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Male circumcision does not confer significant protection against HIV infection among men who have sex with men, a new study has found. However, circumcision may reduce HIV risk for MSM who mostly practice insertive anal sex, and study authors recommend continuing to assess male circumcision's effect for this subgroup "across diverse cohorts of MSM." Researchers evaluated circumcision, insertive anal sex practices, and HIV acquisition among 1,824 herpes simplex virus type 2-infected, HIV-negative MSM from Peru and the United States. The men were screened for HIV every three months for up to 18 months, and partner-specific sex practices were analyzed for up to the last three partners.
Over the period of 18 months, 5 percent of the 1,365 uncircumcised MSM had seroconverted, as did 4 percent of the 457 circumcised men. Among MSM who practiced insertive anal sex for at least 60 percent or more of the time with recent partners, circumcision was associated with a 69 percent reduction in HIV acquisition (relative risk=0.31, 95 percent confidence interval 0.06-1.51); but the difference was not statistically significant. Generally, the data "indicate no overall protective benefit from male circumcision" for the MSM, wrote Dr. Jorge Sanchez, of Impacta Peru in Lima, and colleagues.
The results for MSM stand in contrast to several studies among heterosexual men in Africa finding male circumcision reduces the risk of female-to-male HIV infection by up to 60 percent. In countries and regions experiencing heterosexual HIV epidemics, the World Health Organization recommends male circumcision by well-trained health professionals.
One reason circumcision is apparently ineffective among MSM could be that it would have no impact for receptive anal sex. In wealthier countries, the effect of antiretroviral therapy might overshadow any protective effect of circumcision, some experts say.
Especially for MSM, public health messages should "reinforce the importance of condom use for HIV prevention," Sanchez and colleagues wrote.
The study, "Male Circumcision and Risk of HIV Acquisition Among Men Who Have Sex with Men," was published online ahead of print by the journal AIDS (2010; doi:10.1097/QAD.0b013e328340fd81).
The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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