AIDS 2014 - Abstract HIV incidence among women is associated with their partners' circumcision status in the township of Orange Farm (South Africa) where the male circumcision roll-out is ongoing (ANRS-12126)

FRAE0105LB - Oral Abstract

HIV incidence among women is associated with their partners' circumcision status in the township of Orange Farm (South Africa) where the male circumcision roll-out is ongoing (ANRS-12126)

Presented by Kévin Jean (France).

K. Jean¹, P. Lissouba¹, D. Taljaard², R. Taljaard³, B. Singh⁴, J. Bouscaillou¹, G. Peytavin⁵, R. Sitta⁶, S.G. Mahiane⁷, D. Lewis^4,8, A. Puren^4,8, B. Auvert^1,9,10

¹INSERM, UMRS-1018, CESP, Villejuif, France, ²CHAPS, Johannesburg, South Africa, ³Progressus, Johannesburg, South Africa, ⁴National Institute for Communicable Diseases, Centre for HIV and STIs, Johannesburg, South Africa, ⁵Assistance Publique-Hôpitaux de Paris, Hôpital Bichat - Claude-Bernard, Paris, France, ⁶University of Bordeaux-2, Bordeaux, France, ⁷The Johns Hopkins University School of Public Health, Baltimore, United States, ⁸University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa, ⁹University of Versailles-Saint Quentin, UMRS-1018, Villejuif, France, ¹⁰Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne, France

Background: The roll-out of medical male circumcision (MMC) is progressing in Southern and Eastern Africa. Little is known about the effect of this roll-out on HIV infection among women. The objective of this study was to assess the association between women''s HIV incidence and the circumcision status of their male partners in a South African township where the roll-out has been ongoing since 2008.
Methods: This study was conducted in the township of Orange Farm (South Africa), where male circumcision (MC) prevalence has increased from 12% to 53% in recent years and where circumcised men have a 48% reduction in HIV prevalence in comparison with uncircumcised men. Data from three community-based cross sectional biomedical surveys conducted in 2007, 2010 and 2012 were combined. HIV incidence was studied among young women as a function of the MC status of their sexual partners. Age-specific HIV incidence rate were obtained using classical infected-susceptible mathematical modeling. The predicted HIV prevalence rate by age was fitted on the observed HIV prevalence rate by the likelihood estimation method weighted to adjust on covariates such as lifetime number of partners. 95% confidence intervals were obtained using the bootstrap technique.
Results: Among 2452 women aged 15 to 29 having had only circumcised partners and other women ever having had sex, HIV prevalence rate was 17.8% (162/910) and 30.4% (469/1542), respectively. The association between HIV prevalence among women and partners´ MC status has been reported elsewhere. HIV incidence rate was 0.037 (95% CI: 0.031 to 0.043) and 0.047 (95% CI: 0.043 to 0.050), respectively, which corresponds to an adjusted incidence rate ratio of 0.80 (95% CI: 0.66 to 0.94). The adjusted reduction of HIV incidence rate was 20.3% (95% CI: 5.8% to 33.8%). Among 4538 women aged 15 to 49 the adjusted reduction was 16.9% (1.1% to 31.0%).
Conclusions: Findings reveal for the first time that MMC roll-out is associated with a reduction of HIV incidence among women having only circumcised sexual partners, which is consistent with the observed lower HIV prevalence among circumcised men. The roll-out of MMC may benefit women and should be accelerated.