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25 Nov 2009

Circumcision protects gay men who have a 'preference' for insertive sex from HIV

Circumcision may protect gay men who are exclusively insertive for anal sex from infection with HIV, an Australian study published in the November 13th edition of AIDS suggests.

But this finding is based upon just seven infections amongst men who expressed a preference for insertive sex. The investigators found that amongst the men who reported only insertive sex as a behaviour, circumcision did not significantly reduce the risk of infection with HIV.

The study also showed that overall circumcision did not protect gay men from infection with HIV. Earlier data from the study presented to the conference of the International AIDS Society in Sydney in 2007 showed that circumcision had no protective effect.

Gay and other men who have sex with men continue to be one of the groups most affected by HIV. Consequently, there is a need for new approaches to HIV prevention in this population.

Studies in Africa have shown that circumcision reduces the risk of HIV infection for heterosexual men. However, a recent meta-analysis found no conclusive evidence that circumcision was protective for gay men.

An anti-circumcision group protests circumcision
practices during the 2009 San Francisco Pride Parade.
Circumcision is a hotly debated topic with some arguing
that circumcision in both males and females is pure
genital mutilation and others arguing that male
circumcision could be an effective intervention.

Researchers from the Health in Men (HIM) study therefore investigated the relationship between circumcision and the risk of HIV infection in a population of 1426 HIV-negative gay men in Sydney. In total, 938 of these men were circumcised

The men were recruited between 2001 and 2004 and followed until the end of 2007. On entry to the study, the men reported their circumcision status and this was confirmed by clinical examination.

Every six months the men attended for a follow-up visit when they were tested for HIV and the men were asked if they had had unprotected anal intercourse. In addition, individuals were also asked to say if they were insertive or receptive, and if they had a strong preference for adopting the insertive position.

A total of 5161 person years of follow-up were available for analysis, and the median duration of follow-up for each man was 3.9 years.

There were 53 HIV infections, providing an overall incidence of 0.78 per 100 person years.

Statistical analysis that included the entire study population showed that circumcision did not provide any significant protection against infection with HIV.

Only 10% of the study’s person years of follow-up was contributed by men who reported insertive unprotected sex but not receptive sex without a condom. There were only four HIV infections in these men. Analysis showed that circumcised men who only reported insertive unprotected sex did not have a significantly reduced risk of HIV.

Next the investigators restricted their analysis to men who stated a preference for the insertive position in all anal intercourse. These 435 men (279 of whom were circumcised) contributed 1710 person years of follow-up.

There were a total of seven HIV infections in these men, five of which were in the uncircumcised men.

Statistical analysis showed that circumcision was associated with a significant reduction in the risk of HIV infection for men with a preference for insertive anal sex (p = 0.049). This association was strengthened when the investigators adjusted for age and potentially serodiscordant unprotected anal intercourse.

However, three of the men with a preference for insertive sex reported unprotected receptive anal intercourse. But the study's lead author, Dr David Templeton, told aidsmap.com that men expressing a preference for insertive sex adopted this position in almost 99% of instances of anal intercourse.

It is of note, however, that the investigators do not comment on the possibility of study participants providing inaccurate information about their sexual preferences or behaviour to the investigators. It is of note that for reasons of social desirability receptive anal sex is consistently under reported by gay men.

Nevertheless, the investigators comment: “Being circumcised was associated with a significant reduction in HIV incidence among the one-third of participants who reported a preference for the insertive role in anal intercourse”.

A total of 9% of HIV infections in the cohort could, the investigators conclude be attributed to being uncircumcised. “Among participants who preferred the insertive role in anal intercourse, the estimate proportion of HIV infections that could be attributed to being uncircumcised by 75.7%.”

They do however acknowledge that “the key limitation of our analysis was lack of power due to relatively small numbers of HIV infections in the HIM cohort and the low incidence of HIV infection among predominately insertive men.”

The investigators call for randomised controlled trials to further explore the relationship between circumcision and the risk of HIV for gay men.

Such studies could, however, be difficult to design and the investigators question if they would be worthwhile. They note that the studies “would require high HIV incidence, low baseline circumcision prevalence and large numbers of participants exclusively or predominately practicing the insertive role.” The investigators emphasise that “such attributes are necessary for sufficient study power to detect an association between circumcision status with the relatively infrequent outcome measure of HIV acquisition via insertive anal intercourse.”

Reference

Templeton DJ et al. Circumcision and risk of HIV infection in Australian homosexual men. AIDS 23: 2347-51, 2009.

This article was first published by NAM/Aidsmap.com and is republished with permission.

