Title

Human immunodeficiency virus (HIV) and the association of male circumcision with HIV, and history of Viral and non-viral sexually transmitted infections in Rwandan men who have sex with men

Presenter

Jean D Amour Sinayobye

Authors

J.D.A. Sinayobye^1,2, A. Adedimeji³, V. Patel⁴, H.Y. Kim⁵, Q. Shi⁵, G. Murenzi¹, P. Mugenzi¹, P.E. Castle³, L. Mutesa⁶, B. Kateera⁶, J. Palefsky⁷, K. Anastos⁴

Institutions

¹Rwanda Military Hospital, KIgali, Rwanda, ²COTREC REGIONAL LTD, Kigali, Rwanda, ³Albert Einstein College of Medicine, Epidemiology and Population Health, Bronx, United States, ⁴Albert Einstein College of Medicine, General Internal Medicine, Bronx, United States, ⁵New York Medical College, Valhalla, United States, ⁶University of Rwanda, Kigali, Rwanda, ⁷University of California, San Francisco, United States

Background: Male circumcision (MC) protects against HIV acquisition and other sexually transmitted infections (STIs) in heterosexual men. However, results from numerous studies of MC on risk for STI in HIV-infected men who have sex with men (MSM) remain inconclusive. There are few studies MSM in Africa and Rwanda. We therefore examined the associations of male circumcision with HIV infection, and self-reported history of viral and non-viral STIs in Rwandan MSM.
Methods: 322 self-identified MSM in Kigali, Rwanda completed a 45-minute questionnaire, including prior history of STI, using audio-computer assisted survey interview (ACASI). Respondents were tested for HIV. Data were analyzed using SAS. Alpha ≤ 0.05 was considered to be statistically significant.
Results: Participants were 90 % aged 18-36 years, 90.7 % were single, 59% had low income (< $25/month) and most were circumcised (72%). HIV prevalence was 13.6% in the study population and 5.8% when we excluded 27 participants deliberately recruited with HIV infection. Fewer HIV-positive MSM were circumcised (43% vs.76%) and were less likely to report viral STIs (29.5% vs. 11.9%) and non-viral STIs (45% vs. 19%) than HIV-uninfected MSM. In multivariate stepwise logistic regression, MC was inversely associated with HIV infection (adjusted OR (aOR) 0.30; 95 % CI [0.15 - 0.65]). Age 25-35 years (aOR 3.5; 95% CI [1.3 - 8.9]) and ≥ 36 years (aOR 22.7; 95% CI [7.3-70.4]) versus age < =24 years were respectively associated with increased likelihood of having HIV infection. MC (aOR 0.25; 95 % CI [0.13-0.48]) was associated with lower risk of viral STDs whereas a previous report of sex with a man at least 10 years older (aOR 2.8; 95%CI [1.42-5.79]) was associated with higher risk of viral STIs. Male circumcision (aOR 0.99; 95%CI [0.5-1.9]), marital status and sex with a man ≥10 years older were not associated with non-viral STIs.
Conclusions: We found a higher HIV prevalence (5.7%) in Rwandan MSM than in general population of men (4.4%) living in Kigali, and that MC was associated with significantly reduced risk of HIV and other viral STIs, but not of non-viral STIs.