# Investigating the Factors Influencing Traditional Male Circumcision and Its Contribution to HIV Transmission Amongst Men in Lesotho: A Multilevel Binary Logistic Regression Approach

## TL;DR

This study explores how traditional male circumcision affects HIV transmission in Lesotho, identifying factors that influence its practice and impact.

## Contribution

The study introduces a multilevel logistic regression approach to analyze TMC's role in HIV transmission in Lesotho.

## Key findings

- 51.0% of men in Lesotho had undergone traditional male circumcision.
- Older men and those in rural areas were more likely to be circumcised.
- Education and higher income were associated with lower TMC rates.

## Abstract

Background: Traditional Male Circumcision (TMC) has been practiced in many parts of the world. However, the impact thereof on reducing HIV transmission is still unclear. This study aimed to examine the prevalence and determinants of TMC and the associated risk of HIV transmission in Lesotho. Method: Using data from the 2023–24 Lesotho Demographic and Health Survey, the analysis included a weighted sample of 3202 men aged 15–59 years. Missing data was addressed through multiple imputations, and multilevel logistic regression was used to assess the factors associated with TMC, incorporating intra-class correlation to evaluate cluster-level variation. Results: The findings revealed that 51.0% (95% CI: 49.3–52.7) of men in Lesotho had undergone TMC. Older men, particularly those aged 35 years and above, were more likely to be circumcised compared to younger men aged 15–24 years (AOR = 1.63; 95% CI: 1.46–1.86). Other individual-level factors positively associated with TMC included smoking, being married to one partner, previous sexual experience, and rural residence. Conversely, men with formal education, unknown or undisclosed HIV status, residing in the Berea or Maseru districts, and those from middle- or high-income households were less likely to undergo TMC. Conclusion: The study highlights significant variation in TMC practices across communities and identifies both individual and contextual factors influencing its uptake. These insights underscore the need for culturally sensitive, voluntary, and medically safe circumcision programs. Public health initiatives should consider these determinants when designing interventions to ensure a safer and more effective implementation of TMC in Lesotho.