Is traditional male circumcision effective as an HIV prevention strategy? Evidence from Lesotho
Is traditional male circumcision effective as an HIV prevention strategy? Evidence from Lesotho
复制标题
DOI：
10.1371/journal.pone.0177076
复制
发表时间：
2017-05-12
期刊：
影响因子：
3.7
通讯作者：
Maffioli, Elisa M.
中科院分区：
文献类型：
--
作者：
Maffioli, Elisa M.
在许多发展中国家，男性包皮环切术已被宣传为一种有效的艾滋病毒预防策略，医学随机对照试验确实显示了其中的因果关系。然而，在个人可以自愿选择不同类型包皮环切术的国家，支持这一结论的经验证据有限。本研究考虑了莱索托的男性包皮环切术，该国艾滋病毒感染率是世界上最高的（23%）。在这里，男性可以选择两种类型的包皮环切术之一：启蒙学校的传统男性包皮环切术，或健康诊所的医疗选择。本文调查了前者对个人艾滋病毒状况的医疗影响是否与后者一样有益。控制手术后潜在的个人行为反应后，发现在启蒙学校进行的包皮环切术完全抵消了手术的医疗效益。这支持了轶事证据，即传统包皮环切师进行的手术并不具有与医疗手术相同的预防艾滋病毒传播的保护作用。没有发现割礼男性中“去抑制”行为的证据，也没有发现割礼男性中传统或医学上存在差异的危险性行为。考虑到在莱索托，90%以上的男性接受了传统的男性包皮环切术，研究结果强调需要进一步研究启蒙学校的手术方式及其医疗益处。
In many developing countries, male circumcision has been promoted as an effective HIV prevention strategy, and medical randomized controlled trials have indeed shown a causal link. However, there is limited empirical evidence to support this conclusion in countries where individuals can voluntary opt for different types of circumcision. The present study considers male circumcision in Lesotho, where HIV prevalence is among the highest in the world (23%). Here, men can opt for one of two types of circumcision: traditional male circumcision in initiation schools, or the medical option in health clinics. This paper investigates whether the former has medical effects on individual HIV status that are as beneficial as those shown for the latter. Controlling for the potential individual behavioral response after the operation, it was found that circumcision performed in initiation schools wholly offset the medical benefits of the surgical procedure. This supports anecdotal evidence that the operation performed by traditional circumcisers does not have the same protective effect against HIV transmission as the medical operation. No evidence of "disinhibition" behavior among circumcised men was found, nor differential risky sexual behavior among men circumcised, traditionally or medically. Considering that, in Lesotho, traditional male circumcision is undertaken by more than 90% of circumcised men, the findings highlight the need for further research into how the operation in initiation schools is performed and its medical benefits.