Volume 38 Number 2 June 2007 73 Studies in Family Planning Female genital cutting (FGC) 1 is widely practiced through- out much of Africa, particularly in the northeast and north- ern half of the sub-Saharan region. Researchers have pos- tulated its association with HIV 2 (Kun 1997; Brady 1999), but few studies have assessed this relationship (Klouman et al. 2005; Pépin et al. 2006). 3 FGC’s possible association with HIV is important to investigate because women comprise 57 percent of HIV-infected adults in sub-Saha- ran Africa (UNAIDS and WHO 2004), and young women are infected more often than are young men (Glynn et al. 2001). To explain these differences, researchers have im- plicated women’s greater biological susceptibility (Caraël and Holmes 2001; Glynn et al. 2001; Coombs et al. 2003), riskier sexual behavior (Glynn et al. 2001), and higher prevalence of risk factors for HIV infection (for exam- ple, herpes simplex virus 2 [HSV-2]) (Auvert et al. 2001; Coombs et al. 2003). Another explanation for the differ- ence, however, could be the practice of FGC, which, for example, could increase women’s risk of acquiring HIV if circumcisers use septic tools. Cut women, and especially severely cut women, also may begin sexual activity at an early age, be much younger than their partners, or engage in particular sexual practices (for example, frequent anal intercourse) that enhance their risk of HIV transmission beyond that of their uncut counterparts. Finally, cut wom- en may be at greater risk for reproductive tract infections, such as bacterial vaginosis, candida, and HSV-2, which in- crease the risk of HIV infection (see Morison et al. 2001). 4 Using national data from 3,167 women aged 15–49 years in Kenya, we test whether FGC is directly or indirectly as- sociated with the odds of testing positive for HIV. Prevalence and Characteristics of FGC and HIV Female genital cutting refers to practices that involve the surgical manipulation of the female genitalia. The current system of classification is under revision, but historically, WHO has identified four types of cutting. Type I involves partial or total removal of the clitoris. Type II involves re- moval of the clitoris and some or all of the labia minora (inner vaginal lips). Type III includes Type II plus the cut- ting and suturing of the labia majora. Type IV includes Female Genital Cutting and HIV/AIDS Among Kenyan Women Kathryn M. Yount and Bisrat K. Abraham Female genital cutting (FGC) and HIV/AIDS are both highly prevalent in sub-Saharan Africa, and researchers have speculated that the association may be more than coincidental. Data from 3,167 women aged 15–49 who participated in the 2003 Kenya Demographic and Health Survey (KDHS) are used to test the direct and indirect associations of FGC with HIV. Our adjusted models suggest that FGC is not associated directly with HIV, but is associated indirectly through several pathways. Cut women are 1.72 times more likely than uncut women to have older partners, and women with older partners are 2.65 times more likely than women with younger partners to test positive for HIV. Cut women have 1.94 times higher odds than uncut women of initiating sexual intercourse before they are 20, and women who experience their sexual debut before age 20 have 1.73 times higher odds than those whose sexual debut comes later of testing positive for HIV. Cut women have 27 percent lower odds of having at least one extra-union partner, and women with an extra-union partner have 2.63 times higher odds of testing positive for HIV. Therefore, in Kenya, FGC may be an early life- course event that indirectly alters women’s odds of becoming infected with HIV through protective and harmful practices in adulthood. (STUDIES IN FAMILY PLANNING 2007; 38[2]: 73–88) Kathryn M. Yount is Associate Professor, Department of Sociology and Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 724, Atlanta, GA 30322. E-mail: kyount@sph.emory.edu. Bisrat K. Abraham is a resident in internal medicine at the Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore.