DEMOGRAPHIC

AND

HEALTH

SURVEYS

DHS WORKING PAPERS

2013 No. 102

Antony Chikutsa

Alfred C. Ncube 

Shepard Mutsau 

September 2013

This document was produced for review by the United States Agency for

International Development.

Male Circumcision and Risky Sexual 

Behavior in Zimbabwe: 

Evidence from the 2010-11 Zimbabwe 

Demographic and Health Survey

Male Circumcision and Risky Sexual Behavior in Zimbabwe: Evidence from the 2010-11 

Zimbabwe Demographic and Health Survey 

Antony Chikutsa 

Alfred C. Ncube 1 

Shepard Mutsau 2

ICF International 

Calverton, Maryland, USA 

September 2013 

1 Faculty of Applied Social Sciences, Zimbabwe Open University 2 Department of Development Studies, Zimbabwe Open University

Corresponding author: Antony Chikutsa, Department of Development Studies, Zimbabwe Open University, Harare, 

Zimbabwe; Email: antony.chikutsa@gmail.com 
ACKNOWLEDGMENTS 

We would like to express our most sincere gratitude to ICF International and USAID for 

funding us through the MEASURE DHS Fellowship program. We are very grateful to our 

facilitators Sarah Staveteig (PhD), Wenjuan Wang (PhD), Kerry MacQuarrie, Ambrose Akinlo 

(PhD), and Samwel Mbugua. Special mention goes to Sarah for her constructive comments on 

our paper. We are also greatly indebted to our colleagues in the 2013 DHS Fellowship program 

for their support and feedback. We also wish to thank Joanna Lowell (PhD) for her reviews of 

earlier drafts, Bryant Robey for editing, and Yuan Cheng for formatting. 
ABSTRACT 

Background: Zimbabwe has one of the highest HIV prevalence rates in the world, 

currently estimated at 15.2 percent among adults age 15-49. In 2009, voluntary medical male 

circumcision (VMMC) was adopted as an additional method of HIV prevention and since then 

has become a significant dimension of Zimbabwe’s HIV prevention strategy. The promotion of 

VMMC has raised a major concern that it might lead to an increase in high-risk sexual behavior, 

because circumcision could lead to a false sense of effective protection against HIV, a 

phenomenon known as risk compensation or behavioral disinhibition. According to the risk 

compensation hypothesis, as the risk of an undesirable outcome is reduced, people may 

compensate by behaving in riskier ways. In Zimbabwe, as in other countries with high HIV 

prevalence, male circumcision is often promoted using evidence that it reduces the risk of HIV. 

Purpose: This study sought to test whether circumcised men in Zimbabwe are more 

likely to have engaged in risky sexual behavior. The study also investigated the association 

among uncircumcised men between wanting male circumcision and engaging in high-risk sexual 

behavior. 

Data and methods: The study used data collected from men age 15-54 who were 

interviewed during the 2010-11 Zimbabwe Demographic and Health Survey (ZDHS). A total of 

7,480 men were included in the sample for this study. Logistic regression was used to assess the 

association between circumcision and risky sexual behaviors. 

Findings: The findings of this study do not support the risk compensation hypothesis. 

The study found no statistically significant association between male circumcision and risky 

sexual behavior. In contrast, the findings do show a strong association among uncircumcised 

men between wanting male circumcision and engaging in risky sexual behaviors. 

Recommendations: Given the recency of the campaign to promote male circumcision in 

Zimbabwe, these results suggest a need to continue monitoring the relationships between 

ongoing VMCC campaigns and men’s risky sexual behavior. Communication and information 

dissemination on VMMC should emphasize caution in messages promoting medical male 

circumcision to avoid giving the impression that it provides immunity against HIV. 
 
1 

INTRODUCTION 

Zimbabwe has one of the highest HIV prevalence rates in the world, currently estimated 

at 15.2 percent among adults age 15-49 (ZIMSTAT and ICF International, 2012). While HIV can 

spread through many channels, it has been suggested that most HIV infections (92 percent) in 

Zimbabwe occur through heterosexual contact, followed by mother-to-child transmission 

(Zimbabwe National AIDS Council, 2005). Existing approaches to preventing the spread of HIV 

have mainly been based on the “ABC” approach to behavior change, which promotes abstinence, 

faithfulness and correct use of condoms. In devising policy guidelines on the effective prevention 

of new HIV infections, Zimbabwe came up with a Behavior Change Strategy, which focuses on 

increasing the age at sexual debut, increasing correct condom use, and reducing the average 

number of sexual partners. The approach also encouraged individuals and couples to get tested 

for HIV. 

In 2009, Zimbabwe adopted voluntary medical male circumcision (VMMC) as an 

additional HIV prevention strategy to the existing ABC behavior change model. The campaign 

for scaling up VMMC for HIV prevention focuses on men from the age of 13 who are HIVnegative. The procedure is offered free of charge at designated public hospitals and health 

centers throughout the country. 

Medical male circumcision has become a significant dimension of HIV prevention 

interventions, after the results of three randomized controlled trials (RCTs) in Uganda, South 

Africa and Kenya demonstrated that circumcision has a protective effect against contracting 

HIV of up to 60 percent for men having sex with women (Auvert et al., 2005; Bailey et al., 

2007; Gray et al., 2007). Pursuant to these findings, the World Health Organization (WHO) and 

UNAIDS recommended that VMMC be implemented immediately as an additional HIV 

prevention strategy in countries with high HIV prevalence rates but low male circumcision rates 

(WHO and UNAIDS, 2007). 

Notwithstanding the WHO and UNAIDS recommendation, and the promotion of VMMC 

as an additional HIV prevention strategy in a number of sub-Saharan African countries, 

including Zimbabwe, fundamental questions remain about whether promoting VMMC as an HIV 

prevention intervention will result in decreases in HIV incidence. A major concern is that 

promoting VMMC may lead circumcised men to develop a false sense of effective protection 
2 

against HIV and engage in risk compensation or behavioral disinhibition. The Zimbabwe 

National AIDS Council (NAC) highlighted concern over the risk compensation behaviors among 

circumcised men (Yikoniko, 2012). This phenomenon involves either halting or decreasing 

previous protective behaviors such as condom use or partner reduction, thus reducing or 

nullifying the protective effects of male circumcision (Westercamp et al., 2012). 

