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9 October 2008
New doubts about circumcision’s HIV preventative effect
by George Atkinson

A new meta-study appearing in the Journal of the American Medical Association has found that there is a lack of evidence that circumcision reduces the risk of human HIV infection among men who have sex with men. The new finding comes after earlier studies (see below) had shown circumcision provided a prophylactic effect against HIV amongst heterosexual men.

The earlier trials, conducted in Africa, showed that male circumcision reduced the likelihood of female-to-male transmission of HIV infection by 50 to 60 percent. The results also suggested that male circumcision may protect heterosexual men from other sexually transmitted infections, such as syphilis or chlamydial infection.

The new review, conducted by Gregorio A. Millett, of the Centers for Disease Control and Prevention in Atlanta, was undertaken to find out more about whether circumcision provides protection against HIV infection among men who have sex with men (MSM). The review took in 15 previous studies.

Millett found that the odds of being HIV-positive were not significantly lower among MSM who were circumcised than uncircumcised. Interestingly, a statistically significant protective association of circumcision with HIV infection was found for MSM studies conducted prior to the introduction of highly active antiretroviral therapy (HAART) in 1996.

"A possible explanation for [these differences] may be related to an increase in the sexual risk behaviors of MSM after HAART. It has been well documented that beliefs that HAART limits HIV transmissibility are associated with increases in sexual risk behavior among MSM, and that the era since the advent of HAART has been defined by higher rates of sexual risk behaviors among MSM, outbreaks of sexually transmitted infections, and increasing rates of HIV infection," explained Millett.

"Taken together, these findings indicate insufficient evidence among available observational studies conducted with MSM of an association between circumcision and HIV infection or other sexually transmitted infections," Millett concludes. "Additional studies are necessary to elucidate further the relationship between circumcision status and HIV infection among MSM."

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Source: Journal of the American Medical Association

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