Reader's Comments

1. 2009-11-25 18:05  
The only safe way to have anal sex is with a condom. Circumcision to reduce the chance of catching HIV or any other STDs sounds like false security. So people put a rubber on and keep your foreskin on.
2. 2009-11-25 18:46  
I'm on the same side of the circumcision fence as Post#1. Academic and statistics-based research studies may be interesting for the academics, researchers and those offering grants for further research, BUT we should NOT run out and get circumcised, assuming the "experts" have shown us we will not become infected with HIV. These academic and research studies make me nauseous because they can so easily be misunderstood by the general public. When a CURE for AIDS and HIV is found, THAT is the news report I will read and follow. DON'T ANYONE RUN OUT AND GET CIRCUMCISED, thinking you won't catch "it"!!!! Keep your beautiful foreskin and stay natural, the way your maker made you.
Comment #3 was deleted by its author on 2009-11-25 18:48
4. 2009-11-25 20:54  
Again and again from d medical pro to ask ppl to circumcise...

this news sound like telling d some circumcised ppl think foolishly it is OK to hv sex without protection

or during such bad economic...to earn EXTRA bucks for that procedure
5. 2009-11-25 22:09  
i circumcised.. and i love it.. make urs clean and not smell :D
6. 2009-11-26 00:09  
What a RIDICULOUSLY misleading heading. Journalism of the absolute lowest order.

The Heading: Circumcision protects gay men who have a 'preference' for insertive sex from HIV

A summaryt of the text:
This finding is based upon just seven infections amongst men who expressed a preference for insertive sex.

The study also showed that overall circumcision did not protect gay men from infection with HIV.

Get your act together, Fridae, and stop presenting scientifically flawed nonsense as Headlin Truth.

7. 2009-11-26 01:24  
This article is a disgrace. the English is poor and the content generally unintelligible.

Fridae should proof material before they confuse viewers with the work of an apparently incompetent journalist.
8. 2009-11-26 01:53  
Totally agree with #6. The headline, which may be all some people truly read, is completely misleading when compared even with the actual text in the story it precedes, let alone any peer-reviewed scientific findings.

There MAY be some truth that a circumcised man who is exclusively insertive might possibly have a subsequently reduced risk of HIV contraction, but that man is by no means free from risk... and to say as much in a headline by stating that circumcision PROTECTS gay men from HIV... wow, very irresponsible journalism, compounded by the fact that it's on a gay website.

9. 2009-11-26 02:12  
Totally agree with dynhoyw and therd9. So glad that you guys said that. At least I know somebody is reading and understanding english. This is such a badly written article that has no structures, plannings or purposes. Apprarently, the writer has no idea what he's writing about and presents the facts irresponsibly. Hope articles like this will be studied and corrected thoroughly before posted in the future. Peace Out!
10. 2009-11-26 06:21  
Well there is some logic to reduction in HIV risk associated with circumcision. Fist is hygiene and lesser chance of bleeding during sex intercourse.

I am sure we have come across guys with long foreskin that could easily tear under forceful sex. In addition, long foreskin could result in large deposit of bacteria ad germs beneath the surface of the shaft.

As such, to be safe, its better to circumcise if u have a long foreskin .
11. 2009-11-26 14:21  
The belief that circumcision prevents AIDS infection is the equivalent of treating the symptom instead of the cause.

It's most likely not the foreskin, but a DIRTY(as in unclean) foreskin which abets transmission of disease. Soap and water to clean the foreskin(penis) before and after sex undoubtedly would be just as beneficial and much more cost effective.
12. 2009-11-26 17:47  
Not only a misleading headline, but a dangerous suggestion for disease protection. Use a condom for anal sex and you don't have to cut off part of your penis. Circumcised men are NOT safeguarded from STD transmission by their lack of foreskin. Both of my best friends who died of AIDS were circumcised.
13. 2009-11-26 18:53  
What a stupid misleading headline - please be more responsible when re-reporting.

Buried in the text of the article is this: "The study also showed that overall circumcision did not protect gay men from infection with HIV."

"But this finding is based upon just seven infections amongst men who expressed a preference for insertive sex." Only SEVEN!

