CAPE TOWN, SOUTH AFRICA Circumcision appears to exert a protective role among men who have sex with men, according to survey findings from nearly 400 men in Soweto, South Africa.
The evidence suggests that circumcision lowers the risk of infection with HIV for men who nearly exclusively practice insertive anal intercourse or receptive anal intercourse, according to a presentation at the International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention.
However, a clinical trial to prove the effectiveness of circumcision will be required, according to the study's lead investigator, Tim Lane, Ph.D., assistant professor in medicine at the Center for AIDS Prevention Studies at the University of California, San Francisco. During his poster presentation, Dr. Lane added that "the acceptability and ethical implications of male circumcision in the men who have sex with men must be assessed prior to initiating clinical trials."
Dr. Lane and colleagues recruited 363 men who lived in Soweto between February and August 2008. The men completed a one-time behavioral survey, focusing particularly on their sexual behavior with their last five most recent partners in the previous 6 months.
HIV status was determined through rapid antibody testing; the prevalence of HIV infection was 13%. A total of 36% of the men were circumcised.
The risk of HIV infection in an uncircumcised man who practiced insertive sex with other men was 4.5 times higher than in a circumcised man who practiced insertive sex with other men.
A circumcised man who practiced receptive sex with other men had a nonsignificant 1.4 times greater risk of HIV infection than a circumcised man who practiced insertive sex.
Uncircumcised men who practiced receptive sex with other men were at 7.5 times the risk of HIV infection than circumcised men who practiced insertive sex.
In the population studied, the vast majority of men who had sex with men practiced either insertive or receptive sex exclusively, Dr. Lane said. "Only 14% of the men said they practice both insertive and receptive sex," he said. "About 40% of the men said they also had sex with women."
"This study may open the door for other studies," said Dr. Naomi Bock, medical officer at the Global AIDS Program, at the Centers for Disease Control and Prevention, Atlanta.
However, the study findings are limited by the fact that the information was self-reported and because most of the men said that they engaged in either receptive or insertive sex.
The Soweto Men's Study was supported by the National Institute of Mental Health; the Peninsula Community Foundation; the Hurlbut-Johnson Fund; the UCSF Research Institute Jesse Miller Memorial Fund; United States Agency for International Development; and the President's Emergency Plan for AIDS Relief. The researchers did not disclose any financial conflicts. The International AIDS Society does not require financial disclosures.