However, studies have not found evidence of this phenomenon. Mattson and colleagues 

(2008) developed an 18-item measure of risky sexual behavior for their RCT in Kisumu, Kenya, 

and found no significant differences in the risk propensity scores between circumcised and 

uncircumcised men. Another study in Kenya by Westercamp and colleagues (2012) followed up 

circumcised men after 24 months and compared their perception of risk and their sexual behavior 

with that of uncircumcised males. The findings supported the earlier findings by Mattson and 

colleagues. In a related study in Malawi, Godlonton and colleagues (2010) concluded that after 

learning that circumcision lowers the risk of HIV infection, circumcised men did not become 

riskier in their sexual behavior. Despite this evidence, there is still debate on the issue of 

behavioral disinhibition. 

In Zimbabwe, male circumcision is not significantly related to HIV status (see Appendix 

A). In light of the discourse on male circumcision and risky sexual behavior, the present study 

instead sought to investigate the relationship between male circumcision status and engaging in 

risky sexual behavior. Proxies of risky sexual behavior were developed and compared between 

circumcised and uncircumcised men interviewed in the 2010-11 Zimbabwe Demographic and 

Health Survey (ZDHS). The present study also sought to understand whether, among men who 

are not circumcised, those who engage in riskier sexual behaviors are more likely to want to be 

circumcised. 

 

Research Questions 

The present analysis was guided by two key questions: 

• What individual and household factors are associated with male circumcision? 

• Among uncircumcised men, what individual and household factors are associated 

with wanting male circumcision? 
3 

• What is the relationship between male circumcision and high-risk sexual behavior? 

• Among uncircumcised men, what is the relationship between wanting male 

circumcision and high-risk sexual behavior? 

Hypothesis 

Risk compensation theory suggests that as the risk of an undesirable outcome is reduced, 

people may compensate by behaving in riskier ways that keep their overall level of risk constant 

(cf. Hedlund, 2000). This study tests the hypothesis that in Zimbabwe men who are circumcised 

engage in riskier sexual behaviors. As a secondary hypothesis, it tests whether—among men who 

are not circumcised—those who engage in riskier sexual behaviors are more likely to want to be 

circumcised. The corresponding null hypotheses for this study are that there is no significant 

association between male circumcision status and risky sexual behavior, and that there is no 

significant association between wanting a circumcision and risky sexual behavior. 

Conceptual Framework 

The conceptual framework designed for this study shows the possible individual and 

household factors associated with male circumcision on one hand, and the link between male 

circumcision status and indicators of risky sexual behavior on the other (see Figure 1). 

It is not clear how or when male circumcision began, but it is known that religion has an 

influence on circumcision. Among Jews and Muslims, male circumcision is practiced as a 

symbol of keeping the covenant with God1

, although circumcision is not mentioned in the Holy 

Koran (Aldeeb Abu Sahlieh, 1999). Thus, in the present study we have included religion as 

determinant of circumcision. 

Another significant determinant of circumcision is ethnicity. Male circumcision has been 

practiced for many decades as a rite of passage into adulthood among some groups of the Xhosa 

of South Africa and the Aborigines of Australia (Vincent, 2008; Emery, 2005). However, the 

present study did not include ethnicity as a determinant of circumcision because most national 

 

1

 See Genesis 17:9-14 
4 

surveys in Zimbabwe, including the ZDHS, do not collect statistics on ethnicity as a national 

policy. 

Other studies have linked male circumcision to demographic and socioeconomic 

variables, such as level of education. The 2004-05 Tanzania DHS shows higher rates of 

circumcision among men with higher levels of education compared with men with lower levels 

of education. Tanzanian males with above primary school education had significantly higher 

odds of being circumcised than those with incomplete primary school education (Wambura et al., 

2009). The 2005-06 ZDHS found a weak relationship between education and circumcision; men 

with primary school education were the most likely to be circumcised (CSO and Macro 

International, 2007). In Central Uganda the willingness to undergo MMC was found to have an 

inverse relationship with education (Asiimwe, 2012). 

The influence of age as a determinant of male circumcision cannot be understood outside 

of the context of ethnicity and the generally accepted culture. In many Western countries, and 

among Jewish people, circumcision is generally performed at birth or within the first week of life 

(Gallaher, 2000). Among Muslims, circumcision may be performed in early childhood or 

adolescence. Studies in the United Kingdom have found that circumcision is mostly done by the 

upper middle class (Gallaher, 2000). In Zimbabwe, traditional circumcision is done at different 

ages depending on the ethnic group performing the ritual. 

Several major surveys have explored the measurement of risky sexual behaviors. 

Consecutive studies in the British National Survey of Sexual Attitudes and Lifestyles (Natsal) 

have used proxies of risky sexual behavior such as a person’s number of sexual partners and 

condom use during intercourse (Mercer, 2010). Data for common indicators of risky sexual 

behaviors used by agencies such as UNAIDS2

 are collected by MEASURE DHS. As well as 

number of sexual partners and condom use, these indicators also include having paid sex and 

higher-risk sex (defined as recent sex with a non-marital or non-cohabiting partner). In the 

conceptual framework of this study, shown in Figure 1, male circumcision is hypothesized to be 

a determinant of these risky sexual behaviors. 

 

2

 See also http://www.unaids.org/en/media/unaids/contentassets/documents/document/2010/8_2-Intro-to-Indicators 

FMEF.pdf 
5 

Figure 1. Conceptual framework of male circumcision and risky sexual behavior 

 

Male circumcision 

status 

Individual 

characteristics 

• Age 

• Level of education 

• Religion 

Risky sexual behaviors 

• Number of sexual 

partners 

• Condom use 

• Paid sex 

• Higher-risk sex 

Household 

characteristics 

• Residence 

• Province 

• Wealth 
6 

METHODS 

This study used data on men from the 2010-11 ZDHS. The ZDHS is designed to produce 

nationally and provincially representative estimates of data on population and health indicators. 

The survey interviewed men age 15-54 who are usual residents of a household or were visitors 

who stayed in the household the night before the survey. In total, 7,480 men were interviewed in 

the survey. 

Of particular interest for this study were the data on men’s circumcision status and sexual 

behavior. All interviewed men (7,480) were included in the analysis of factors associated with 

circumcision, regardless of whether or not the men reported having ever had sex. Men who were 

not circumcised or who did not know if they were circumcised (6,795) were included in the 

analysis of factors associated with wanting circumcision. 

Individual and household characteristics included in the analysis were men’s age, level of 

education, religion, province, and urban-rural residence. These were considered as determinants 

of male circumcision. The categories of religion, education and province were collapsed into 

summary categories according to the characteristics considered to be most salient for the 

analysis. The key variables in the present analysis were defined as highlighted below. 

