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  • Male Circumcision and HIV provides a place for a public health policy debate on the linking of male circumcision and HIV/AIDS. It seeks to address questions of cost versus benefit, the effectiveness of circumcision in the fight against HIV/AIDS in real world settings, and the differing points of view of researchers, the media, and all contributors to the policy discussion.

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  • David Wilton

    David Wilton is a lawyer by training. He has a long-standing interest in issues of body integrity and HIV/AIDS. He maintains this site and blogs from San Francisco, California. His primary interests outside of nurturing a debate on the controversial measure of removing sexual tissue to reduce the spread of HIV are in the areas of international relations, languages, and journalism.
  • Adrienne Soti
    Adrienne Soti has provided research and monitoring of the media for Male Circumcision and HIV. A native of Hungary who came to the US in 1990, she lives with her husband and two small children in New Jersey. She has a B.A. in Psychology and Philosophy from Rutgers University. She lists biology and medicine among her many interests and is particularly interested in bio-ethical issues. The circumcision controversy came to her attention after the birth of her son in 2005.

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« Notebook: On predicting the future and being wrong ... | Main | Human Genetics Yields New Frontiers in HIV Research »

Sunday, July 22, 2007

Circumcision is not predictive of HIV infection (seroconversion) in gay men.

But not content with these results, the authors conclude, "More studies, please."

Edit: Aidsmap has an excellent summary of the study and one other study showing Peruvian gay men would be willing to be test subjects for a future circumcision study in that country. Obviously, the first study would seem to preclude any need for making guinea pigs out of South American men.

Abstract after the break.

Abstract

Circumcision status and risk of HIV seroconversion in the HIM cohort of homosexual men in Sydney

Presented by David James Templeton, Australia.

Templeton D.J.1, Jin F.1, Prestage G.P.1, Donovan B.1, Imrie J.2, Kippax S.C.2, Kaldor J.M.1, Grulich A.E.1

1National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, Australia, 2National Centre in HIV Social Research, University of New South Wales, Randwick, Australia

Objectives: Circumcision substantially lowers the risk of HIV acquisition among heterosexual African men, but there are few data addressing circumcision status as a risk factor for HIV among homosexual men. We examined circumcision status as an independent risk factor for HIV seroconversion in the community-based Health in Men (HIM) cohort of homosexual men in Sydney, Australia.

Methods: Between 2001 and 2004, 1,427 initially HIV-negative men were enrolled. Circumcision status was self-reported at baseline and was validated by clinical examination during study visits in a sub-sample of participants. All participants were tested annually for HIV and offered testing for other sexually transmitted infections (STIs). Demographic information was collected at baseline and detailed information on sexual risk behaviours was collected every 6 months.

Results: At baseline, 66% of participants reported being circumcised; mostly as infants. There were 49 HIV seroconversions through 2006, an incidence of 0.80 per 100PY. On multivariate analysis controlling for non-concordant unprotected anal intercourse (UAI), anorectal STIs and age, being circumcised was not associated with HIV seroconversion (RR = 0.88, 95% CI 0.45-1.74). Among men who reported no receptive UAI, there were nine seroconversions, an incidence of 0.35 per 100PY. When analyses were restricted to this group, there was also no association with HIV seroconversion (RR = 0.99, 95% CI 0.25-3.96).

Conclusion: Circumcision status was not associated with HIV seroconversion in this cohort. Although statistical power was limited, among men who were more likely to acquire HIV by insertive UAI, there was also no relationship. As most HIV infections in homosexual men occur after receptive anal sex, circumcision is unlikely to be an effective HIV prevention intervention in Australian gay men. However, further research in populations where there is more separation into exclusively receptive or insertive sexual roles by homosexually active men is warranted.

Reference

Presented at the 4th Annual IAS Conference, Sydney, Australia. July 22-24, 2007.

http://www.ias2007.org/pag/Abstracts.aspx?SID=55&AID=2465

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Elsewhere on the Web

  • Circumcision and AIDS at MGMbill.org
    A decidedly anti-circumcision site with a calm approach to addressing the human rights issues likely to become problematic in the rush to roll out circumcision as an HIV prophylactic.
  • Circumcision and HIV at circumstitions.com
    One of the most thorough reviews anywhere of circumcision and the history behind the HIV prevention community's study of it. The science behind this prophylactic tool is much more equivocal than the most recent researchers would have you believe. New Zealand based.
  • Circumcision and HIV: Harm Outweighs Benefits from circumcision.org
    From the Circumcision Resource Center, Boston, Massachusetts. This human rights organization has published such books as Questioning Circumcision: A Jewish Perspective and Circumcision: The Hidden Trauma. Sitting on its board are a number of individuals affiliated with Harvard and other Ivy League institutions.
  • Circumcision and HIV infection from CIRP.org
    From the Circumcision Information Resource Pages. Not as up-to-date, but an excellent primer on the issue.
  • Doctors Opposing Circumcision statement on HIV
    Doctor's Opposing Circumcision is a Seattle based physicians group that provides education, information and advice on medical circumcision and its effects.
  • Statement on AIDS and Circumcision from the International Coalition for Genital Integrity
    Another thorough treatment of male circumcision's likely impact on the spread of HIV from an "alliance of organizations dedicated to protecting the normal anatomy of males, females and the intersexed ... [that] was formed to coalesce the many activist organizations, each with a specific focus, into one, common voice."
  • Does circumcision prevent HIV infection? - NORM-UK
    John Dalton puts together a critique of the African studies and their weaknesses. He examines the evidence, appropriateness, and possible outcomes from promoting circumcision and calling it a "prevention."

Sources

  • HIV/AIDS Medscape [free registration required]
    This site is owned by WebMD.com. It is a great source for breaking news. I wouldn't necessarily trust it completely on the issue of circumcision as it is US-based. But the HIV/AIDS coverage is pretty good.
  • UCSF HIV InSite Gateway to HIV Information
    The University of California - San Francisco is a leading medical teaching and research university in the HIV/AIDS field. Generally very reliable, it occasionally oversells or misstates the prevention message, most obviously and unfortunately regarding circumcision.
  • IRIN PlusNews
    I don't like this source because it tends to be a bit sensationalist, in my opinion. But it is pretty good for divining which way the wind is blowing.
  • Aidsmap: Circumcision News
    An otherwise great source, they have recently begun to climb on the bandwagon. The tone of the reports seem reticent as evidenced by their providing some great quotes. Coincidence? Inadvertent? Maybe, but hope not.

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