Our findings suggest that it should be given more attention.
Accepted August 31, 2006
Original paper
Factors associated with HIV sero-positivity in young, rural South African men
R. Jewkes 1 *, K. Dunkle 2, M. Nduna 3, J. Levin 4, N. Jama 1, N. Khuzwayo 1, M. Koss 5, A. Puren 6, and N. Duvvury 7
2 Gender & Health Research Unit, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa; Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
3 Gender & Health Research Unit, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa; Department of Psychology, University of the Witwatersrand, PO Box 104, Wits 2050, South Africa
4 Biostatistics Unit, Medical Research Council, Private Bag X385, Pretoria 0001, South Africa
5 College of Public Health, University of Arizona, Tucson, Arizona, USA
6 National Institute for Communicable Disease, Private Bag X4, Sandringham 2131 South Africa
7 International Council for Research on Women, Washington DC, USA
R. Jewkes, E-mail: rjewkes{at}mrc.ac.za.
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