Background Variables 

All of the respondents were grouped into 10-year age groups due to their relative 

homogeneity. Education was defined as highest level of education attended. Secondary and 

higher categories were combined into the “Secondary and above” category. Similarly, marital 

status categories were also combined to produce “never married”, “married/living together” and 

“formerly married” categories. The latter category included all men who reported that they were 

divorced, separated or widowed at the time of the survey. Wealth was regrouped into terciles at 

the household level. 

For the purposes of this study, Zimbabwe’s 10 provinces were collapsed into five groups. 

Mashonaland Central, Mashonaland East, Mashonaland West and Masvingo provinces were 

combined into “Mashonaland”; Matabeleland North and South and Midlands were combined 
7 

into “Matabeleland/Midlands”; while Manicaland, Harare and Bulawayo were left as is because 

of their uniqueness in relation to the rest of the country. 

The ZDHS asked respondents to state their religion according to nine categories. For the 

purposes of this study, respondents were reclassified into four groups: Christian, Muslim, None, 

and Traditional/Other. 

Circumcision 

There are varying definitions of male circumcision across cultures (Hewett et al., 2012). 

However, the ZDHS defined circumcision as the complete removal of the foreskin. This was 

necessary to achieve a common understanding of the concept between interviewers and 

respondents. Thus for this study, circumcision status was determined by the responses to the 

question: “Some men are circumcised, that is, the foreskin is completely removed from the penis. 

Are you circumcised?” A small proportion of men who reported that they did not know their 

circumcision status were assumed to be uncircumcised. Men who reported that they were not 

circumcised or did not know if they were circumcised were asked: “If circumcision were 

available for free and was safe, would you want to be circumcised?” Men who responded “yes” 

were considered to want circumcision; all others were assumed to not want circumcision. 

Risky Sexual Behavior 

Four indicators of risky sexual behavior were considered for this study, as follows: 

(1) Paid sex: In the present study, all men who reported to have ever paid for sex were 

considered to have engaged in risky sexual behavior. 

(2) Multiple sexual partners in the past 12 months: Having had two or more sex 

partners in the 12 months preceding the survey. While this indicator is often 

reported as a percentage of sexually active men, we considered all men to be ‘at 

risk’; hence the denominator is all men. 

(3) Higher-risk sex in the past 12 months: Higher-risk sex is defined as any sexual 

intercourse with a non-marital or non-cohabiting partner, among those who had sex 

in the 12 months before the survey. 
8 

(4) Not using a condom during last higher-risk sex: Condom use during sexual 

intercourse is considered a preventive measure against the transmission of sexually 

transmitted infections (STIs). The ZDHS collected data on condom use in the past 

12 months during last sexual intercourse with up to three different partners. Not 

using a condom at the last sexual intercourse with a high-risk partner was 

considered a risky behavior. In eight cases, men reported higher-risk sex in the past 

12 months, but use of a condom with that partner could not be determined because 

their last three partners were spousal; these men were excluded from the 

denominator. 

Data Analysis 

The analysis was done using STATA version 12. Bivariate analysis using unadjusted 

odds ratios was conducted to determine the strength of the association between male 

circumcision and selected individual and household characteristics. Multivariate analysis was 

also done to measure whether there is an association between male circumcision status or 

wanting circumcision and the indicators of risky sexual behavior, net of other factors. In the data 

analysis, we took into account the complex multi-stage sampling design and the weights that 

were calculated for the ZDHS. 

 
9 

RESULTS 

Sample Characteristics 

Table 1a summarizes the characteristics of the 7,480 men age 15-54 interviewed by the 

2010-11 ZDHS. Forty-two percent were age 15-24, while 30 percent were age 25-34. Seventysix percent of the respondents had at least some secondary education, 51 percent were married or 

living together, 74 percent gave their religion as Christian, and 63 percent resided in a rural area 

at the time of the survey. 

Table 1a. Sample characteristics 

Background characteristic Weighted percent Number of men 

Age 

 15-24 41.6 3,107 

 25-34 29.5 2,207 

 35-44 18.9 1,417 

 45-54 10.0 749 

Education 

 No education 1.0 77 

 Primary 23.0 1,724 

 Secondary and above 75.9 5,680 

Religion 

 Traditional/other 4.3 324 

 Christians 73.5 5,501 

 Muslim 0.6 44 

 None 21.6 1,612 

Marital status 

 Never married 44.5 3,329 

 Married/living together 50.7 3,794 

 Formerly married 4.8 357 

Residence 

 Urban 36.9 2,757 

 Rural 63.1 4,723 

Region 

 Manicaland 13.6 1,013 

 Mashonaland 40.3 3,017 

 Matabeleland/Midlands 22.3 1,669 

 Harare 18.3 1,371 

 Bulawayo 5.5 410 

 

Total age 15-54 100.0 7,480 
10 

Table 1b shows the proportion of men reporting risky sexual behavior. Eighteen percent 

reported having ever paid for sex in their lifetime. Eleven percent of all men reported having had 

two or more partners in the past 12 months, while 33 percent of sexually-active men had sex with 

a higher-risk partner, that is a non-marital non-spousal partner, in the past year. Of the men who 

reported having had a higher-risk partner in the past year, 22 percent did not use a condom 

during their last sexual encounter with that partner. 

Table 1b: Indicators of risky sexual behavior 

Indicator Weighted percent Denominator

Ever paid for sex 18.0 7,480 

Two or more partners in the past 12 months 10.5 7,480 

Higher-risk sexa

 in the past 12 months 33.2 5,100 

Did not use condom use at last higher-risk sexb

 22.3 1,686 

a

 Higher-risk sex is defined as sex with a non-marital, non-cohabiting partner in the past 12 months among men 

who had sex in the past 12 months. 

b In eight weighted cases, men who had higher-risk sex in the past 12 months were excluded because their last 3 

partners were spouses; condom use with non-spousal partner could not be determined 

Characteristics of Circumcised and Uncircumcised Men 

Of the 7,480 men interviewed, 9 percent (685) reported being circumcised. An additional 

37 percent of men responded that they would want to be circumcised if it were available for free 

and were safe. Table 2 shows the proportion of men who are circumcised, want circumcision, or 

do not want circumcision by their background characteristics. Men age 35-44, men who attended 

only primary education, Muslim men, men who are married, and men from the Manicaland 

region are most likely to be circumcised. The proportion of circumcised men is lowest in the 

Mashonaland region, where only 7 percent of men are circumcised. 

