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Circumcision and HIV Infection among Men Who Have Sex with Men in Britain: The Insertive Sexual Role
Authors:Rita Doerner  Eamonn McKeown  Simon Nelson  Jane Anderson  Nicola Low  Jonathan Elford
Institution:1. School of Health Sciences, City University London, 20 Bartholomew Close, London, EC1A 7QN, UK
2. Terrence Higgins Trust, Bristol, UK
3. Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
4. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Abstract:The objective was to examine the association between circumcision status and self-reported HIV infection among men who have sex with men (MSM) in Britain who predominantly or exclusively engaged in insertive anal intercourse. In 2007–2008, a convenience sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey which included questions on circumcision status, HIV testing, HIV status, sexual risk behavior, and sexual role for anal sex. The analysis was restricted to 1,521 white British MSM who reported unprotected anal intercourse in the previous 3 months and who said they only or mostly took the insertive role during anal sex. Of these men, 254 (16.7 %) were circumcised. Among men who had had a previous HIV test (n = 1,097), self-reported HIV seropositivity was 8.6 % for circumcised men (17/197) and 8.9 % for uncircumcised men (80/900) (unadjusted odds ratio OR], 0.97; 95 % confidence interval 95 % CI], 0.56, 1.67). In a multivariable logistic model adjusted for known risk factors for HIV infection, there was no evidence of an association between HIV seropositivity and circumcision status (adjusted OR, 0.79; 95 % CI, 0.43, 1.44), even among the 400 MSM who engaged exclusively in insertive anal sex (adjusted OR, 0.84; 95 % CI, 0.25, 2.81). Our study provides further evidence that circumcision is unlikely to be an effective strategy for HIV prevention among MSM in Britain.
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