Circumcision among men who have sex with men in Scotland: limited potential for HIV prevention

McDaid, Lisa; Weiss, Helen A.; Hart, Graham

doi:10.1136/sti.2010.042895

Cited by 19 publications

(18 citation statements)

References 13 publications

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“…The oral fluid specimen response rate was relatively low, and may not be representative. However, the overall survey response rate was higher (66% in 2005 and 71% in 2008), and there were few differences between the men who did and did not provide oral fluid specimens;7 8 suggesting that the men who provided these were representative of the larger venue-based sample. It should also be noted that the question used to derive recent HIV testing, and therefore the period defined as recent testing, was different in 2005 and 2008 (16 months in 2005 and 12 months in 2008).…”

Section: Discussionmentioning

confidence: 95%

Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005-8: support for the opt-out testing policy?

McDaid

Hart

2011

Sexually Transmitted Infections

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ObjectiveTo examine changes in HIV testing and undiagnosed infection among men who have sex with men in Scotland between 2005 and 2008.MethodsSelf-completed questionnaires and Orasure oral fluid collection kits were distributed to men visiting the commercial gay scene in Glasgow and Edinburgh.ResultsQuestionnaires and oral fluid specimens were provided by 1350 men (51.6% response rate) in 2005 and 1277 (59.7% response rate) in 2008. 2572 men were eligible for inclusion in the analyses. Recent HIV testing increased from 33.2% in 2005 to 48.3% in 2008 (p<0.001). HIV prevalence was comparable in 2005 and 2008 (4.4% and 4.6%, respectively). Among HIV-positive men, there was a reduction in undiagnosed infection between 2005 and 2008 from 41.7% to 26.3% (p=0.08). Undiagnosed HIV did not differ between men who were and were not tested in the past year. In 2008, only four (26.7%) HIV-positive men tested in the past 6 months were undiagnosed, compared with 11 (42.3%) HIV-positive men who had not tested (p=0.03).ConclusionThere was a substantial increase in recent HIV testing between 2005 and 2008. Although there was a concurrent (non-significant) reduction in undiagnosed HIV, there was no difference in undiagnosed infection between men who had and had not tested recently. However, lower proportions of undiagnosed infection among the most recent HIV-positive testers suggest frequent testing could play a role in reducing undiagnosed HIV and should remain central to HIV prevention efforts.

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Section: Discussionmentioning

confidence: 95%

Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005-8: support for the opt-out testing policy?

McDaid

Hart

2011

Sexually Transmitted Infections

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“…In Scotland, only 14% of MSM indicated their willingness to take part in a circumcision trial [117]. One study in China found 43% of MSM were willing to be circumcised [96], and in another, 8% were willing initially, but this rose to 31% after an information session [118].…”

Section: Discussionmentioning

confidence: 99%

A 'snip' in time: what is the best age to circumcise?

Waskett²,

et al. 2012

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Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Summary Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.

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“…Willingness is generally low (∼10%) in high-resource settings [23], [24], but higher (∼30%) in some resource-limited Asian settings [25]–[27]. One San Francisco study found moderate willingness (20%) among the target population (HIV-negative, predominantly insertive, uncircumcised MSM who have UAI); however, the proportion of the MSM sample found in the target population was so small (3.7% or n = 15) that the study anticipated limited public health benefits for MSM-MC [28].…”

Section: Introductionmentioning

confidence: 99%

Can Male Circumcision Have an Impact on the HIV Epidemic in Men Who Have Sex with Men?

Goodreau

Carnegie²,

Vittinghoff

et al. 2014

PLoS ONE

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BackgroundThree trials have demonstrated the prophylactic effect of male circumcision (MC) for HIV acquisition among heterosexuals, and MC interventions are underway throughout sub-Saharan Africa. Similar efforts for men who have sex with men (MSM) are stymied by the potential for circumcised MSM to acquire HIV easily through receptive sex and transmit easily through insertive sex. Existing work suggests that MC for MSM should reach its maximum potential in settings where sexual role segregation is historically high and relatively stable across the lifecourse; HIV incidence among MSM is high; reported willingness for prophylactic circumcision is high; and pre-existing circumcision rates are low. We aim to identify the likely public health impact that MC interventions among MSM would have in one setting that fulfills these conditions—Peru—as a theoretical upper bound for their effectiveness among MSM generally.Methods and FindingsWe use a dynamic, stochastic sexual network model based in exponential-family random graph modeling and parameterized from multiple behavioral surveys of Peruvian MSM. We consider three enrollment criteria (insertive during 100%, >80% or >60% of UAI) and two levels of uptake (25% and 50% of eligible men); we explore sexual role proportions from two studies and different frequencies of switching among role categories. Each scenario is simulated 10 times. We estimate that efficiency could reach one case averted per 6 circumcisions. However, the population-level impact of an optimistic MSM-MC intervention in this setting would likely be at most ∼5–10% incidence and prevalence reductions over 25 years.ConclusionsRoll-out of MC for MSM in Peru would not result in a substantial reduction in new HIV infections, despite characteristics in this population that could maximize such effects. Additional studies are needed to confirm these results for other MSM populations, and providers may consider the individual health benefits of offering MC to their MSM patients.

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Circumcision among men who have sex with men in Scotland: limited potential for HIV prevention

Cited by 19 publications

References 13 publications

Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005-8: support for the opt-out testing policy?

Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005-8: support for the opt-out testing policy?

A 'snip' in time: what is the best age to circumcise?

Can Male Circumcision Have an Impact on the HIV Epidemic in Men Who Have Sex with Men?

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