The latest study to suss out the impact of circumcision on rates of HIV acquisition among gay men has provided some important insights. The general conclusion to be drawn is that the failure to show a statistical difference between circumcised and intact men who have sex with men continues to appear. The study appeared in the journal AIDS Patient Care and STDs, and was entitled “Relations Between Circumcision Status, Sexually Transmitted Infection History, and HIV Serostatus Among a National Sample of Men Who Have Sex with Men in the United States.”
The latest study has provided an interesting additional insight. Circumcised men are more likely to use condoms. Yet intact men as a group do not appear to show higher rates of HIV acquisition DESPITE this apparent disadvantage. The converse however may not be true. The higher rates of condom use among circumcised men may mask a greater susceptibility to HIV acquisition among men who have sex with men.
The authors go on to describe a lower rate of herpes in circumcised men, a finding that can be entirely explained by higher rates of condom use in this cohort.
An additional finding that did not affect the relative levels of HIV in either group is that men who reported always vs. never using condoms was higher among a subset of circumcised men for always wearing condoms. Yet apparently, never using condoms among a subset of intact men did nothing to change the over all balance between the two groups in HIV acquisition the fact this finding did not change the over all level of HIV acquisition between the two groups is underappreciated and the implications could be disruptive for those proposing circumcision campaigns generally.
The bottom line: circumcision does not result in a protective effect against HIV acquisition. It should be emphasised that circumcised men who have sex with men should be especially careful to continue to use condoms in every encounter with men of unknown HIV status due to the possible greater susceptibility to HIV acquisition.
Kristen Jozkowski, Joshua G. Rosenberger, Vanessa Schick, Debby Herbenick, David S. Novak, Michael Reece. AIDS Patient Care and STDs. August 2010, 24(8): 465-470. doi:10.1089/apc.2010.0082.
Download PDF: Jozkowski et al -Aids Pt Care – 2010