HIV This Week

Begley EB, Jafa K, Voetsch AC, Heffelfinger JD, Borkowf CB, Sullivan PS. Willingness of men who have sex with men (MSM) in the United States to be circumcised as adults to reduce the risk of HIV infection. PLoS ONE. 2008;3(7):e2731.

Circumcision reduces HIV acquisition among heterosexual men in Africa, but it is unclear if circumcision may reduce HIV acquisition among men who have sex with men in the United States, or whether men who have sex with men would be willing to be circumcised if recommended. Begley and colleagues interviewed presumed-HIV negative men who have sex with men at gay pride events in 2006. They asked uncircumcised respondents about willingness to be circumcised if it were proven to reduce risk of HIV among men who have sex with men and perceived barriers to circumcision. Multivariate logistic regression was used to identify covariates associated with willingness to be circumcised. Of 780 men who have sex with men, 133 (17%) were uncircumcised. Of these, 71 (53%) were willing to be circumcised. Willingness was associated with black race (exact odds ratio [OR]: 3.4, 95% confidence interval [ CI]: 1.3-9.8), non-injection drug use (OR: 6.1, 95% CI: 1.8-23.7) and perceived reduced risk of penile cancer (OR: 4.7, 95% CI:2.0-11.9). The most commonly endorsed concerns about circumcision were post-surgical pain and wound infection. Over half of uncircumcised men who have sex with men, especially black men who have sex with men, expressed willingness to be circumcised. Perceived risks and benefits of circumcision should be a part of educational materials if circumcision is recommended for men who have sex with men in the United States.

Editors’ note: Among the male US population born between 1940 and 1990, 73% of African Americans and 88% of Caucasian Americans have been circumcised, usually at birth. Neonatal circumcision reduces the risk of penile cancer, acquisition of many sexually transmitted diseases, incidence of urinary tract infections in infants, and cervical cancer diagnoses in female sexual partners. No randomised controlled trials have been conducted to assess whether circumcision at any age reduces the risk of HIV acquisition in men who have sex with men, presumably for the insertive men. Nonetheless, as this innovative survey at gay pride events reveals, there would be considerable interest among American men who have sex with men if male circumcision were found to confer significant levels of protection in this population.