Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men

Templeton, David J^a,b; Millett, Gregorio A^c; Grulich, Andrew E^a

^aNational Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Australia

^bRPA Sexual Health, Royal Prince Alfred Hospital, Sydney, Australia

^cDivision of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA

Correspondence to Dr David J. Templeton, MBChB, DipVen, MForensMed, PhD, MFFLM, MACLM, FAChSHM, Senior Lecturer, National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Level 2, 376 Victoria Street, Sydney, NSW 2010, Australia Tel: +61 2 9385 0900; fax: +61 2 9385 0920; e-mail:[email protected]

Current Opinion in Infectious Diseases23(1):p 45-52, February 2010. |DOI:10.1097/QCO.0b013e328334e54d

Abstract

Purpose of review

The success of male circumcision in reducing HIV acquisition among African heterosexuals has led to renewed interest in this biological intervention for HIV/sexually transmissible infection (STI) prevention in men who have sex with men (MSM). This review summarizes the available data on the association of circumcision and HIV/STI among MSM populations.

Recent findings

Results of observational studies indicate that circumcision has limited impact on HIV/STI acquisition among MSM populations overall. Longitudinal data suggest that circumcision may reduce the risk of incident syphilis, but there is little evidence of a protective effect for other STIs. The subgroup of MSM who predominantly practise the insertive role in anal intercourse may be at lower risk of HIV, although the relative inefficiency of HIV acquisition for insertive compared with receptive partners has resulted in imprecise estimates of effect.

Summary

The evidence that circumcision reduces HIV and other STIs among MSM is weak and inconsistent. However, recent studies have found that circumcised MSM who predominantly take the insertive role in anal intercourse may be at a lower risk of HIV infection. Although MSM may be willing to undergo adult circumcision, should it be proven to reduce HIV acquisition risk, there is substantial potential that behavioural disinhibition could offset any benefits achieved by a circumcision intervention.