Disentangling the Complex Association between Female Genital Mutilation and HIV among Kenyan Women: A Multilevel Analysis

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

The adverse health implications of Female Genital Mutilation (FGM) are well documented in research studies. It was hypothesised by Kun (1997) that FGM increases the risk of HIV transmission. In their detailed analysis of 2003 Kenyan Demographic and Health Survey, Yount and Abraham (2007) reported that FGM is not directly associated with HIV but indirectly through several pathways. We applied multilevel analysis on the same dataset to demonstrate that there is a significant direct and positive association between FGM and HIV after controlling for the data hierarchical structure, confounding factors and interactions. Furthermore, the results show that women who had FGM 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 genital ulcer. These results suggest the underlying complex interplay of bio-behavioural and social variables in disentangling the association between FGM and HIV.