GHENT UNIVERSITY Karoline FONCK - International Centre for ...

Almost all women in this study reported that their partner was circumcised. Male circumcision
was associated with a reduced prevalence of HIV infection in the female partner, and this
association remained after multivariate analysis. The association between HIV infection and
circumcision in males has been demonstrated (Moses 1998), and a reduction in risk among
the female partners of circumcised men has been reported by Kapiga et al. There is a
possibility of reporting bias of circumcision status, as shown in other studies (Lilienfeld 1958).
However, in a recent study in Tanzania, misreporting was found mostly in men who reported
themselves as circumcised but who where found to be not circumcised on examination
(Urassa 1997). This may reflect a change in norms in that society that favor male
circumcision. Because the society in northwestern Tanzania is closely related to the society
in Kenya, the same might be true in this study. The women from the only tribe in Kenya that
does not traditionally practice circumcision reported their husbands to be circumcised 18%,
whereas for the other tribes the proportion was more than 90%. If there has been overreporting
of circumcision status in our study, the association between HIV and circumcision
might have been even stronger.
We found a low rate of regular condom use, which is consistent with findings in other African
settings. Some studies have been able to report a protective effect of reported condom use
for STD (Kapiga 1994). However, women who reported a history of condom use were more
likely to be infected with HIV. A possibly explanation of this finding might be that reported use
of condoms may be a surrogate marker for risky sexual behavior or extramarital sex.
Women engaging in such high-risk behavior may use condoms more often than other
women.
Women attending this clinic came from lower socio-economic groups that usually have less
access to preventive information from mass media or written materials. Few women reported
the practice of safe sex, but also reported few high-risk behaviors. Attendance to the clinic
provides a good opportunity for health education on a group and an individual basis, and this
opportunity should be seized for information, education, and counseling activities (especially
regarding safe-sex methods). Techniques to negotiate safe sex with regular partners could
be an important protective tool in this population. Program addressing the empowerment of
women in relation to their sexual behavior, especially with their regular partner, should be
strengthened to achieve more effect on prevention and control activities in the field of STD
and HIV.
PREVALENCE AND RISK FACTORS OF STI 31