Venkataramani, A.S. and Maughan-Brown, B. AIDS and Behavior (2013), Vol. 17, pp. 1668-1674.
The authors assessed the impact of household shocks, including economic losses, illness, or death, on traditional circumcision age among Xhosa men in Cape Town, South Africa. The results showed a relationship between such shocks and delayed age at traditional circumcision, especially among respondents in poorer households. With growing indication that male circumcision can reduce the risk of HIV, the findings support evidence on the impact of poverty on vulnerability to HIV. Respondents in the poorest households were circumcised more than two years later if their household experienced a shock compared with respondents who experienced no shocks. The initial sample, 930 men between the ages of 15 and 22, were surveyed at baseline; surveys in 2002, 2005, and 2006 assessed household shocks, and a 2009 survey captured traditional circumcision data. In total, 480 African men provided data on both shocks and circumcision. The average age at circumcision was 20 years. Forty-two percent of respondents experienced shocks during the two years before the 2005 survey. The findings suggested policy strategies, including educating traditionally circumcised groups about the importance of early circumcision, and improving access to financial support. Finally, additional research should investigate interventions to address the complex relationship between poverty and HIV risk.