Skip to main content Accessibility help




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.



Hide All
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, S1530.
Baldwin, J. I. & Baldwin, J. D. (2000) Heterosexual anal intercourse: an understudied, high-risk sexual behavior. Archives of Sexual Behavior 29(4), 357373.
Baleta, A. (1998) Concern voiced over “dry sex” practices in Southern Africa. Lancet 352, 1292.
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.
Bongaarts, J. (1996) Global trends in AIDS mortality. Population and Development Review 22(1), 2145.
Bongaarts, J. (2007) Late marriage and the HIV epidemic in sub-Saharan Africa. Population Studies 61(1), 7383.
Brady, M. (1999) Female genital mutilation: complication and risk of HIV transmission. AIDS Patient Care and STDs 13(12), 709716.
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), 217226.
Brown, J. E. & Brown, R. C. (2000) Traditional intravaginal practices and the heterosexual transmission of disease: a review. Sexually Transmitted Diseases 27(4), 183187.
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, S127131.
Caldwell, J. (2000) Rethinking the African AIDS epidemic. Population and Development Review 26(1), 117135.
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), 11811193.
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.
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.
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, 2126.
Clark, S. (2004) Early marriage and HIV risks in Sub-Saharan Africa. Studies in Family Planning 35(3), 149160.
Draper, N. R. & Smith, H. (1998) Applied Regression Analysis (3rd edition). Wiley, New York.
Goldstein, H. (2003) Multilevel Statistical Models (3rd edition). Arnold, London.
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), 219230.
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, 446451.
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), 105115.
Kun, K. E. (1997) Female genital mutilation: the potential for increased risk of HIV infection. International Journal of Gynecology and Obstetrics 59, 153155.
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), 125134.
Luke, N. (2003) Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Studies in Family Planning 34(2), 6786.
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, 3342.
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), 643653.
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), 159165.
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), 120124.
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, 10891096.
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, 13031311.
Rasbash, J., Browne, W. & Goldstein, H. (2003) MLwiN 2.0 Command Manual. Institute of Education, London.
Shapiro, R.L. (2002) Drawing lines in the sand: the boundaries of the HIV pandemic in perspective. Social Science and Medicine 55, 21892191.
Shell-Duncan, B. (2001) The medicalization of female “circumcision”: harm reduction or promotion of a dangerous practice? Social Science and Medicine 52, 10131028.
Skaine, R. (2005) Female Genital Mutilation: Legal, Cultural and Medical Issues (1st edition). McFarland & Company, Jefferson, NC, USA.
Snow, R. C. (2001) Female genital cutting: distinguishing the rights from the health agenda. Tropical Medicine and International Health 6(2), 8991.
UNGASS (2008) United Nations General Assembly Special Session on HIV and AIDS: Country Report – Kenya. URL (accessed 6th June 2008). United Nations, New York.
UNICEF (2005) Female Genital Mutilation/Cutting. URL (accessed 24th August 2007). The United Nations Children's Fund, New York.
WHO (2001) Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates. URL (accessed 23rd September 2007). World Health Organization, Geneva.
WHO (2008) Eliminating Female Genital Mutilation: An Interagency Statement. URL (accessed 1st June 2008). World Health Organization, Geneva.
Yount, K. M. & Abraham, B. K. (2007) Female genital cutting and HIV/AIDS among Kenyan women. Studies in Family Planning 38(2), 7388.

Related content

Powered by UNSILO




Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.