Objective: To study the differences in sexual practices, hygienic behaviors
, and other HIV risk factors between circumcised and uncircumcised men.
Design: A cross-sectional study of men >17 years of age selected by single
stage cluster sampling in the Industrial Borough, Mbale, Uganda.
Methods: Using a structured questionnaire, 188 circumcised and 177 uncircum
cised consenting Ugandan men were interviewed in one of four native languag
es during April and May, 1997.
Results: Among non-Muslims, circumcised men had a higher risk profile than
uncircumcised men in that they were more Likely to drink alcohol in conjunc
tion with sex (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.09-3.
16), to have sexual contacts with women on the first day of meeting (OR, 2.
37; 95% CI, 1.39-4.04), to have had sexual contacts in exchange for money o
r gifts (OR, 2.08; 95% CI, 1.21-3.09), to have experienced episodes of pain
on urination or to have experienced penile discharge (OR, 1.68; 95% CI, 1.
07-2.64), had an earlier age at sexual debut (15.7 versus 16.9 years), and
had more extramarital sex partners in the last year (1.13 versus 0.62). Cir
cumcised men also reported a preference for nonwet sex. Muslims generally h
ad a lower risk profile than other circumcised men except they were less li
kely to have ever used a condom (OR, 0.34; 95% CI, 0.15-0.78) or to have us
ed a condom during the last sex encounter (OR, 0.37; 95% CI, 0.14-0.87).
Conclusions: These results suggest that differences between circumcised and
uncircumcised men in their sex practices and hygienic behaviors do not acc
ount for the higher risk of HN infection found among uncircumcised men. Fur
ther consideration should be given to male circumcision as a prevention str
ategy in areas of high prevalence of HIV and other sexually transmitted dis
eases. Studies of the feasibility and acceptability of male circumcision in
traditionally noncircumcising societies are warranted.