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DISENTANGLING THE COMPLEX ASSOCIATION BETWEEN FEMALE GENITAL CUTTING AND HIV AMONG KENYAN WOMEN

Published online by Cambridge University Press:  16 July 2009

OLGA MASLOVSKAYA ,
JAMES J. BROWN  and
SABU S. PADMADAS
OLGA MASLOVSKAYA
Affiliation:
Division of Social Statistics, School of Social Sciences, University of Southampton, UK
JAMES J. BROWN
Affiliation:
Department of Quantitative Social Science, Institute of Education, University of London, UK
SABU S. PADMADAS
Affiliation:
Division of Social Statistics, School of Social Sciences, University of Southampton, UK
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Summary

Female genital cutting (FGC) is a widespread cultural practice in Africa and the Middle East, with a number of potential adverse health consequences for women. It was hypothesized by Kun (1997) that FGC increases the risk of HIV transmission through a number of different mechanisms. Using the 2003 data from the Kenyan Demographic and Health Survey (KDHS), this study investigates the potential association between FGC and HIV. The 2003 KDHS provides a unique opportunity to link the HIV test results with a large number of demographic, social, economic and behavioural characteristics of women, including women's FGC status. It is hypothesized that FGC increases the risk of HIV infection if HIV/AIDS is present in the community. A multilevel binary logistic regression technique is used to model the HIV status of women, controlling for selected individual characteristics of women and interaction effects. The results demonstrate evidence of a statistically significant association between FGC and HIV, after controlling for the hierarchical structure of the data, potential confounding factors and interaction effects. The results show that women who had had FGC and a younger or the same-age first-union partner have higher odds of being HIV positive than women with a younger or same-age first-union partner but without FGC; whereas women who had had FGC and an older first-union partner have lower odds of being HIV positive than women with an older first-union partner but without FGC. The findings suggest the behavioural pathway of association between FGC and HIV as well as an underlying complex interplay of bio-behavioural and social variables being important in disentangling the association between FGC and HIV.

Type
Research Article
Information
Journal of Biosocial Science , Volume 41 , Issue 6 , November 2009 , pp. 815 - 830
Copyright
Copyright © Cambridge University Press 2009

