This analysis involved 1824 MSM, 1362 (75%) of them from Peru and 462 (25%) from the United States. All men were negative for HIV and positive for herpes simplex virus type 2 (HSV-2). They were enrolled in a randomized placebo-controlled trial of HSV-2 suppression to prevent HIV infection. That study found treating HSV-2 did not lower the risk of HSV-2 acquisition.
All study participants were assessed for circumcision status at enrollment and were tested for HIV every 3 months for up to 18 months. Researchers determined partner-specific sexual behavior for up to the last 3 partners during the previous 3 months.
Univariate analysis revealed no significant association between circumcision and HIV acquisition (relative risk [RR] 0.84, 95% confidence interval [CI] 0.50 to 1.42). Multivariate analysis that assumed a linear relationship between the proportion of insertive sex acts and effect of circumcision on HIV acquisition found that the interaction between circumcision and the proportion of insertive acts was not significant in lowering HIV risk (P = 0.11).
A third analysis that divided men into those who had fewer than 60 insertive acts with recent partners and those who had 60 or more partners determined that circumcision reduced the risk of HIV acquisition 69% (RR 0.31), but that association was not statistically significant (95% CI 0.06 to 1.51) among men who repeated at least 60% of insertive acts with recent male partners.
The researchers conclude that “circumcision does not have a significant protective effect against HIV acquisition among MSM from Peru and US.” However, they suggest “there may be reduced risk for men who are primarily insertive with their male partners” and they call for further investigation of this association.
Source: Jorge Sánchez, Victor G. Sal y Rosas, James P. Hughes, Jared M. Baeten, Jonathan Fuchs, Susan P. Buchbinder, Beryl A. Koblin, Martín Casapia, Abner Ortiz, Connie Celum. Male circumcision and risk of HIV acquisition among MSM. AIDS. 2011; 25: 519-529.