And you can keep your foreskin clean without the need to cut it off. Most of you cut boys (and believe me I also like cut cocks a lot) had no say or choice in the matter anyway. But you do not need to assume that it is normal or natural.
14. 2009-11-26 19:00  
my friends and family members who have died of AIDS or HIV related infections were also circumcised. If you learn how to wash your uncut penis with soap and water and dry it properly, it won't smell (post #5). I've had sex with "many" uncircumcised guys, and their penis's smell wonderful....many gay guys like certain body odors. Post #12 sums it up wonderfully. And fridae.com editors should be ashamed of the lack of quality (in terms of accuracy, practicality, and journalism) this article presents to its audience. We're not illiterate, uneducated, clueless idiots!!!
15. 2009-11-26 20:12  
LOLOLOL I had a good laugh over this article. I couldn't believe my eyes when I saw the headline and that's why I have to click on it!
16. 2009-11-27 03:55  
Yes, I agree with many posts here, it is a ridiculous article. Particularly annoying is the use of "a behaviour". For God's sake, behaviour is behaviour and it is not separable or able to be made plural. Americans really do take some stupid liberties with the English language, which may be why their thinking is so blurred and ugly. Although I much prefer cut, I admit that it is for aesthetic reasons. You can keep your uncut cock clean with washing, and it is always your liberty to remain uncut. Aids is more to do with lack of condoms, lack of hygiene and promiscuity.
17. 2009-11-28 18:14  
Please, Fridae! Don't publish this kind of rubbish!!
Article is badly written, and the headline contradicts the context. Irresponsible... do you have someone editing the site? The credibility of Fridae dot com is now down at a very low level, from which it may not recover in a long time.
I hope everyone reading this still uses condoms when having sex.
Comment #18 was deleted by its author on 2009-11-29 14:17
19. 2009-12-02 09:03  
anyway, this hot gay jewish daddy battled his chinese mother of my son to get his son circumsized, i am proud he will have a great looking dick and feel that i am a good jew to follow on the traditions of my dad's family.... thank god we have religious freedom to do what we want to do and choices in life... his chinese mother still thinks i tortured my son though

inspite of all this condoms are the answer for every dick
20. 2009-12-07 17:49  
The picture is of BANG Bay Are iNtactivists Group (USA) I (Frank McGinness, twitter.com/KOTFrank) am top left holding up another sign saying "I did not consent". Top right is Tina Kimmel (BANG leader and is Jewish), bottom left is Will Sanderson, bottom right is Lloyd Schofield, and others, David Wilton & James Loewen doing video & film. See youtube "Penis Parade".

Why put us intactivists in a bad light saying "anti-circumcision group" like a pro-circ'r does. Please call us "pro-foreskin group" marching for equal AND sexual rights!

BTW- David Wilton heads up CircumcisionAndHIV.com, go here for this issue. (check out Operation Abraham Elephant to see who the CDC is about and not being scientific and racially motivated.

Our BANG contingent was bannering under MGMbill.org Male Genital Mutilation Bill .org which seeks equality in the United States (where supposedly we stand for equality but do not) for it is illegal since 1996 to circumcise female minors, even to draw one drop of blood for ritual circumcision. MGMbill.org simply seeks to state male where it says female amending the existing law.

@#11 it is not recommended to use soap, just water to clean under the foreskin because a proper balance of pH is to be maintained. The foreskin is internal like the vagina also mouth. You wouldn't and shouldn't use soap at these places. There is also a study that showed a higher HIV infection rate among intact men who immediately clean their foreskins after insertive sex compared to those that waited a bit then washed.

#14- The foreskin contains apocrine glands which secrete pheromones ergo the attraction. BTW- there also at the anus armpits, ...

#19- Genesis 15 said nothing about cutting the genitals. Only cutting a contract, a covenant, and of cutting animals. Then walking through this bloody mess, animals halved on both sides, then a vigil to night. It was the Judean Priests who wrote Genesis 17 (P text) 13 centuries after Abraham's putative lifetime that called for male circumcision of infants. A initiation rite not so much for the infant but of the father who must circumcise his son himself for he is cognizant of the event whereas the infant is not. (Glick, Jewish, "Marked in Your Flesh").

Langerhans cells are in all mucosas of the body and are part of the immune system. Cutting off the foreskin lessens the immune system. Langerhans cells secrete Langerin which has been proved to kill HIV dead. There are more Langerhans cells in the tonsils but no one is advocating tonsillectomies.

The African studies are flawed by not taking into account confounders. Such as gay sex, more HIV education and time given to those circ'd, those circ'd had time off for sex and disease for haeling, etc. (Doctors Opposing Circumcision).
New study gives #'s to what we knew before- that HIV is aslo spread by medical care.

http://tinyurl.com/yks9apv 1 in 5 (20%0 new HIV Infections Caused by Medical Staff (5 million/yr, Africa,09) papers backed by Royal Society of Medicine #i2
21. 2009-12-08 06:50  
Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are more likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
22. 2009-12-12 22:34  
@#21

Er.... No. "ABC" is not the (only) way forward. Education on contraction forms, and easy, inexpensive access to barrier contraceptives should be the key. So is testing & help services to minimise spread. Couching safety in conservative moral tones is not going to bring forward anything but conservative values--by all means do that, but don't assume it should be relevant to everyone or essential in STI prevention.

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