Male circumcision programmes in Kenya: lessons from the Kenya AIDS Indicator Survey 2007

ABSTRACT

Objective:To provide guidance for male circumcision programmes in Kenya by estimating the population of uncircumcised men and investigating the association between circumcision and infection with the human immunodeficiency virus (HIV); with particular reference to uncircumcised; HIV-uninfected men. Methods Data on men aged 15 to 64 years were derived from the 2007 Kenya AIDS Indicator Survey; which involved interviews and blood collection to test for HIV and herpes simplex virus 2 (HSV-2). The prevalence of HIV infection and circumcision in Kenyan provinces was calculated and the demographic characteristics and sexual behaviour of circumcised and uncircumcised; HIV-infected and HIV-uninfected men were recorded. Findings The national prevalence of HIV infection in uncircumcised men was 13.2(95confidence interval; CI 10.8-15.7) compared with 3.9(95CI 3.3-4.5) among circumcised men. Nyanza province had the largest estimated number of uncircumcised; HIV-uninfected men (i.e. 601 709); followed by Rift Valley; Nairobi and Western Province; respectively; and most belonged to the Luo ethnic tribe. Of these men; 77.8did not know their HIV status and 33.2were HSV-2-positive. In addition; 65.3had had unprotected sex with a partner of discordant or unknown HIV status in the past 12 months and only 14.7consistently used condoms with their most recent partner. However; only 21.8of the uncircumcised; HIV-uninfected men aged 15 to 19 years were sexually active. Conclusion The Kenyan male circumcision strategy should focus on the provinces with the highest number of uncircumcised; HIV-uninfected men and target young men before or shortly after sexual debut