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Medically, Traditionally, and Dually Circumcised Men in Lesotho: Population-Based Measurements of HIV/STI Infections, Sexual Risk Behaviors, and Service Use Patterns

Abstract

Voluntary medical male circumcision (VMMC) is an HIV prevention priority in Lesotho, but uptake remains suboptimal. We analyzed the 2014 Lesotho Demographic and Health Survey to assess population-level social, behavioral, and serological correlates of circumcision status, specifically traditional and/or medical circumcision. Among 2931 men, approximately half were traditionally circumcised, and fewer than 25% were medically circumcised. Only 4% were dually (traditionally and medically) circumcised. In multivariate analysis, only medical circumcision emerged as significantly (p < 0.05) protective against HIV infection, whereas dual circumcision was significantly associated with past-year STI symptomology. Younger (ages 15–24), lower educated, rural-dwelling, and traditionally circumcised men, including those who never tested for HIV, had significantly lower odds of medical circumcision. Our findings indicate other unmeasured behavioral factors may mitigate VMMC's protective effect against HIV and STI infections in dually circumcised men. Further research can help identify counseling and demand creation strategies for traditionally circumcised men presenting for VMMC.

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Acknowledgements

MAC and JGR conducted formal analysis. MAC prepared the first draft of the paper. All authors contributed to, revised, and approved the final version of the manuscript.

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The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of United States Agency for International Development (USAID) or the United States Government.

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Correspondence to Maria A. Carrasco.

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Carrasco, M.A., Rosen, J.G., Maile, L. et al. Medically, Traditionally, and Dually Circumcised Men in Lesotho: Population-Based Measurements of HIV/STI Infections, Sexual Risk Behaviors, and Service Use Patterns. AIDS Behav (2020). https://doi.org/10.1007/s10461-019-02776-2

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Keywords

  • HIV prevention
  • Voluntary medical male circumcision
  • Traditional circumcision
  • Male engagement
  • Demand creation
  • Lesotho