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Female Genital Cutting and HIV Transmission: Is There an Association?

American Journal of Reproductive Immunology. Article first published online: 13 OCT 2012. DOI: 10.1111/aji.12028

Female Genital Cutting and HIV Transmission: Is There an Association?

Diouf K, Nour N

ABSTRACT

Female Genital Cutting (FGC) refers to the practice of surgically removing all or part of the female external genitalia for non-medical purposes. It is a common practice in many countries in Africa, the Middle East, and to a lesser extent, Asia. Over 130 million women worldwide have undergone this procedure, and over 2 million women and girls are subject to it every year. Various complications have been described, including infection, hemorrhage, genitourinary and obstetric complications, as well as psychological sequelae. Since the beginning of the HIV epidemic, a few reports have also described a potentially elevated risk of HIV transmission among women with FGC. In this report, we aim to review the evidence and identify unanswered questions and research gaps regarding a potential association between FGC and HIV transmission.

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A case–control study on the association between female genital mutilation and sexually transmitted infections in Sudan

BJOG. 2006 April; 113(4):469-474

A case–control study on the association between female genital mutilation and sexually transmitted infections in Sudan

Elmusharaf S, Elkhidir I, Hoffmann S, Almroth L

ABSTRACT

Objective  To assess whether the extent of female genital mutilation (FGM) influences the risk of acquiring sexually transmitted infections (STIs).

Design  Hospital-based case–control study.

Setting  Two obstetric/gynaecological outpatient clinics in Khartoum, Sudan, 2003–2004.

Population  A total of 222 women aged 17–35 years coming to antenatal and gynaecological clinics.

Methods  Women recruited for the study were divided into cases with seropositivity for Neisseria gonorrhoeae (gonococcal antibody test), Chlamydia trachomatis (enzyme immunoassay) or Treponema pallidum (Treponema pallidum haemagglutination assay) (n= 26) and controls without antibodies to these species (n= 196). Socio-demographic data were obtained and physical examination including genital examination was performed in order to classify the form of FGM. Cases and controls were compared using logistic regression to adjust for covariates.

Main outcome measures  Extent of FGM and seropositivity for C. trachomatis, N. gonorrhoeae or T. pallidum.

Results  Of the cases, 85% had undergone the most severe form of FGM involving labia majora compared with 78% of controls (n.s.). Thus, there was no association between serological evidence of STIs and extent of FGM. The only factor that differed significantly between the groups was the education level, cases with STIs having significantly shorter education (P= 0.03) than controls.

Conclusions  There is a little difference between cases and controls in regard to FGM. Having in mind the relatively small sample size, the results still indicate that FGM seems neither to be a risk factor for nor protective against acquiring STIs. This is important as argument against traditional beliefs that FGM protects against pre/extramarital sex.

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Knowledge and attitudes about reproductive health and HIV/AIDS among family planning clients

Eastern Mediterranean Health Journal. 1996; 2 (3): 459-469.

Knowledge and attitudes about reproductive health and HIV/AIDS among family planning clients

Megeid AA, El Sheikh S, El Ginedy M, Mohammed M.

ABSTRACT

The knowledge of and attitudes towards reproductive health, and in particular STDs and AIDS, were assessed in 4000 women attending primary health care/family planning facilities in Alexandria, Egypt. In all, 66% did not know the significance of the term reproductive health and 50% considered female circumcision necessary. Of the 69% of women using contraceptives, 93% were using interuterine devices. The majority knew about AIDS but did not know that the use of condoms can prevent transmission of STDs, including HIV. A comprehensive programme should be initiated to increase public awareness of the issues of reproductive health.

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Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections.

Trop Med Int Health. 2005 Jan;10(1):105-15.

Self-reported and observed female genital cutting in rural Tanzania: associated demographic factors, HIV and sexually transmitted infections.

Klouman E, Manongi R, Klepp KI.

Department of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. elise.klouman@medisin.uio.no

OBJECTIVES: To determine (i) the prevalence and type of female genital cutting (FGC) in a rural multi-ethnic village in Tanzania, (ii) its associated demographic factors, (iii) its possible associations with HIV, sexually transmitted infections (STIs) and infertility and (iv) to assess the consistency between self-reported and clinically observed FGC.

METHOD: The study was part of a larger community-based, cross-sectional survey with an eligible female population of 1993. All were human immunodeficiency virus (HIV)-tested and asked whether they were circumcised (n = 1678; 84.2%). Participants aged 15-44 years were interviewed (n = 636; 79.7%), and 399 (50.0%) were gynaecologically examined to screen for STIs and determine the FGC status.

RESULTS: At a mean age of 9.6 years, 45.2% reported being circumcised. In the age-group 15-44 years, 65.5% reported being cut, while FGC was observed in 72.5% and categorized as clitoridectomy or excision. The strongest predictors of FGC were ethnicity and religion, i.e. being a Protestant or a Muslim. FGC was not associated with HIV infection, other STIs or infertility. A positive, non-significant association between FGC and bacterial vaginosis was found with a crude odds ratio of 4.6. There was a significant decline of FGC over the last generation. An inconsistency between self-reported and clinically determined FGC status was observed in more than one-fifth of the women.

CONCLUSION: The data indicate that both women and clinicians might incorrectly report women’s circumcision status. This reveals methodological problems in determining women’s circumcision status in populations practising the most common type of FGC. The positive association between FGC and bacterial vaginosis warrants further investigation.

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Assessing the burden of sexual and reproductive ill-health: questions regarding the use of disability-adjusted life years

Bull World Health Organ 2000 78(5)

Assessing the burden of sexual and reproductive ill-health: questions regarding the use of disability-adjusted life years

C. AbouZahrI; J.P. VaughanII

IFormerly Technical Officer, Department of Reproductive Health and Research, World Health Organization, Geneva 
IIProfessor of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, England

ABSTRACT

The use of the disability-adjusted life year (DALY) as the unit in which to calculate the burden of disease associated with reproductive ill-health has given rise to considerable debate. Criticisms include the failure to address the problem of missing and inadequate epidemiological data, inability to deal adequately with co-morbidities, and lack of transparency in the process of ascribing disability weights to sexual and reproductive health conditions. Many of these criticisms could be addressed within the current DALY framework and a number of suggestions to do so are made. These suggestions include: (1) developing an international research strategy to determine the incidence and prevalence of reproductive ill-health and diseases, including the risk of long-term complications; (2) undertaking a research strategy using case studies, population-based surveillance data and longitudinal studies to identify, evaluate and utilize more of the existing national data sources on sexual and reproductive health; (3) comprehensively mapping the natural history of sexual and reproductive health conditions — in males and in females — and their sequelae, whether physical or psychological; (4) developing valuation instruments that are adaptable for both chronic and acute health states, that reflect a range of severity for each health state and can be modified to reflect prognosis; (5) undertaking a full review of the DALY methodology to determine what changes may be made to reduce sources of methodological and gender bias. Despite the many criticisms of the DALY as a measurement unit, it represents a major conceptual advance since it permits the combination of life expectancy and levels of dysfunction into a single measure. Measuring reproductive ill-health by counting deaths alone is inadequate for a proper understanding of the dimensions of the problem because of the young age of many of the deaths associated with reproductive ill-health and the large component of years lived with disability from many of the associated conditions.

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