 
11 

Table 2. Characteristics of circumcised and uncircumcised men 

Background 

characteristics 

Circumcision status 

Total 

Number 

Circumcised of men 

Not circumcised 

Want 

circumcision 

Do not want 

circumcisiona

Age 

 15-24 6.5 34.6 58.9 100.0 3,107 

 25-34 9.8 41.5 48.1 100.0 2,207 

 35-44 11.8 38.5 50.1 100.0 1,417 

 45-54 11.5 27.0 60.8 100.0 749 

Education 

 No education 9.0 21.4 69.6 100.0 77 

 Primary 9.8 28.9 61.3 100.0 1,724 

 Secondary and above 9.0 39.2 51.8 100.0 5,680 

Religion 

 Traditional/other 12.6 40.5 46.9 100.0 324 

 Christians 8.7 37.3 54.0 100.0 5,501 

 Muslim 77.9 14.7 7.4 100.0 44 

 None 8.0 34.1 57.9 100.0 1,612 

Marital status 

 Never married 6.6 34.7 58.7 100.0 3,329 

 Married/living together 11.2 37.8 51.0 100.0 3,794 

 Formerly married 10.7 41.0 48.3 100.0 357 

Residence 

 Urban 9.7 40.4 49.9 100.0 2,757 

 Rural 8.8 34.5 56.7 100.0 4,723 

Region 

 Manicaland 13.1 32.3 54.5 100.0 1,013 

 Mashonaland 6.9 34.8 58.4 100.0 3,017 

 Matabeleland/Midlands 11 38.3 50.7 100.0 1,669 

 Harare 8.6 38.6 52.9 100.0 1,371 

 Bulawayo 12.4 47.1 40.5 100.0 410 

 

Total age 15-54 9.2 36.6 54.2 100.0 7,480 

a Includes men who either didn’t know if they were circumcised or didn’t know if they would want to be (54 and 146 

weighted cases, respectively) 

The 2010-11 ZDHS did not ask men whether they were circumcised as a result of 

Zimbabwe’s voluntary medical male circumcision (VMMC) campaign, but did ask about their 

age at circumcision and who performed their circumcision. Figure 2 shows the distribution of 

circumcision by age at circumcision. Nearly half of men (47 percent) were circumcised before 

age 5, while 31 percent of respondents were circumcised at age 15 or above. As mentioned, 
12 

Zimbabwe’s male circumcision campaign was scaled up in 2009; few of the respondents in the 

2010-11 ZDHS had been circumcised in the two years preceding the survey.3 Moreover, only 

health professionals are employed as part of the VMMC program, whereas 58 percent of the 

circumcised men were circumcised by a traditional practitioner or a family friend, while 24 

percent were circumcised by a health professional (data not shown). In all, the findings indicate 

that relatively few men interviewed by the ZDHS could have been circumcised as a result of the 

VMMC campaign. 

Figure 2. Distribution of circumcised men by age at circumcision 

 

3

 The circumcision scale-up began in 2009 and the survey was fielded in 2010-2011. In the ZDHS 58 men 

(weighted=62.6 cases) reported having been circumcised in the past two years. 

46.6

22.2

12.6

18.6

Under age 5 5-14 15-19 20+

Age at circumcision
13 

Factors Associated with Male Circumcision 

The present study analyzed background factors that are associated with male 

circumcision. We fitted logistic regression models and computed unadjusted and adjusted odds 

ratios. Table 3 presents the results of the analysis. Unadjusted odds ratios of being circumcised 

increase with men’s age, which is consistent with later ages of circumcision overall in 

Zimbabwe. Ever-married men are significantly more likely to be circumcised. Education and 

urban-rural residence are not significantly associated with circumcision. 

After controlling for other factors, age is not significantly associated with circumcision; 

only religion, province, and marital status are significant in the adjusted odds ratios (see Table 

3). Married men are more likely to be circumcised compared with never-married men. Men in 

Mashonaland and Harare are significantly less likely to be circumcised compared with men in 

Manicaland (the reference group). Muslim men are overwhelmingly more likely to be 

circumcised compared with other religions. 

 
14 

Table 3. Factors associated with male circumcision 

Variable Unadjusted ORs Adjusted ORs 

Age 

15-24 1.00 1.00 

25-34 1.67*** [1.34-2.08] 1.33 [0.97-1.83] 

35-44 1.85*** [1.47-2.32] 1.34 [0.94-1.89] 

45-54 1.99*** [1.54-2.57] 1.41 [0.98-2.04] 

Level of education 

None 1.00 1.00 

Primary 1.09 [0.50-2.41] 1.26 [0.55-2.88] 

Secondary and above 0.99 [0.44-2.22] 1.10 [0.48-2.54] 

Religion 

Traditional/Other 1.00 1.00 

Christians 0.66* [0.45-0.97] 0.82 [0.57-1.18] 

Muslim+

 24.4*** [9.56-62.4] 35.9*** [12.82-100.5] 

None 0.60* [0.39-0.93] 0.74 [0.49-1.12] 

Residence 

Urban 1.00 1.00 

Rural 0.89 [0.72-1.12] 1.07 [0.77-1.48] 

Province 

Manicaland 1.00 1.00 

Mashonaland 0.48*** [0.35-0.69] 0.46*** [0.33-0.64] 

Matabeleland/Midlands 0.78 [0.53-1.15] 0.78 [0.54-1.14] 

Harare 0.62* [0.42-0.91] 0.57* [0.36-0.88] 

Bulawayo 0.94 [0.63-1.40] 0.87 [0.55-1.38] 

Marital status 

Never married 1.00 1.00 

Married/Living together 1.79*** [1.51-2.12] 1.45** [1.10-1.92] 

Formerly married 1.69*** [1.17-2.46] 1.34 [0.86-2.10] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 0.81 [0.61-1.06] 0.85 [0.65-1.12] 

Highest 1.11 [0.83-1.47] 1.13 [0.82-1.57] 

N 7,480 

Exponential coefficients; 95percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 
15 

Factors Associated with Wanting Circumcision 

The 2010-11 ZDHS asked the 6,795 men who were not circumcised at the time of the 

survey if they would want to be circumcised, if circumcision were available for free and were 

safe. Forty percent (2,741 men) said they would want circumcision if it were free and safe (data 

not shown). Table 4 shows factors associated with wanting to be circumcised, presenting 

unadjusted and adjusted odds ratios. Men age 45-54 are significantly less likely to want 

circumcision compared with men age 15-24. Men in Matabeleland/Midlands and Bulawayo are 

significantly more likely to want circumcision than men in the other provinces. Currently or 

formerly married men are significantly more likely than never-married men to want 

circumcision. This finding is intriguing in that if married men were in stable and monogamous 

relationships, then presumably they would be at lower risk for HIV. 

