A Protective Effect of Circumcision Among Receptive Male Sex Partners of Indian Men Who Have Sex with Men

Schneider, John A.; Michaels, Stuart; Gandham, Sabitha; McFadden, Rachel; Liao, Chuanhong; Yeldandi, Vijay; Oruganti, Ganesh

doi:10.1007/s10461-011-9982-2

Cited by 24 publications

(19 citation statements)

References 29 publications

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“…Our study found the strongest HIV protective association to date of circumcision among MSM, 15,27-30 at the borderline of statistical significance (2-tailed α=0.05). A meta-analysis of 20 observational studies with 65,784 participants showed a weaker, also marginally significant association (OR, 0.86; 95% CI, 0.70-1.06).…”

Section: Discussioncontrasting

confidence: 49%

Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China

Qian

Ruan

Liu³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain. Methods Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed. Results Among1155 participants (242 known seropositives and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by exam) was associated with 47% lower odds of being HIV seropositive (adjusted odds ratio [aOR], 0.53; 95% confidence interval [CI], 0.27-1.02) after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR, 0.38, 95%CI, 0.09-1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR, 0.54, 95%CI, 0.25-1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR, 0.15; 95%CI, 0.04-0.65). Circumcision was not associated clearly with lower syphilis risk (aOR, 0.91; 95%CI, 0.51-1.61). Conclusions Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.

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Section: Discussioncontrasting

confidence: 49%

Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China

Qian

Ruan

Liu³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…11 studies found circum cision to have a significant protective association with HIV infection among all MSM. 18,41,42,63,64,67,73,76,83,86,90 Two studies found a significant protective association with circumcision only among MSM who primarily engage in insertive anal sex. 25,87 Two studies reported a significant protective association with circum cision only among bisexual men.…”

Section: Resultsmentioning

confidence: 99%

Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data

Yuan

Fitzpatrick

et al. 2019

The Lancet Global Health

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Background Men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. Previous reviews investigating the role of circumcision in preventing HIV and other STIs among MSM were inconclusive. Many new studies have emerged in the past decade. To inform global prevention strategies for HIV and other STIs among MSM, we reviewed all available evidence on the associations between circumcision and HIV and other STIs among MSM.Methods In this systematic review and meta-analysis, we searched PubMed, Web of Science, BioMed Central, Scopus, ResearchGate, Cochrane Library, Embase, PsycINFO, Google Scholar, and websites of international HIV and STI conferences for studies published before March 8, 2018. Interventional or observational studies containing original quantitative data describing associations between circumcision and incident or prevalent infection of HIV and other STIs among MSM were included. Studies were excluded if MSM could not be distinguished from men who have sex with women only. We calculated pooled odds ratios (ORs) and their 95% CIs using random-effect models. We assessed risk of bias using the Newcastle-Ottawa scale. (0·99, 0·90-1·09; k=20; I²=40%). Circumcision was associated with reduced odds of herpes simplex virus (HSV) infection among MSM overall (0·84, 0·75-0·95; k=5; I²=0%) and penile human papillomavirus (HPV) infection among HIV-infected MSM (0·71, 0·51-0·99; k=3; I²=0%). Findings We identified 62 observational studies including 119 248 MSM. Circumcision was associated with 23% reduced odds of HIV infection among MSM overall (OR 0·77, 95% CI 0·67-0·89; number of estimates [k]=45; heterogeneity I²=77%). Circumcision was protective against HIV infection among MSM in countries of low and middle income (0·58, 0·41-0·83; k=23; I²=77%) but not among MSM in high-income countries Interpretation We found evidence that circumcision is likely to protect MSM from HIV infection, particularly in countries of low and middle income. Circumcision might also protect MSM from HSV and penile HPV infection. MSM should be included in campaigns promoting circumcision among men in countries of low and middle income.In view of the substantial proportion of MSM in countries of low and middle income who also have sex with women, well designed longitudinal studies differentiating MSM only and bisexual men are needed to clarify the effect of circumcision on male-to-male transmission of HIV and other STIs.

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“…Circumcision rates among MSM remain low (<20%) in countries such as Thailand 76 or China. 182,183 Although a recent study in India suggests that circumcised MSM who predominantly take the receptive role in anal intercourse may be at a lower risk of HIV infection, 184 evidence that circumcision reduces HIV among MSM remains weak and inconsistent. 185,186 Despite the willingness to undergo circumcision among MSM populations, 187,188 male circumcision is not promoted as a priority in Asian countries with concentrated epidemics and has not been recommended for MSM unless they also engage in vaginal sex.…”

Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

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A Protective Effect of Circumcision Among Receptive Male Sex Partners of Indian Men Who Have Sex with Men

Cited by 24 publications

References 29 publications

Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China

Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China

Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

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