While studies in African countries showed circumcising heterosexual men could reduce HIV transmission rates by 50- 60 percent, snipping away the foreskin would have little to no effect for gay Americans.
Earlier this year results from a meta-study of other research concluded circumcision likely wouldn’t effect gay or bisexual men in the Western world. Now a study conducted in 2008 in San Francisco, whose results were released last week in Vienna at the International AIDS Conference, says the theory is almost certainly bunk — if only because many of these men are already circumcised, AIDS Meds notes.
Whether or not circumcision of adult males in the United States, notably men who have sex with men, will influence the incidence of HIV in this country remains a matter of debate. As recently as March, an analysis of data collected in the United States and other Western countries indicated that circumcision will not necessarily prevent transmission among MSM.
To explore this further, Jonathan Fuchs, MD, MPH, of the San Francisco Department of Health and his colleagues conducted a survey of MSM in San Francisco measuring HIV prevalence, circumcision status, condom use with insertive and receptive anal intercourse, and willingness to be circumcised.
Of the 521 MSM surveyed, 115 (21.1 percent) were HIV positive and 327 (62.7 percent) were already circumcised, leaving 69 (13.2 percent) for whom circumcision may have an additional preventive benefit. Among those for whom circumcision may confer a protective effect—those who predominantly engaged in insertive anal intercourse (21.7 percent reported “topping” at least 80 percent of the time, without condoms, with their five most recent partners)—only three (0.5 percent) were willing to participate in an MSM circumcision trial. What’s more, only four (0.7 percent) were willing to get circumcised, even if it proved to be a safe method that did reduce the risk of HIV transmission.
Extrapolating these findings to the entire MSM population of San Francisco—an estimated 65,700 people, Fuchs indicated—only 500 men would potentially benefit from circumcision.
Then again, maybe it’s missed opportunity if these 500 men will probably sleep with each other at some point in the future.