Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China: Interaction With Anal Sex Role in a Cross Sectional Study
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.
Journal of acquired immune deficiency syndromes