Does circumcision influence risky sexual behaviour among circumcised sexually active men in Zambia?

Abstract

Low circumcision and high rates of heterosexual acquired HIV infections are among factors that have “influenced” Zambia to adopt, encourage and spearhead Voluntary Medical Male Circumcision (VMMC) as a preventive tool against HIV infection. Circumcision has been portrayed as the single most important “panacea” or “magic bullet” to HIV prevention in some circles of the Zambian society and many African countries. In this respect, this study aimed at answering two questions: Does circumcision influence risky sexual behaviour among circumcised men in Zambia? And; how do socio-economic and demographic characteristics influence such behaviour? Data for men age 15–59 years interviewed during the 2013–14 Zambia Demographic and Health Survey was used. A total of 14773 men were included in the sample. Logistic regression - the odds ratio - was used to assess the association between circumcision on one hand and socio-economic and demographic characteristics as well as risky sexual behaviours on the other hand. Men aged 35-45 and 45-54 were likely to report being circumcised comparatively (OR=0.691, p<0.001; OR=0.761, p<0.047). Men aged 45-54 were more likely to engage in risky sexual behaviour (OR=0.397, p<0.0001). Being married/living with a partner and being formerly married were highly associated with risky sexual behaviour (OR=0.0004, p<0.0001). In terms of wealth quintile, being in the rich bracket is highly associated with engaging in risky sexual behaviour (OR=1.396, p<0.026). Other sexual characteristics such as having two or more non-marital sexual partners was also highly associated with circumcision (OR=0.085, p<0.014). However, paying for sex, taking alcohol before sex and using a condom at last sexual intercourse with non-cohabiting sexual partner were not associated with circumcision status (OR=0.906, p<0.42; OR=0.846, p<0.138 and OR=0.906, p<0.420). There is strong evidence suggesting that men who are circumcised are also having two or more extra non-cohabiting sexual partners. Proponents of VMMC require to up their messages to ensure complete adherence to safe sexual messages, behaviour and practice if transmission of HIV and other STIs is to be halted and reversed.