 
16 

Table 4. Factors associated with wanting to be circumcised 

Variable Unadjusted ORs Adjusted ORs 

Age 

15-24 1.00 1.00 

25-34 1.47*** [1.29-1.66] 1.21* [1.01-1.44] 

35-44 1.31*** [1.13-1.51] 1.01 [0.82-1.24] 

45-54 0.75** [0.61-0.93] 0.63** [0.48-0.84] 

Level of education 

None 1.00 1.00 

Primary 1.53 [0.87-2.68] 1.40 [0.78-2.51] 

Secondary and above 2.45** [1.40-4.28] 1.98 [1.10-3.56] 

Religion 

Traditional/Other 1.00 1.00 

Christians 0.79 [0.59-1.08] 0.74* [0.54-0.99] 

Muslim+

 2.30 [0.48-10.8] 1.70 [0.34-8.42] 

None 0.68* [0.49-0.93] 0.67* [0.49-0.91] 

Residence 

Urban 1.00 1.00 

Rural 0.75*** [0.66-0.85] 1.02 [0.82-1.29] 

Province 

Manicaland 1.00 1.00 

Mashonaland 1.00 [0.79-1.27] 1.06 [0.84-1.32] 

Matabeleland/Midlands 1.27* [1.00-1.61] 1.41** [1.12-1.76] 

Harare 1.23 [0.94-1.61] 1.06 [0.77-1.44] 

Bulawayo 1.96*** [1.45-2.65] 1.73** [1.23-2.42] 

Marital status 

Never married 1.00 1.00 

Married/Living together 1.26*** [1.13-1.40] 1.34** [1.13-1.59] 

Formerly married 1.44** [1.14-1.82] 1.57** [1.19-2.07] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 1.11 [0.95-1.28] 1.12 [0.97-1.29] 

Highest 1.49*** [1.30-1.72] 1.36** [1.11-1.67] 

N 6,795 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 

 
17 

Male Circumcision and Risky Sexual Behavior 

The major objective of this study was to determine if there are significant differences 

among circumcised and uncircumcised men in engaging in risky sexual behavior, and whether 

wanting circumcision is related to risky sexual behavior. We examined unadjusted and adjusted 

odds of the association between male circumcision and risky sexual behaviors, as shown in 

Tables 5-8. The unadjusted odds ratios show that circumcised men are significantly more likely 

to have ever paid for sex (Table 5) and to have had multiple sexual partners in the past 12 

months (Table 6). However, these associations are not statistically significant after adjusting for 

other background factors. Being circumcised is not significantly associated with higher-risk sex 

in the past 12 months (Table 7) nor with condom use at last higher-risk sex (Table 8). 

The adjusted models for each of these dependent variables indicate that older men and 

men who have ever been married are more likely to have ever paid for sex (Table 5). Evermarried men also have more than twice the relative odds of having multiple sexual partners in 

the past 12 months, while men’s age has an inverse association with having multiple sexual 

partners (Table 6). Currently and formerly married men are significantly less likely to have had 

higher-risk sex in the past 12 months. Wealth and education have no significant relationship with 

higher-risk sexual behaviors. The relationship between province and risky sexual behavior is 

inconsistent across indicators. 

 
18 

Table 5. Unadjusted and adjusted odds ratios of having ever paid for sex, by circumcision status 

Variable Unadjusted ORs Adjusted ORs 

Circumcised (ref=no or DK) 1.44*** [1.21-1.62] 1.17 [0.93-1.48]

Age 

15-24 1.00 1.00 

25-34 4.58*** [3.69-5.69] 2.47 *** [1.84-3.32] 

35-44 6.10*** [4.91-7.58] 3.04*** [2.18-4.22] 

45-54 10.3*** [7.95-13.3] 5.28*** [3.73-7.46] 

Level of education 

None 1.00 1.00 

Primary 1.29 [0.53-3.09] 1.69 [0.65-4.36] 

Secondary and above 1.08 [0.45-2.56] 1.65 [0.64-4.24] 

Religion 

Traditional/Other 1.00 1.00 

Christians 0.37*** [0.27-0.49] 0.52*** [0.37-0.71] 

Muslim+

 0.86 [0.43-1.69] 0.88 [0.39-1.99] 

None 0.68* [0.48-0.93] 0.94 [0.68-1.29] 

Residence 

Urban 1.00 1.00 

Rural 0.69*** [0.58-0.80] 0.59** [0.44-0.80] 

Province 

Manicaland 1.00 1.00 

Mashonaland 0.88 [0.69-1.12] 0.86 [0.66-1.11] 

Matabeleland/Midlands 0.79 [0.62-1.02] 0.79 [0.61-1.04] 

Harare 1.29 [0.98-1.69] 0.89 [0.64-1.26] 

Bulawayo 0.53** [0.35-0.79] 0.33*** [0.21-0.54] 

Marital status 

Never married 1.00 1.00 

Married/Living together 5.19*** [4.33-6.23] 2.18*** [1.64-2.89] 

Formerly married 7.70*** [5.7-10.3] 3.40*** [2.38-4.86] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 1.16 [0.94-1.43] 1.25* [1.03-1.53] 

Highest 1.36*** [1.14-1.61] 1.21 [0.88-1.66] 

N 7,480 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 

 
19 

Table 6. Unadjusted and adjusted odds ratios of having multiple sex partners in the past 12 

months, by circumcision status 

Variable Unadjusted ORs Adjusted ORs 

Circumcised (ref=no or DK) 1.33* [1.03-1.72] 1.21 [0.92-1.59]

Age 

15-24 1.00 1.00 

25-34 2.03*** [1.67-2.46] 0.95 [0.92-1.59] 

35-44 1.52** [1.19-1.94] 0.63 [0.68-1.33] 

45-54 1.27 [0.91-1.76] 0.55** [0.43-0.89] 

Level of education 

None 1.00 1.00 

Primary 0.95 [0.37-2.45] 0.97 [0.37-2.52] 

Secondary and above 1.10 [0.43-2.85] 1.22 [0.48-3.10] 

Religion 

Traditional/Other 1.00 1.00 

Christians 0.61* [0.41-0.91] 0.69 [0.46-1.02] 

Muslim+

 0.94 [0.27-3.28] 0.86 [0.24-3.12] 

None 0.97 [0.65-1.42] 1.06 [0.73-1.55] 

Residence 

Urban 1.00 1.00 

Rural 0.84 [0.68-1.03] 0.69 [0.48-1.01] 

Province 

Manicaland 1.00 1.00 

Mashonaland 0.76 [0.56-1.05] 0.72* [0.53-0.98] 

Matabeleland/Midlands 0.81 [0.58-1.13] 0.81 [0.58-1.13] 

