Background: Although the World Health Organization now recommends routine male circumcision to reduce risk of HIV infection, studies of whether male circumcision (MC) reduces HIV transmission to their female partners indicate no additional protective effect. However, women are theorized to indirectly benefit from increased rates of MC as rates of transmission will be lower overall. To date, there has been limited research directed at exploring the influence of MC on the women''s HIV risk, and there are currently are no estimates that account for the indirect protective effect of MC for women. This study examines the potential benefit of MC for women accounting for individual and population level risk factors using couples data from Demographic and Health Survey (DHS) collected between 2003-2010.
Methods: This study assessed HIV risk among women from a sample of 11,621 couples from Kenya (2003, 2008), Lesotho (2004, 2009), Malawi (2004, 2010), and Zimbabwe (2006, 2010). We examined the relationship between a woman''s HIV status, her partner''s circumcision status and regional rates of male circumcision using multivariate regression models. We then adjusted all models for male and female sexual behaviors (multiple partners) and demographic characteristics (age, wealth, and education).
Results: Neither regional rates of male circumcision nor their partner''s circumcision status were associated with lower odds of HIV infection in women once individual''s sexual behaviors and demographic characteristics were accounted for. Having multiple partners was associated with higher odds of HIV infection in women [OR=2.32, p< 0.01] as was having an older male partner [OR=1.03, p< 0.01]. Women whose male partners had other partners also had a higher odds of HIV [OR=1.43, p< 0.01].
Conclusions: After adjustment, we found no association between MC and female HIV risk either directly or indirectly though having multiple partners was strongly associated with increased odds of HIV risk. These results suggest that programs aimed at expanding MC may need to be pay additional attention to how the benefits of MC may be offset by the presence of multiple partnerships.

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