Circumcision Unlikely to Have Major HIV Prevention Benefit Among Gay Men

July 23, 2010

By Tim Horn

Circumcising men who have sex with men (MSM) is likely to have a negligible effect on the rate of new HIV cases in the United States, according to a survey conducted in San Francisco in 2008 and reported Thursday, July 22, at the International AIDS Conference in Vienna.

Clinical trials in South Africa, Uganda and Kenya have indicated that heterosexual men who undergo circumcision are 60 percent less likely to become infected compared with uncircumcised men. Ever since these findings, public health leaders have sought to promote circumcision as a proven, cost-effective method. In Vienna, ambassador Eric Goosby, the U.S. global AIDS coordinator, and David Okello of the World Health Organization, along with Bill Clinton and Bill Gates, lent their voices to support male circumcision in Africa.

Circumcision is thought to reduce the risk of HIV transmission by removing cells in the foreskin that are most susceptible to infection by the virus.

Whether or not circumcision of adult males in the United States, notably men who have sex with men, will influence the incidence of HIV in this country remains a matter of debate. As recently as March, an analysis of data collected in the United States and other Western countries indicated that circumcision will not necessarily prevent transmission among MSM.

To explore this further, Jonathan Fuchs, MD, MPH, of the San Francisco Department of Health and his colleagues conducted a survey of MSM in San Francisco measuring HIV prevalence, circumcision status, condom use with insertive and receptive anal intercourse, and willingness to be circumcised.

Of the 521 MSM surveyed, 115 (21.1 percent) were HIV positive and 327 (62.7 percent) were already circumcised, leaving 69 (13.2 percent) for whom circumcision may have an additional preventive benefit.

Among those for whom circumcision may confer a protective effect—those who predominantly engaged in insertive anal intercourse (21.7 percent reported “topping” at least 80 percent of the time, without condoms, with their five most recent partners)—only three (0.5 percent) were willing to participate in an MSM circumcision trial. What’s more, only four (0.7 percent) were willing to get circumcised, even if it proved to be a safe method that did reduce the risk of HIV transmission.

Extrapolating these findings to the entire MSM population of San Francisco—an estimated 65,700 people, Fuchs indicated—only 500 men would potentially benefit from circumcision.

Fuchs and his team concluded that circumcision as an HIV prevention strategy would apply to few MSM in San Francisco and thus, even if effective, would have limited influence on HIV incidence in this population. However, if shown to be an effective prevention strategy for MSM, the researchers argue, circumcision could potentially benefit MSM populations with low rates of circumcision and condom use among those who engage in predominately insertive anal intercourse.

Search: circumcision, prevention, gay, men who have sex with men, MSM, incidence, San Francisco, International AIDS Conference, Vienna

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Previous Comments:

James Loewen, Vancouver, 2010-08-06 15:49:14
At the recent 2010 Symposium for Genital Autonomy we heard from lawyers and researchers who have been documenting the connections of the pro circumcision cabal with cir-cum-fetish websites. The comment here from Alan I is typical of the vile and irrational comments from the pro-circ cabal. Genital integrity rights for all children will supersede the junk science and racist manipulations of the "roll out the African circumcision campaign."

Alan I, , 2010-07-31 11:56:53
Why don't you anteaters pull your foreskins over your heads & enjoy the smell. If you don't agree with circumcision fine! Just leave the rest of us alone that know better from experience.

Joseph4GI, Stockton, CA, 2010-07-29 01:19:45
Circumcision is genital mutilation any way you slice it. In healthy, non-consenting infants, it is a violation of basic human rights. Shouldn't "researchers" be seeking to displace invasive surgical procedures, not preserve them? Is there any research being done in other kinds of HIV prevention? 34 "studies" presented in Vienna focused on finding ways to pawn circumcision on Africans. Can't "researchers" focus on anything else? Studying ways to necessitate surgery is backwards thinking.

David, San Francisco, 2010-07-25 15:19:57
Let me translate these circumcision findings for you. Intact gay men don't want it! They know the risks and they prefer to keep their natural genitals as they are. Now how about backing off the "circumcisioncansavetheworld" meme and get back down to what works - outreach, condoms, testing, treatment, and more outreach until we have a cure or a vaccine.