Harare 0.97 [0.66-1.42] 0.82 [0.52-1.29] 

Bulawayo 0.66* [0.44-0.99] 0.61* [0.38-0.98] 

Marital status 

Never married 1.00 1.00 

Married/Living together 2.36*** [1.93-2.90] 2.84*** [2.01-4.01] 

Formerly married 2.42*** [1.59-3.66] 2.87*** [1.68-4.91] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 0.92 [0.71-1.19] 0.89 [0.71-1.12] 

Highest 0.95 [0.76-1.72] 0.77 [0.53-1.11] 

N 7,480 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 
20 

Table 7. Unadjusted and adjusted odds ratios of higher-risk sex in the past 12 months, by 

circumcision status 

Variable Unadjusted ORs Adjusted ORs 

Circumcised (ref=no or DK) 0.94 [0.77-1.14] 1.37 [0.98-1.90]

Age 

15-24 1.00 1.00 

25-34 0.15*** [0.12-0.18] 0.54*** [0.41-0.73] 

35-44 0.06*** [0.05-0.08] 0.34*** [0.25-0.47] 

45-54 0.04*** [0.03-0.05] 0.21*** [0.14-0.32] 

Level of education 

None 1.00 1.00 

Primary 2.95** [1.44-6.07] 4.08 [0.76-22.1] 

Secondary and above 3.64*** [1.77-7.48] 4.62 [0.84-25.1] 

Religion 

Traditional/Other 1.00 1.00 

Christians 1.36 [0.97-1.92] 0.57* [0.35-0.92] 

Muslim+

 1.23 [0.49-3.06] 0.27* [0.10-0.75] 

None 1.76 [1.24-2.49] 0.89 [0.56-1.43] 

Residence 

Urban 1.00 1.00 

Rural 0.78** [0.67-0.90] 0.65* [0.44-0.95] 

Province 

Manicaland 1.00 1.00 

Mashonaland 0.82 [0.63-1.08] 0.87 [0.58-1.29] 

Matabeleland/Midlands 1.41* [1.06-1.88] 1.25 [0.83-1.89] 

Harare 1.24 [0.92-1.67] 1.15 [0.69-1.88] 

Bulawayo 1.69** [1.25-2.29] 0.91 [0.57-1.45] 

Marital status 

Never married 1.00 1.00 

Married/Living together 0.00*** [0.00-0.00] 0.00*** [0.00-0.00] 

Formerly married 0.01*** [0.00-0.03] 0.02*** [0.01-0.06] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 1.41*** [1.18-1.69] 0.96 [0.72-1.29] 

Highest 1.43*** [1.21-1.70] 0.89 [0.59-1.33] 

N 5,100 

Higher-risk sex is defined as sex with a non-marital, non-cohabiting partner in the past 12 months. 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 

 
21 

Table 8. Unadjusted and adjusted odds ratios of not using a condom at last higher-risk sex, by 

circumcision status 

Variable Unadjusted ORs Adjusted ORs 

Circumcised (ref=no or DK) 1.12 [0.73-1.71] 1.13 [0.73-1.73]

Age 

15-24 1.00 1.00 

25-34 0.62*** [0.46-0.83] 0.71 [0.49-1.00] 

35-44 0.71 [0.47-1.08] 0.79 [0.47-1.33] 

45-54 0.75 [0.39-1.43] 0.73 [0.36-1.47] 

Level of education 

None 1.00 1.00 

Primary 0.75 [0.17-3.32] 0.82 [0.18-3.77] 

Secondary and above 0.33 [0.07-1.50] 0.45 [0.09-2.16] 

Religion 

Traditional/Other 1.00 1.00 

Christians 1.57 [0.77-3.20] 1.64 [0.75-3.56] 

Muslim‡

 1.00 1.00 

None 1.75 [0.83-3.67] 1.57 [0.72-3.41] 

Residence 

Urban 1.00 1.00 

Rural 1.61*** [1.23-2.11] 0.85 [0.49-1.45] 

Province 

Manicaland 1.00 1.00 

Mashonaland 1.31 [0.80-2.17] 1.21 [0.71-2.05] 

Matabeleland/Midlands 2.05** [1.24-3.39] 1.76* [1.03-3.01] 

Harare 0.86 [0.49-1.47] 1.05 [0.51-2.11] 

Bulawayo 0.99 [0.54-1.84] 1.26 [0.59-2.68] 

Marital status 

Never married 1.00 1.00 

Married/Living together 0.78 [0.57-1.07] 0.93 [0.63-1.39] 

Formerly married 0.79 [0.53-1.17] 0.91 [0.57-1.46] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 0.69* [0.51-0.93] 0.83 [0.60-1.15] 

Highest 0.42*** [0.31-0.57] 0.57* [0.36-0.88] 

N 1,686 

Not using a condom at last sexual encounter with a non-marital, non-cohabiting partner in the past 12 months, 

among men who had such a partner. Eight cases were excluded because men’s last three partners were spousal, 

so they were not eligible for questions about condom use with the last high-risk partner. 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

‡

 eliminated due to perfect collinearity; all 12 Muslim men who had higher-risk sex in past year used a condom 

during their last encounter. 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 
22 

Wanting Circumcision and Engaging in Risky Sexual Behavior 

We also assessed a possible link between wanting to be circumcised and engaging in 

risky sexual behavior, using the four indicators described above: having ever paid for sex, having 

multiple sexual partners in the past 12 months, higher-risk sex in the past 12 months, and 

condom use during last higher-risk sex. We used logistic regression models to compute 

unadjusted and adjusted odds ratios for each measure. 

The results show that men who wanted a circumcision are statistically significantly more 

likely to have ever paid for sex (Table 9), to have had multiple sexual partners in the past 12 

months (Table 10), and to have engaged in higher-risk sex in the past 12 months (Table 11), even 

after controlling for other socio-demographic characteristics. However, men who wanted a 

circumcision are significantly less likely to have engaged in the risky behavior of not using a 

condom at last higher-risk sex (Table 12), even after controlling for other socio-demographic 

covariates. This finding was marginally significant (the high end of the confidence interval for 

the exponentiated beta is 0.999), but nonetheless runs counter to findings on other indicators of 

risky sexual behaviors. 

