Age of male circumcision and risk of prevalent HIV infection in rural Uganda.

TLDR: Prepubertal circumcision is associated with reduced HIV risk, whereas circumcision after age 20 years is not significantly protective against HIV-1 infection.

Abstract: This cross-sectional study aims to assess whether circumcision performed on postpubertal men affords the same level of protection from HIV-1 acquisition as circumcisions performed earlier in childhood. The study was conducted in Rakai district in rural Uganda and included 6821 men aged 15-49 years. Venous blood samples were drawn from these men and tested for HIV-1 and syphilis. Age at circumcision was dichotomized into men who were circumcised before or at age 12 (prepubertal) and men circumcised after age 12 (postpubertal). Postpubertally circumcised men were also subdivided into those reporting circumcision at age 13-20 and 21 years and above. Results revealed that the prevalence of HIV-1 in uncircumcised males was 14.1% compared with 16.2% for men circumcised at age 21 and above 10.0% for men circumcised between the ages of 13 and 20 years and 6.9% in men circumcised before age 12. On bivariate analysis lower prevalence of HIV-1 associated with prepubertal circumcision was observed in all of the age education ethnic and religious groups. Multivariate adjusted odds ratio of prevalent HIV-1 infection associated with prepubertal circumcision was 0.39. In the postpubertal group the adjusted odds ratio for men circumcised at ages 13-20 was 0.46 (0.28-0.77); it was 0.78 (0.43-1.43) for men circumcised after age 20. This study concludes that prepubertal circumcision is associated with reduced HIV risk whereas circumcision after age 20 years is not significantly protective against HIV-1 infection.