The Association of HIV Status and HIV Risk Behavior with Female Genital Cutting In Mali

Background and Purpose: It has been estimated that 130,000 Malians are living with HIV/AIDS, and the adult prevalence is 1.3%. HIV has feminized in Mali, with females accounting for 60% of HIV cases (USAID, 2010). In Mali, FGC has a prevalence of 91.6% and a high societal endorsement (80.3%); moreover, FGC is often justified as a protective against HIV (WHO, 2010). A review of the literature reveals little empirical research on the relationship of HIV and FGC. The objective of this study is to empirically test the association of HIV status and HIV risk behavior with FGC. The research question is: what is the association of female genital cutting with HIV status and HIV risk behavior while controlling for socio-demographic variables?

Methods: This study is an analysis of secondary data collected as part of the Demographic and Health Survey (DHS). The Mali DHS is a nationally representative survey of randomly selected respondents using a stratified multistage sampling strategy. The sample consists of 12,998 ever-married women of reproductive age (15-49 years old), collected in 2006. Measures included responses to an orally administered survey that asked about HIV risk behavior and biospecimens for HIV antibody testing. Generalized estimating equations (GEE) were used to assess the significance of difference in HIV status and HIV risk behavior with FGC among participants. GEE were also used 1) to correct for the intra-class correlation as some participants were from the same household and 2) to adjust for age, education, wealth, region, and religion.

Results: All results are given in odds ratios with 95% confidence intervals. Participants with FGC were at a 3.51 (p< .05; CI: 1.33, 9.25) lower risk of being HIV positive than those participants without FGC. FGC was a protective against several HIV risk factors: a 2.00 (p< .05; CI: 1.03, 3.86) decrease in number of persons they had sex with in the last 12 months; a 2.55 (p< .05; CI: 1.08, 5.99) lower risk of having sex with persons who were not their husbands; and a 3.03 (p< .05; CI: 1.14, 6.50) decrease in number of persons they had sex with in their lifetime. Concurrently, participants with FGC showed greater risk on two variables: a 2.75 (p< .05; CI: 1.07, 7.08) decrease in age of sexual debut and a 3.67 (p< .05; CI: -1.60, 8.41) greater risk of not having been tested for HIV/AIDS.

Conclusions and Implications: FGC and HIV is a controversial and understudied topic. The results of this study pose challenges for the intersection of social work, feminism, and multiculturalism. Namely, these results lend empirical evidence to the assertion that FGC is sometimes a protective against HIV, despite the practice being widely opposed in the West. This research informs HIV prevention efforts with new data. The data also add to the body of social work knowledge in the international context, and provide opportunities for rich discussion within the context of a social work profession that is increasingly multicultural and concerned with social justice.