Circumcision Status and HIV Infection Among MSM in the U.S.

Summary and Comment |
February 4, 2008

Circumcision Status and HIV Infection Among MSM in the U.S.

  1. Rebeca M. Plank, MD

Results from an observational study do not support a protective effect of circumcision among Latino and black MSM in the U.S.

  1. Rebeca M. Plank, MD

Circumcision can reduce the risk for heterosexually acquired HIV infection (ACC Mar 19 2007), but does it have similar benefits in men who have sex with men (MSM)? To explore this possibility, researchers conducted a cross-sectional study among 1079 black MSM and 957 Latino MSM in three U.S. cities. Participants underwent HIV testing and provided information about demographic factors, high-risk behaviors, and circumcision status.

Seventy-four percent of black MSM reported being circumcised, compared with 33% of Latino MSM (P<0.0001). In both groups, circumcised men were more likely than uncircumcised men to be U.S.-born or to have U.S.-born parents. Among blacks, circumcised men were more likely to self-identify as gay (vs. bisexual or heterosexual), to be older, to have higher levels of education and income, and to report recent use of marijuana or amyl nitrates; they were also more likely to report being the receptive partner in anal sex and to have recently engaged in unprotected anal intercourse. Among Latinos, circumcised men were more likely than uncircumcised men to report recent use of cocaine and heroin; they also reported more-frequent and more-recent HIV testing.

In multivariate analyses, circumcision status was not associated with HIV serostatus in either ethnic group. Similar null results were found when analyses were limited to men who have sex only with men — and when analyses were even further limited to men who acted exclusively as the insertive partner during recent unprotected anal intercourse.

Comment

Although circumcision cannot be expected to protect an individual from HIV infection during receptive anal intercourse, results from this cross-sectional study suggest that it does not protect individuals during insertive anal intercourse either. Two previous observational studies among MSM showed a doubling of HIV risk among uncircumcised men (J Infect Dis 1993; 168:1404 and J Acquir Immune Defic Syndr 2005; 39:82), but those studies included very few black or Latino men. These groups are affected disproportionately by the HIV epidemic in the U.S. and are also less likely than whites to be circumcised. Furthermore, in one of these studies, several other factors played a larger role in HIV seroconversion than did circumcision status. Overall, results from these observational studies have not made a compelling case for circumcision as an HIV-prevention tool among MSM in the U.S.

Dr. Plank is a physician in the Division of Infectious Diseases at Brigham and Women’s Hospital in Boston.

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