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References

Auvert, B., Buvé, A., Ferry, B., Caraël, M., Morison, L., Lagarde, E. et al. (2001) Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection. AIDS 15, Supplement 4, S15–30.CrossRefGoogle ScholarPubMed
Baldwin, J. I. & Baldwin, J. D. (2000) Heterosexual anal intercourse: an understudied, high-risk sexual behavior. Archives of Sexual Behavior 29(4), 357–373.CrossRefGoogle ScholarPubMed
Baleta, A. (1998) Concern voiced over “dry sex” practices in Southern Africa. Lancet 352, 1292.CrossRefGoogle Scholar
Baltazar, G., Chakaya, J., Gatua, E., Korir, J., Kunyanga, E., Mansoer, J. et al. (2005) AIDS in Kenya: Trends, Interventions and Impact (7th edition). Ministry of Health, Nairobi.Google Scholar
Bongaarts, J. (1996) Global trends in AIDS mortality. Population and Development Review 22(1), 21–45.CrossRefGoogle Scholar
Bongaarts, J. (2007) Late marriage and the HIV epidemic in sub-Saharan Africa. Population Studies 61(1), 73–83.CrossRefGoogle Scholar
Brady, M. (1999) Female genital mutilation: complication and risk of HIV transmission. AIDS Patient Care and STDs 13(12), 709–716.CrossRefGoogle ScholarPubMed
Brewer, D. D., Potterat, J. J., Roberts, J. M. & Brody, S. (2007) Male and female circumcision associated with prevalent HIV infection in virgins and adolescents in Kenya, Lesotho, and Tanzania. Annals of Epidemiology 17(3), 217–226.CrossRefGoogle ScholarPubMed
Brown, J. E. & Brown, R. C. (2000) Traditional intravaginal practices and the heterosexual transmission of disease: a review. Sexually Transmitted Diseases 27(4), 183–187.CrossRefGoogle ScholarPubMed
Buvé, A., Caraël, M., Hayes, R. J., Auvert, B., Ferry, B., Robinson, N. J. et al. (2001) The multicentre study on factors determining the differential spread of HIV in four African cities: summary and conclusions. AIDS 15, Supplement 4, S127–131.CrossRefGoogle Scholar
Caldwell, J. (2000) Rethinking the African AIDS epidemic. Population and Development Review 26(1), 117–135.CrossRefGoogle Scholar
Caldwell, J. C., Orubuloye, I. O. & Caldwell, P. (1997) Male and female circumcision in Africa from a regional to a specific Nigerian examination. Social Science and Medicine 44(8), 1181–1193.CrossRefGoogle ScholarPubMed
Central Bureau of Statistics (CBS) [Kenya], Ministry of Health (MOH) [Kenya] & ORC Marco (2004a) Kenya Demographic and Health Survey 2003: Key Findings. CBS, MOH and ORC Marco, Calverton, MD, USA.Google Scholar
Central Bureau of Statistics (CBS) [Kenya], Ministry of Health (MOH) [Kenya] & ORC Marco (2004b) Kenya Demographic and Health Survey 2003. CBS, MOH and ORC Marco, Calverton, MD, USA.Google Scholar
Cheluget, B., Baltazar, C., Orege, P., Ibrahim, M., Marum, L. H. & Stover, J. (2006) Evidence for population level declines in adult HIV prevalence in Kenya. Sexually Transmitted Infections 82, 21–26.CrossRefGoogle ScholarPubMed
Clark, S. (2004) Early marriage and HIV risks in Sub-Saharan Africa. Studies in Family Planning 35(3), 149–160.CrossRefGoogle ScholarPubMed
Draper, N. R. & Smith, H. (1998) Applied Regression Analysis (3rd edition). Wiley, New York.CrossRefGoogle Scholar
Goldstein, H. (2003) Multilevel Statistical Models (3rd edition). Arnold, London.Google Scholar
Jones, H., Diop, N., Askew, I. & Kabore, I. (1999) Female genital cutting practices in Burkina Faso and Mali and their negative health outcomes. Studies in Family Planning 30(3), 219–230.CrossRefGoogle ScholarPubMed
Kelly, R. J., Gray, R. H., Sewankambo, N. K., Serwadda, D., Wabwire-Mangen, F., Lutalo, T. & Wawer, M. J. (2003) Age differences in sexual partners and risk of HIV-1 infection in rural Uganda. Journal of Acquired Immune Deficiency Syndromes 32, 446–451.CrossRefGoogle ScholarPubMed
Klouman, E., Manongi, R. & Klepp, K-I. (2005) Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections. Tropical Medicine and International Health 10(1), 105–115.CrossRefGoogle ScholarPubMed
Kun, K. E. (1997) Female genital mutilation: the potential for increased risk of HIV infection. International Journal of Gynecology and Obstetrics 59, 153–155.CrossRefGoogle ScholarPubMed
Longfield, K., Glick, A., Waithaka, M. & Berman, J. (2004) Relationships between older men and younger women: implications for STIs/HIV in Kenya. Studies in Family Planning 35(2), 125–134.CrossRefGoogle ScholarPubMed
Luke, N. (2003) Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Studies in Family Planning 34(2), 67–86.CrossRefGoogle ScholarPubMed
Monjok, E., Essien, E. J. & Holmes, L. (2007) Female genital mutilation: potential for HIV transmission in sub-Saharan Africa and prospect for epidemiologic investigation and intervention. African Journal of Reproductive Health 11, 33–42.CrossRefGoogle ScholarPubMed
Morison, L., Scherf, C., Ekpo, G., Paine, K., West, B., Coleman, R. & Walraven, G. (2001) The long-term reproductive health consequences of female genital cutting in rural Gambia: a community-based survey. Tropical Medicine and International Health 6(8), 643–653.CrossRefGoogle ScholarPubMed
Msuya, S. E., Mbizvo, E., Hussain, A., Sundby, J., Sam, N. E. & Stray-Pedersen, B. (2002) Female genital cutting in Kilimanjaro, Tanzania: changing attitudes? Tropical Medicine and International Health 7(2), 159–165.CrossRefGoogle ScholarPubMed
Nickerson, D. M. (1994) Construction of a conservative confidence region from projections of an exact confidence region in multiple linear regression. American Statistician 48(2), 120–124.Google Scholar
Okonofua, F. E., Larsen, U., Oronsaye, F., Snow, R. C. & Slanger, T. E. (2002) The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria. BJOG: An International Journal of Obstetrics and Gynaecology 109, 1089–1096.CrossRefGoogle Scholar
Pépin, J., Plamondon, M., Alves, A. C., Beaudet, M. & Labbé, A-C. (2006) Parenteral transmission during excision and treatment of tuberculosis and trypanosomiasis may be responsible for the HIV-2 epidemic in Guinea-Bissau. AIDS 20, 1303–1311.CrossRefGoogle ScholarPubMed
Rasbash, J., Browne, W. & Goldstein, H. (2003) MLwiN 2.0 Command Manual. Institute of Education, London.Google Scholar
Shapiro, R.L. (2002) Drawing lines in the sand: the boundaries of the HIV pandemic in perspective. Social Science and Medicine 55, 2189–2191.CrossRefGoogle Scholar
Shell-Duncan, B. (2001) The medicalization of female “circumcision”: harm reduction or promotion of a dangerous practice? Social Science and Medicine 52, 1013–1028.CrossRefGoogle ScholarPubMed
Skaine, R. (2005) Female Genital Mutilation: Legal, Cultural and Medical Issues (1st edition). McFarland & Company, Jefferson, NC, USA.Google Scholar
Snow, R. C. (2001) Female genital cutting: distinguishing the rights from the health agenda. Tropical Medicine and International Health 6(2), 89–91.CrossRefGoogle ScholarPubMed
UNGASS (2008) United Nations General Assembly Special Session on HIV and AIDS: Country Report – Kenya. URL http://data.unaids.org/pub/Report/2008/kenya_2008_country_progress_report_en.pdf (accessed 6th June 2008). United Nations, New York.Google Scholar
UNICEF (2005) Female Genital Mutilation/Cutting. URL http://www.unicef.org/publications/files/FGM-C_final_10_October.pdf (accessed 24th August 2007). The United Nations Children's Fund, New York.Google Scholar
WHO (2001) Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates. URL http://www.who.int/hiv/pub/sti/who_hiv_aids_2001.02.pdf (accessed 23rd September 2007). World Health Organization, Geneva.Google Scholar
WHO (2008) Eliminating Female Genital Mutilation: An Interagency Statement. URL http://www.unfpa.org/upload/lib_pub_file/756_filename_fgm.pdf (accessed 1st June 2008). World Health Organization, Geneva.Google Scholar
Yount, K. M. & Abraham, B. K. (2007) Female genital cutting and HIV/AIDS among Kenyan women. Studies in Family Planning 38(2), 73–88.CrossRefGoogle ScholarPubMed