 
23 

Table 9. Unadjusted and adjusted odds ratios of having ever paid for sex 

Variable Unadjusted ORs Adjusted ORs 

Want to be circumcised (ref=no or DK) 1.40*** [1.22-1.62] 1.42*** [1.22-1.66]

Age 

15-24 1.00 1.00 

25-34 4.58*** [3.69-5.69] 2.47 *** [1.81-3.35] 

35-44 6.10*** [4.91-7.58] 3.11*** [2.20-4.39] 

45-54 10.3*** [7.95-13.3] 5.80*** [3.99-8.44] 

Level of education 

None 1.00 1.00 

Primary 1.29 [0.53-3.09] 1.46 [0.55-3.86] 

Secondary and above 1.08 [0.45-2.56] 1.40 [0.52-3.71] 

Religion 

Traditional/Other 1.00 1.00 

Christians 0.37*** [0.27-0.49] 0.54*** [0.38-0.74] 

Muslim+

 0.86 [0.43-1.69] 1.86 [0.49-7.01] 

None 0.68* [0.48-0.93] 0.98 [0.70-1.35] 

Residence 

Urban 1.00 1.00 

Rural 0.69*** [0.58-0.80] 0.55*** [0.41-0.76] 

Province 

Manicaland 1.00 1.00 

Mashonaland 0.88 [0.69-1.12] 0.83 [0.63-1.09] 

Matabeleland/Midlands 0.79 [0.62-1.02] 0.74* [0.55-0.99] 

Harare 1.29 [0.98-1.69] 0.81 [0.56-1.18] 

Bulawayo 0.53** [0.35-0.79] 0.31*** [0.18-0.50] 

Marital status 

Never married 1.00 1.00 

Married/Living together 5.19*** [4.33-6.23] 2.13*** [1.58-2.87] 

Formerly married 7.70*** [5.7-10.3] 3.39*** [2.30-4.98] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 1.16 [0.94-1.43] 1.25* [1.03-1.53] 

Highest 1.36*** [1.14-1.61] 1.16 [0.85-1.58] 

N 6,795 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 

 
24 

Table 10. Unadjusted and adjusted odds ratios of having multiple sex partners in the past 12 

months

Variable Unadjusted ORs Adjusted ORs 

Want to be circumcised (ref=no or DK) 1.44*** [1.20-1.73] 1.35** [1.12-1.63]

Age 

15-24 1.00 1.00 

25-34 2.03*** [1.67-2.46] 0.87 [0.62-1.23] 

35-44 1.52** [1.19-1.94] 0.61** [0.42-0.88] 

45-54 1.27 [0.91-1.76] 0.61** [0.41-0.91] 

Level of education 

None 1.00 1.00 

Primary 0.95 [0.37-2.45] 0.95 [0.33-2.65] 

Secondary and above 1.10 [0.43-2.85] 1.18 [0.43-3.21] 

Religion 

Traditional/Other 1.00 1.00 

Christians 0.61* [0.41-0.91] 0.59** [0.40-0.88] 

Muslim+

 0.94 [0.27-3.28] 0.44 [0.04-5.01] 

None 0.97 [0.65-1.42] 0.97 [0.66-1.43] 

Residence 

Urban 1.00 1.00 

Rural 0.84 [0.68-1.03] 0.70 [0.47-1.03] 

Province 

Manicaland 1.00 1.00 

Mashonaland 0.76 [0.56-1.05] 0.69* [0.50-0.96] 

Matabeleland/Midlands 0.81 [0.58-1.13] 0.75 [0.53-1.06] 

Harare 0.97 [0.66-1.42] 0.81 [0.51-1.30] 

Bulawayo 0.66* [0.44-0.99] 0.59* [0.35-0.98] 

Marital status 

Never married 1.00 1.00 

Married/Living together 2.36*** [1.93-2.90] 2.99*** [2.10-4.30] 

Formerly married 2.42*** [1.59-3.66] 2.94*** [1.66-5.21] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 0.92 [0.71-1.19] 0.88 [0.69-1.11] 

Highest 0.95 [0.76-1.72] 0.79 [0.55-1.12] 

N 6,795 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 
25 

Table 11. Unadjusted and adjusted odds ratios of higher-risk sex in the past 12 months 

Variable Unadjusted ORs Adjusted ORs 

Want to be circumcised (ref=no or DK) 1.23** [1.08-1.41] 1.36** [1.06-1.74]

Age 

15-24 1.00 1.00 

25-34 0.15*** [0.12-0.18] 0.52*** [0.37-0.72] 

35-44 0.06*** [0.05-0.08] 0.35*** [0.25-0.49] 

45-54 0.04*** [0.03-0.05] 0.24*** [0.15-0.37] 

Level of education 

None 1.00 1.00 

Primary 2.95** [1.44-6.07] 3.79 [0.39-36.1] 

Secondary and above 3.64*** [1.77-7.48] 4.14 [0.44-38.8] 

Religion 

Traditional/Other 1.00 1.00 

Christians 1.36 [0.97-1.92] 0.51** [0.31-0.82] 

Muslim+

 1.23 [0.49-3.06] 0.05*** [0.02-0.15] 

None 1.76 [1.24-2.49] 0.86 [0.54-1.39] 

Residence 

Urban 1.00 1.00 

Rural 0.78** [0.67-0.90] 0.66** [0.44-0.99] 

Province 

Manicaland 1.00 1.00 

Mashonaland 0.82 [0.63-1.08] 0.88 [0.57-1.35] 

Matabeleland/Midlands 1.41* [1.06-1.88] 1.18 [0.74-1.85] 

Harare 1.24 [0.92-1.67] 1.21 [0.74-1.99] 

Bulawayo 1.69** [1.25-2.29] 0.83 [0.49-1.39] 

Marital status 

Never married 1.00 1.00 

Married/Living together 0.00*** [0.00-0.00] 0.00*** [0.00-0.00] 

Formerly married 0.01*** [0.00-0.03] 0.02*** [0.00-0.05] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 1.41*** [1.18-1.69] 0.95 [0.69-1.31] 

Highest 1.43*** [1.21-1.70] 0.96 [0.64-1.44] 

N 4,571 

Higher-risk sex is defined as sex with a non-marital, non-cohabiting partner in the past 12 months. 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

+

 based on <50 weighted cases 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 

 
26 

Table 12. Unadjusted and adjusted odds ratios of not using a condom at last higher-risk sex 

Variable Unadjusted ORs Adjusted ORs 

Want to be circumcised (ref=no or DK) 0.67** [0.52-0.87] 0.76* [0.57-1.00]

Age 

15-24 1.00 1.00 

25-34 0.62*** [0.46-0.83] 0.67* [0.47-0.98] 

35-44 0.71 [0.47-1.08] 0.74 [0.42-1.29] 

45-54 0.75 [0.39-1.43] 0.59 [0.27-1.28] 

Level of education 

None 1.00 1.00 

Primary 0.75 [0.17-3.32] 1.28 [0.19-8.51] 

