Disentangling the complex association between Female Genital Cutting and HIV among Kenyan women: a multilevel analysis

Olga Maslovskaya, University of Southampton
James Brown, University of Southampton
Sabu S. Padmadas, University of Southampton

Female genital cutting (FGC) is a widespread cultural practice in Africa, with a number of potential adverse health consequences for women. International organisations, national governments together with NGOs, community-based and grass-root organisations are trying to reduce the prevalence of FGC. Despite these efforts, female genital cutting is still a widespread practice in a number of countries in Africa and the Middle East. It was hypothesised by Kun (1997) that FGC increases the risk of HIV transmission through a number of different mechanisms. Not many studies have investigated the potential association between FGC and HIV. The Kenyan Demographic and Health Survey 2003 (KDHS 2003) provides the unique opportunity to look at the association between FGC and HIV as it allows the linking of HIV prevalence data with a large number of demographic, social, economic and behavioural characteristics of women, including women’s FGC status. In their detailed analysis of the 2003 Kenyan Demographic and Health Survey, Yount and Abraham (2007) reported that FGC is not directly but indirectly associated with HIV through several pathways. We applied multilevel analysis on the same dataset to demonstrate that after controlling for hierarchical structure of the data, potential confounding factors, and interaction effects, a significant direct and positive association does exist between FGC and HIV. Furthermore, the results show that women who had FGC and older first union partners have higher odds of being HIV positive than their counterparts; the odds of being HIV positive increase further if women reported having a genital ulcer within the 12 months prior to the survey. These results suggest the underlying complex interplay of bio-behavioural and social variables in disentangling the association between FGC and HIV.