Han-Zhu Qian1, Yuhua Ruan, Yu Liu, Douglas F Milam, Hans M L Spiegel, Lu Yin, Dongliang Li, Bryan E Shepherd, Yiming Shao, Sten H Vermund. 1. *Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN; †Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; ‡Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China; §State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; ‖Department of Urology, Vanderbilt University School of Medicine, Nashville, TN; ¶HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD; #Chaoyang District Center for Disease Control and Prevention, Beijing, China; Departments of **Biostatistics; and ††Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
Abstract
BACKGROUND: Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain. METHODS: Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed. RESULTS: Among 1155 participants (242 were seropositive and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by examination) was associated with 47% lower odds of being HIV seropositive [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.27 to 1.02] after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR: 0.38; 95% CI: 0.09 to 1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR: 0.54; 95% CI: 0.25 to 1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR: 0.15; 95% CI: 0.04 to 0.65). Circumcision was not associated clearly with lower syphilis risk (aOR: 0.91; 95% CI: 0.51 to 1.61). CONCLUSIONS: Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.
BACKGROUND: Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain. METHODS: Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed. RESULTS: Among 1155 participants (242 were seropositive and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by examination) was associated with 47% lower odds of being HIV seropositive [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.27 to 1.02] after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR: 0.38; 95% CI: 0.09 to 1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR: 0.54; 95% CI: 0.25 to 1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR: 0.15; 95% CI: 0.04 to 0.65). Circumcision was not associated clearly with lower syphilis risk (aOR: 0.91; 95% CI: 0.51 to 1.61). CONCLUSIONS: Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.
Authors: Chris Beyrer; Stefan D Baral; Frits van Griensven; Steven M Goodreau; Suwat Chariyalertsak; Andrea L Wirtz; Ron Brookmeyer Journal: Lancet Date: 2012-07-20 Impact factor: 79.321
Authors: Taha Hirbod; Robert C Bailey; Kawango Agot; Stephen Moses; Jeckoniah Ndinya-Achola; Ruth Murugu; Jan Andersson; Jakob Nilsson; Kristina Broliden Journal: Am J Pathol Date: 2010-04-15 Impact factor: 4.307
Authors: Samuel Kanyago; David M Riding; Elichum Mutakooha; Alcides Lopez de la O; Mark J Siedner Journal: J Acquir Immune Defic Syndr Date: 2013-10-01 Impact factor: 3.731
Authors: Aaron A R Tobian; David Serwadda; Thomas C Quinn; Godfrey Kigozi; Patti E Gravitt; Oliver Laeyendecker; Blake Charvat; Victor Ssempijja; Melissa Riedesel; Amy E Oliver; Rebecca G Nowak; Lawrence H Moulton; Michael Z Chen; Steven J Reynolds; Maria J Wawer; Ronald H Gray Journal: N Engl J Med Date: 2009-03-26 Impact factor: 91.245
Authors: Steven M Goodreau; Nicole B Carnegie; Eric Vittinghoff; Javier R Lama; Jonathan D Fuchs; Jorge Sanchez; Susan P Buchbinder Journal: PLoS One Date: 2014-07-30 Impact factor: 3.240
Authors: Chen Zhang; David F Penson; Han-Zhu Qian; Glenn F Webb; Jie Lou; Brian E Shephard; Yu Liu; Sten H Vermund Journal: Int J STD AIDS Date: 2019-03-19 Impact factor: 1.359
Authors: Elizabeth Wahome; Alexander N Thiong'o; Grace Mwashigadi; Oscar Chirro; Khamisi Mohamed; Evans Gichuru; John Mwambi; Matt A Price; Susan M Graham; Eduard J Sanders Journal: AIDS Behav Date: 2018-07