Secondary and above 0.33 [0.07-1.50] 0.70 [0.09-4.91] 

Religion 

Traditional/Other 1.00 1.00 

Christians 1.57 [0.77-3.20] 1.46 [0.67-3.19] 

Muslim‡

 1.00 1.00 

None 1.75 [0.83-3.67] 1.38 [0.63-3.03] 

Residence 

Urban 1.00 1.00 

Rural 1.61*** [1.23-2.11] 0.85 [0.48-1.51] 

Province 

Manicaland 1.00 1.00 

Mashonaland 1.31 [0.80-2.17] 1.25 [0.71-2.19] 

Matabeleland/Midlands 2.05** [1.24-3.39] 1.86* [1.04-3.32] 

Harare 0.86 [0.49-1.47] 1.01 [0.46-2.23] 

Bulawayo 0.99 [0.54-1.84] 1.06 [0.43-2.57] 

Marital status 

Never married 1.00 1.00 

Married/Living together 0.78 [0.57-1.07] 1.01 [0.65-1.54] 

Formerly married 0.79 [0.53-1.17] 0.88 [0.52-1.48] 

Wealth tercile 

Lowest 1.00 1.00 

Middle 0.69* [0.51-0.93] 0.86 [0.61-1.23] 

Highest 0.42*** [0.31-0.57] 0.61* [0.38-0.98] 

N 1,518 

Not using a condom at last sexual encounter with a non-marital, non-cohabiting partner in the past 12 months, 

among men who had such a partner. Eight cases were excluded because men’s last three partners were spousal, 

so they were not eligible for questions about condom use with the last high-risk partner. 

Exponential coefficients; 95 percent confidence intervals in brackets 

*p<0.05, **p<0.01, ***p<0.001 

‡

 eliminated due to perfect collinearity; all 3 Muslim men who had higher-risk sex in past year used a condom during 

their last encounter. 

“Mashonaland Province” includes Mashonaland East, Mashonaland West, Mashonaland Central and Masvingo 

“Matabeleland/Midlands” includes Matabeleland North, Matabeleland South and Midlands 
27 

DISCUSSION AND CONCLUSION 

The present study investigated the association between male circumcision and risky 

sexual behavior and also the association between wanting male circumcision and engaging in 

risky sexual behaviors among men who participated in the 2010-11 ZDHS. The study is set 

against the backdrop of the recent promotion in Zimbabwe of voluntary medical male 

circumcision as an additional HIV prevention method. VMMC has raised fears among critics of 

the program on the basis that circumcision would lead to an increase in high-risk behavior. These 

fears emanate from the concern that circumcised men might experience a decline in the 

perception of their risk of contracting HIV, a phenomenon known as risk compensation or 

behavioral disinhibition. 

The study results support the null hypothesis that there is no association between male 

circumcision and risky sexual behavior. These results are in line with earlier findings from 

studies in Kenya (Mattson et al., 2008, Westercamp et al., 2012). While the current study is 

limited to cross-sectional data and thus cannot establish causality, the lack of a relationship 

between circumcision and risky sexual behavior likely reflects the fact that men are circumcised 

for many reasons besides HIV prevention. In fact, given the timing of the ZDHS fieldwork 

(2010-11) in relation to the scale-up of the VMMC campaign (2009), few men surveyed are 

likely to have been circumcised as a result of the campaign. 

The results suggest a strong association between wanting circumcision and risky sexual 

behavior: with the exception of condom use at last high-risk sexual encounter, men who report 

that they want circumcision are more likely to be engaging in risky sexual behavior. It is possible 

that their desire for circumcision could be an outcome of the recent promotion of VMMC for 

HIV prevention. The campaigns could possibly have affected men’s risk perception, leading 

them to want ‘protection’ from HIV through male circumcision. 

All in all, the findings of this study do not support the argument that circumcised men are 

prone to engage in risky sex behaviors compared with uncircumcised men. Nevertheless, the 

study has established a positive association between wanting circumcision and risky sexual 

behavior for three of four indicators. The lack of observed relationship between medical male 

circumcision and risky sex may be due to the short period between the start of the male medical 

circumcision in Zimbabwe which started in 2009 and the collection of ZDHS data (2010-2011). 
28 

Subsequent surveys in Zimbabwe may indeed find a significant association between 

circumcision and sexual risk-taking behavior. 

The results of this study lead us to make the following policy recommendations: 1) There 

is a need to continue observing the relationship between ongoing medical male circumcision 

campaigns and risky sexual behavior. 2) There is a need to continue studies on the acceptability 

and feasibility of medical male circumcision among non-circumcised populations with high 

incidence of HIV. 3) Communication and information dissemination policy must emphasize the 

need to take caution in messages promoting medical male circumcision, to avoid giving the false 

impression that circumcision provides immunity against HIV. 

 
29 

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Arguments about Male and Female Circumcision.” In Male and Female Circumcision, 

Medical, Legal, and Ethical Considerations in Pediatric Practice, edited by C.G. 

Denniston, F.M. Hodges, and M.F. Milos. New York, New York, USA: Kluwer 

Academic/Plenum Publishers. 

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32 

APPENDIX: MALE CIRCUMCISION AND HIV STATUS 

Table A1. Male circumcision status and HIV test result 

Circumcision status 

Blood test result 

HIV negative HIV positive 

Not circumcised .8753 [.8652-.8847] .1247 [.1153-.1348] 

Circumcised .8540 [.8192-.8830] .1460 [.1170-.1808] 

Total .8734 [.8633-.8828] .1266 [.1172-.1367] 

95 percent confidence intervals in brackets 

Pearson: 

 Uncorrected chi2 (1) = 2.0186 

 Design-based F (1, 387) = 1.9235 P = 0.1663 

Table A2. Unadjusted odds ratios of being HIV positive by circumcision status 

Variable Unadjusted ORs 

Circumcision status (ref=not circumcised) 1.199 [0.93-1.55]

 

Table A3. Wanting male circumcision and HIV test result 

Want circumcision 

Blood test result 

HIV negative HIV positive 

No or don’t know .8900 [.8771-.9016] .1100 [.0984-.1229] 

Yes .8555 [.8382-.8712] .1445 [.1288-.1618] 

Total .8753 [.8652-.8847] .1247 [.1153-.1348] 

95 percent confidence intervals in brackets 

Pearson: 

 Uncorrected chi2 (1) = 14.6435 

 Design-based F (1, 387) = 10.9583 P = 0.0010 

Table A4. Unadjusted odds ratios of being HIV positive by desire for circumcision 

Variable Unadjusted ORs 

Want circumcision (ref=no) 1.366** [1.13-1.65]