Abstract
The objective was to examine the association between circumcision status and self-reported HIV infection among men who have sex with men (MSM) in Britain who predominantly or exclusively engaged in insertive anal intercourse. In 2007–2008, a convenience sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey which included questions on circumcision status, HIV testing, HIV status, sexual risk behavior, and sexual role for anal sex. The analysis was restricted to 1,521 white British MSM who reported unprotected anal intercourse in the previous 3 months and who said they only or mostly took the insertive role during anal sex. Of these men, 254 (16.7 %) were circumcised. Among men who had had a previous HIV test (n = 1,097), self-reported HIV seropositivity was 8.6 % for circumcised men (17/197) and 8.9 % for uncircumcised men (80/900) (unadjusted odds ratio [OR], 0.97; 95 % confidence interval [95 % CI], 0.56, 1.67). In a multivariable logistic model adjusted for known risk factors for HIV infection, there was no evidence of an association between HIV seropositivity and circumcision status (adjusted OR, 0.79; 95 % CI, 0.43, 1.44), even among the 400 MSM who engaged exclusively in insertive anal sex (adjusted OR, 0.84; 95 % CI, 0.25, 2.81). Our study provides further evidence that circumcision is unlikely to be an effective strategy for HIV prevention among MSM in Britain.
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Notes
A post hoc calculation showed that our analysis had sufficient power to detect a twofold differential in HIV seropositivity between circumcised and uncircumcised men where overall HIV seropositivity was 9% (uncircumcised men 10%, circumcised men 5%, alpha = .05, beta = .24).
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Acknowledgments
The authors would like to thank all the men who completed the online questionnaire; the community representatives and advisory group; the participating sexual health clinics and HIV prevention projects; Gaydar for technical support and for promoting the survey; the staff at Mount Pleasant where this article was first drafted. The project was funded by a grant from the UK Medical Research Council (grant number GO 500009) for 30 months from July 2006 to December 2008. Additional funding was provided by City University London from October 2009.
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Doerner, R., McKeown, E., Nelson, S. et al. Circumcision and HIV Infection among Men Who Have Sex with Men in Britain: The Insertive Sexual Role. Arch Sex Behav 42, 1319–1326 (2013). https://doi.org/10.1007/s10508-012-0061-1
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DOI: https://doi.org/10.1007/s10508-012-0061-1