Traditional Male Circumcision in Tarime District, Tanzania: A Re-evaluation of HIV Transmission Risk

Results of three recent trials conducted in Sub Saharan Africa have demonstrated the effectiveness of clinical male circumcision in reducing the risk of female-to-male transmission of HIV by 40% to 88 %. As a result, international agencies are promoting circumcision as a key HIV preventive method. The evidence for safe and sterile clinical circumcision in reducing HIV risk is strong and should not be taken lightly; yet caution and cultural sensitivity are requisite in promoting this method across regions in the world where cultural practices surrounding circumcision vary tremendously. In the Bantu tribes of East Africa, traditional circumcision is practiced as a ceremonial rite of passage and varies significantly from the Western method. Not only is this rite often performed in unsterile conditions with repeated use of the same instrument, but it also occurs at the age of sexual debut for many Bantu men, perhaps posing a heightened risk of HIV transmission. It appears that circumcision technique - more so than circumcision itself – may increase or decrease HIV risk. The aim of this study is to investigate the relationship between traditional circumcision and HIV prevalence, along with key correlates such as circumcision technique, HIV knowledge, HIV-related attitudes, risk perception, and sexual behavior. This cross-sectional descriptive study compares cohorts of 160 traditionally circumcised to 160 uncircumcised Bantu men aged eighteen and above in Tarime, a northern district of Tanzania. Data will be collected via interviewer-administered questionnaires in Swahili. Logistic regression analysis and relative risk ratios will be generated using SPSS 12 software. It is anticipated that traditional circumcision is a technique associated with significantly greater risk of HIV infection. Findings will shed further light on the instrumentation of circumcision and its relationship to HIV in a developing country setting. Given that circumcision as a practice occurs across national and international borders, this study will allow public health practitioners to more specifically and accurately assess the utility and effectiveness of traditional circumcision in the context of HIV risk.