Protective effect of voluntary medical male circumcision against sexually transmitted infections among adult men in Malawi: insights from observational data
Résumé
Background Voluntary medical male circumcision (VMMC) has been shown to effectively reduce the risk of contracting Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STIs) in men. However, its implementation in sub-Saharan Africa faces several challenges, including low awareness and persistent cultural myths, which contribute to low participation rates. To improve the understanding of this intervention, further empirical evidence is needed regarding its protective effects. Methods This article applied a mixed-effects logistic regression model to examine the adjusted impact of VMMC on self-reported STIs among men in Malawi, using data from the 2024 Malawi Demographic and Health Survey. The analyses were conducted using R software version 4.5.3. Results The results revealed significant variation in HIV and STI outcomes across different clusters, indicating similarities inmen's sexual behaviors within communities. The protective effect of VMMC on STIs was selective; it was more effective against HIV infection than against other STIs. Medically circumcised men had a lower risk of HIV infection compared to uncircumcised men, but the effect size for other STIs was minimal. Factors such as being married or divorced, having multiple sexual partners, residing in urban areas, and belonging to the Lomwe, Yao , or Sena tribes were associated with an increased risk of HIV or STIs. Conclusion The study recommends that health policymakers in sub-Saharan Africa focus VMMC campaigns on these high-risk subpopulations and involve men's spouses and local leaders to achieve better results from the intervention.
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