ASHM 2008: Fourth study shows circumcision useless in HIV prevention among gay men

A new study has once again shown that circumcision as a strategy to prevent homosexually acquired HIV is essentially useless. The new paper was presented at the 20th annual Australasian Society for HIV Medicine conference the week of the 14th. As was the case in several previously published studies looking at homosexually acquired HIV, there seemed to be no overall benefit from circumcision in gay men. According to a report by One News New Zealand, the analysis of a four year study which followed 1400 HIV negative gay men found:

  • 53 were infected, of which 7 were the “[exclusively] insertive” partner*;
  • According to work presented by Temptleton, DJ et al. at the Perth conference, it was believed [read speculated] that of those seven only 2 would have acquired HIV had they been circumcised, and therefore an 85% RR observed among men who prefer the insertive roll [of course, no studies have shown anal intercourse to be less risky if the insertive partner is circumcised. This is still just hopeful speculation];
  • There was no reduction in the general homosexual population [that is to say either those who prefer being the “receiver” or those who participate in both rolls. Either way, this notion can further be extrapolated to re-enforce the fact that, as has been reported previously, circumcision would have no benefit to women];
  • While it was said that this appears “impressive” it was also shown at the conference that circumcision was not a cost effective method for preventing HIV, circumcising all gay men in Australia would cost $200 million the first two years and only prevent 37 infections over the next 10 years and 57 by 2030.

Dr. David Templeton of the National Centre in HIV Epidemiology and Clinical Research in
Sydney  noted the following.

“That’s only nine percent of all HIV infections overall that can be
attributed to being uncircumcised, not enough to advocate throwing
out condoms or advocating widespread circumcision.” [Note: If this was his conclusion why tout the risk reduction in the title, it just confuses people and generates erroneous press coverage.]

Stevie Clayton, chief executive of the AIDS Council of NSW, added the following.

“And in a public health sense, a mass circumcision program is very
unlikely to be an effective or cost-effective way to go.”

It is curious why this has been described as a landmark study. Perhaps they mean that we now know that circumcision is of little value especially in Western epidemics. We now have this plus at least three additional studies which say essentially the same thing:

  • This work was based off research presented at the 2007 International AIDS Society conference in Sydney, Australia looking at the role of circumcision and STDs in gay men. After following 1427 men over 3 years, two thirds of whom had been circumcised, no association was found between STDs, including HIV, and circumcision;
  • A US study came to similar conclusions in December of 2007, after studying gay black and Latino men in three large US cities;
  • And most recently, a study performed in London which found that while HIV prevalence varied widely among ethnic groups, there was no apparent correlation with circumcision status.

According to CDC figures, 84% of all new HIV cases in 2005 were contracted in men who have sex with men (MSM), MSM who are IV drug users, and in men and women through high-risk heterosexual contact. Despite the mark up in HIV cases in the US presented at the 2008 International AIDS conference in Mexico City, as pointed out in a previous post, the distribution is approximately the same.

From a practical point of view, the US and Australia have a similar HIV epidemic driven largely by these high risk groups and are identical from an anthropological point of view, certainly more so than any country in Africa. Advocating circumcision in the US would have as little value here as it would in Australia and be a colossal waste of money focusing on the least ethical, most broad, and least effective strategy.

It is worth emphasizing that the CDC has recently acknowledged that broadly targeted strategies is in error. Targeted strategies aimed at highest risk individuals should instead be implemented for the greatest effect. The question remains whether pro-circumcision forces at the CDC will twist the data in their favor to promote mass circumcision in the United States, anyway.

Visit The CDC/AAP Project page and be heard.

* The fact that only 7 of 53 newly infected individuals claimed an exclusive preference for the insertive role is instructive. It should be clear from this evidence alone that exclusive roles are more a hope than a reality for the forces advocating circumcision in gay men. It vastly underestimates the changeable nature of sexual conduct, but also assumes a very sexist notion of what gay men do. The idea that they take on an inflexible masculine or feminine role is insulting and, worse for public health policy being made on the basis of such nonsense, simply untrue.

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2 Responses to ASHM 2008: Fourth study shows circumcision useless in HIV prevention among gay men

  1. I think it’s interesting that the CDC would like to do a pilot circumcision study on “heterosexual men who ingage in high-risk behaviour”. Like who? Men who are porn actors? Men who have multiple concurrent partners or like to visit prostitutes and refuse to wear a condom? *WHO* is engaging in “high-risk heterosexual behaviour”? Sadly, it’s any man who has unprotected sex with a woman who’s HIV status is unknown – and that is WAY too many men in the US; that’s why all our STD rates are so high, irregardless of our high circumcision rate. Thanks abstinence only sex-ed promoters and their allies in the religious right! The catholic church has done such an awesome job spreading HIV in Africa through discouraging condom use in sub-Sahara, why not replicate their results here – you know, just to make sure they’re valid? Not promoting protection is promoting HIV, and with protection, circumcision even by their own accounts is unnecessary.
    CDC, could you please define “high-risk heterosexual behaviour”? I’m a little confused.

  2. Joe says:

    I’d like to know what high-risk hetero behavior is too. I wouldn’t consider myself high-risk but who knows. My guess, and this is only a guess, would be MSW whose partners are IV drug users, have multiple concurrent partners, or are bisexual. By that definition I’ve never known anyone to be high-risk.

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