July 22, 2010 Adult circumcision has been proposed as a possible HIV prevention strategy for gay men, but a new study by the University of Pittsburgh Graduate School of Public Health presented at the XVIII International AIDS Conference suggests it would have a very small effect on reducing HIV incidence in the United States.
Circumcision is thought to reduce the risk of HIV transmission by removing cells in the foreskin that are most susceptible to infection by the virus. Clinical trials conducted in Africa have found it reduces the risk of HIV in heterosexual men, yet there is little evidence that it can reduce transmission among American gay men.
The study was based on surveys of 521 gay and bisexual men in San Francisco. Findings indicated that 115 men (21 percent) were HIV-positive and 327 (63 percent) had been circumcised. Of the remaining 69 men (13 percent), only three (0.5 percent) said they would be willing to participate in a clinical trial of circumcision and HIV prevention, and only four (0.7 percent) were willing to get circumcised if it was proven safe and effective in preventing HIV.
The researchers extrapolated these findings to the entire gay and bisexual male population of San Francisco, an estimated 65,700 people, and determined that only 500 men would potentially benefit from circumcision.
"Circumcision in the U.S. already is very common, making it applicable to a limited number of men as a potential HIV prevention strategy in adulthood," said Chongyi Wei, Dr.P.H., study author and post-doctoral associate, Pitt's Graduate School of Public Health. "Our study indicates that any potential benefit may likely be too small to justify implementing circumcision programs as an intervention for HIV prevention."
Study co-authors include H. Fisher Raymond, M.P.H., Willi McFarland, M.D., Ph.D., Susan Buchbinder, M.D., and Jonathan Fuchs, M.D., all of the San Francisco Department of Health. The study was funded by the Centers for Disease Control and Prevention.
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