To assess circumcision status as a risk factor for HIV seroconversion in homosexual men.
The Health in Men (HIM) study was a prospective cohort of homosexual men in Sydney, Australia. HIV-negative men (n = 1426) were recruited primarily from community-based sources between 2001 and 2004 and followed to mid-2007. Participants underwent annual HIV testing, and detailed information on sexual risk behaviour was collected every 6 months.
HIV incidence in circumcised compared with uncircumcised participants, stratified by whether or not men predominantly practised the insertive role in anal intercourse.
There were 53 HIV seroconversions during follow-up; an incidence of 0.78 per 100 person-years. On multivariate analysis controlling for behavioural risk factors, being circumcised was associated with a nonsignificant reduction in risk of HIV seroconversion [hazard ratio 0.78, 95% confidence interval (CI) 0.42-1.45, P = 0.424]. Among one-third of study participants who reported a preference for the insertive role in anal intercourse, being circumcised was associated with a significant reduction in HIV incidence after controlling for age and unprotected anal intercourse (UAI) (hazard ratio 0.11, 95% CI 0.03-0.80, P = 0.041). Those who reported a preference for the insertive role overwhelmingly practised insertive rather than receptive UAI.
Overall, circumcision did not significantly reduce the risk of HIV infection in the HIM cohort. However, it was associated with a significant reduction in HIV incidence among those participants who reported a preference for the insertive role in anal intercourse. Circumcision may have a role as an HIV prevention intervention in this subset of homosexual men.
"Circumcision also affects global health issues such as HIV: male circumcision reduces female to male transmission (Auvert et al., 2005) without altering male to female (Wawer et al., 2009). It also provides protection for men who have sex with men, but again it is one-sided, protecting those who report insertion-only roles (Millett et al., 2008; Templeton et al., 2009). With regard to sexual function, the foreskin could provide additional sexual sensation for the uncircumcised male, perhaps due to the terminal innervation of the foreskin structure or to sensory changes in the glans penis epithelium when the foreskin is removed. "
"Some research suggests a potential protective effect of circumcision for men who have sex with men who primarily or exclusively practice the insertive role. A recent prospective study of gay men in Sydney found that while circumcision status did not reduce the risk of HIV infection overall, circumcision showed a significant protective effect for men who have sex with men who reported a preference for performing the insertive role during unprotected anal intercourse (Templeton et al. 2009). Among Latinos, multiple studies suggest a modest protective effect for men who have sex with men who exclusively practice the insertive role. "
[Show abstract][Hide abstract] ABSTRACT: Male circumcision has received increased attention for its potential to reduce sexual transmission of HIV. Research on the acceptability of circumcision as a means of HIV prevention among men who have sex with men is limited. Men who have sex with men in Bogotá, Colombia, either participated in a focus group in which they shared information regarding their perceptions of circumcision or completed a survey that assessed circumcision experiences, attitudes, beliefs and willingness. Few participants reported they were circumcised, yet most participants reported knowing something about the procedure. Overall, attitudes towards circumcision were mixed: although circumcision was viewed as safe, it was also viewed as unnatural and cruel to babies. Beliefs that circumcision could improve sexual functioning and protect against STIs and HIV were not widely endorsed by survey participants, although focus-group participants discussed the potential impacts of circumcision on the availability of sexual partners and sexual performance. Some focus-group participants and many survey participants reported a hypothetical willingness to get circumcised if strong evidence of its effectiveness could be provided, barriers removed and recovery time minimised.
"Previous studies showed that male circumcision reduced the likelihood of female-to-male transmission of HIV-1 infection by 50%~60% [27-29]. Concerning the protective effect of circumcision for MSM, several studies reported that circumcision had a significant protective effect [30-33]. In contrast, other studies reported that circumcised MSM had greater chances for contracting HIV infection although they were statistically nonsignificant [34,35]. "
[Show abstract][Hide abstract] ABSTRACT: Men having sex with men (MSM) accounts for 33.6% of all reported cases of HIV-1 infection in Taiwan. The aim of this study was to investigate the epidemiology of HIV-1 infection among MSM in gay saunas in Taiwan.
Patrons of 5 gay saunas were recruited for a weekly volunteer counseling and testing program from 2001 to 2005. Questionnaires were collected for a risk factor analysis. HIV-1 subtypes were determined using DNA sequencing and phylogenetic analyses.
HIV-1 prevalence rates among MSM in gay saunas in 2001 through 2005 were 3.4%, 5.1%, 8.9%, 8.5%, and 8.3%, respectively. In total, 81 of 1, 093 (7.4%) MSM had HIV-1 infection. Fifty-two HIV-1 strains were genotyped, and all of them were subtype B. HIV-seropositive men were significantly younger than the seronegatives. Only 37.1% used condoms every time during sexual intercourse. A multivariate logistic regression analysis showed that the risk factors for HIV-1 were being uncircumcised (odds ratio (OR) = 2.19; 95% confidence interval (CI), 1.08~4.45); having sexual intercourse with at least 2 partners during each sauna visit (≥ 2 vs. ≤ 1, OR = 1.71; 95% CI, 1.02~2.89); and the role played during anal intercourse (versatile vs. an exclusively insertive role, OR = 2.76; 95% CI, 1.42~5.36).
Overall, 7.4% Taiwanese MSM participating in this study had HIV-1 subtype B infection. Uncircumcised, being versatile role during anal intercourse, and having sex with more than one person during each sauna visit were main risk factors for HIV-1 infection.
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