Male circumcision for prevention of homosexual acquisition of HIV in men

Abstract

Current evidence suggests that male circumcision may be protective among MSM who practice primarily insertive anal sex, but the role of male circumcision overall in the prevention of HIV and other sexually transmitted infections among MSM remains to be determined. Therefore, there is not enough evidence to recommend male circumcision for HIV prevention among MSM at present. Further research should be of high quality and further explore interaction with the predominant sexual role.

Male circumcision for the prevention of human immunodeficiency virus ( HIV ) acquisition: a meta‐analysis

“…In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 . Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

“…The relationship between circumcision and a reduced risk of HIV in heterosexual men has been shown in three meta‐analyses . Two meta‐analyses found that the protective effect of circumcision among homosexual men was not statistically significant (OR: 0.86, 95% CI 0.70–1.06 and OR: 0.86, 95% CI 0.65–1.13) ; however, the present report has shown that the relationship is in fact statistically significant. In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 .…”

“…Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

Male circumcision for the prevention of human immunodeficiency virus ( HIV ) acquisition: a meta‐analysis

“…In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 . Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

“…The relationship between circumcision and a reduced risk of HIV in heterosexual men has been shown in three meta‐analyses . Two meta‐analyses found that the protective effect of circumcision among homosexual men was not statistically significant (OR: 0.86, 95% CI 0.70–1.06 and OR: 0.86, 95% CI 0.65–1.13) ; however, the present report has shown that the relationship is in fact statistically significant. In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 .…”

“…Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

Pros and cons of circumcision: an evidence-based overview

“…A Cochrane systematic review published in 2011 included 20 observational studies in high-and middle-income countries with a total of 65 784 participants. The meta-analysis showed that circumcision may reduce HIV acquisition among MSM reporting an insertive anal role (seven studies), but might not have an effect among MSM practicing a receptive role (three studies), low-quality evidence [21]. Similar results were reported in another systematic review, highlighting that a protective effect was demonstrated only in studies conducted before the highly active antiretroviral therapy era [22].…”

Male Circumcision and Infection

“…One review of 20 observational studies (N = 71,693), reported that the pooled effect estimate for HIV acquisition in homosexual men was not statistically significant. However, when subgroups were analyzed, the results of 7 studies of men reporting an insertive role were statistically significant for a 27% reduction in HIV acquisition in contrast to the 3 studies of men reporting a receptive role [53]. However, a more recent metaanalysis by Sharma et al that examined the impact of sexual roles among homosexual men reported that MC did not definitively have a protective effect among predominantly insertive homosexual men or receptive men but acknowledged that there were a small number of studies reporting the effect of sexual role on HIV acquisition [54].…”

Male circumcision for the prevention of human immunodeficiency virus ( HIV ) acquisition: a meta‐analysis

“…In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 . Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

“…The relationship between circumcision and a reduced risk of HIV in heterosexual men has been shown in three meta‐analyses . Two meta‐analyses found that the protective effect of circumcision among homosexual men was not statistically significant (OR: 0.86, 95% CI 0.70–1.06 and OR: 0.86, 95% CI 0.65–1.13) ; however, the present report has shown that the relationship is in fact statistically significant. In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 .…”

“…Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

Pros and cons of circumcision: an evidence-based overview

“…A Cochrane systematic review published in 2011 included 20 observational studies in high-and middle-income countries with a total of 65 784 participants. The meta-analysis showed that circumcision may reduce HIV acquisition among MSM reporting an insertive anal role (seven studies), but might not have an effect among MSM practicing a receptive role (three studies), low-quality evidence [21]. Similar results were reported in another systematic review, highlighting that a protective effect was demonstrated only in studies conducted before the highly active antiretroviral therapy era [22].…”

Male Circumcision and Infection

“…One review of 20 observational studies (N = 71,693), reported that the pooled effect estimate for HIV acquisition in homosexual men was not statistically significant. However, when subgroups were analyzed, the results of 7 studies of men reporting an insertive role were statistically significant for a 27% reduction in HIV acquisition in contrast to the 3 studies of men reporting a receptive role [53]. However, a more recent metaanalysis by Sharma et al that examined the impact of sexual roles among homosexual men reported that MC did not definitively have a protective effect among predominantly insertive homosexual men or receptive men but acknowledged that there were a small number of studies reporting the effect of sexual role on HIV acquisition [54].…”

Male circumcision for the prevention of human immunodeficiency virus ( HIV ) acquisition: a meta‐analysis

“…In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 . Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

“…The relationship between circumcision and a reduced risk of HIV in heterosexual men has been shown in three meta‐analyses . Two meta‐analyses found that the protective effect of circumcision among homosexual men was not statistically significant (OR: 0.86, 95% CI 0.70–1.06 and OR: 0.86, 95% CI 0.65–1.13) ; however, the present report has shown that the relationship is in fact statistically significant. In the present review, we found the protective effect of circumcision in predominantly insertive homosexual males to be inconclusive, which is supportive of the meta‐analysis by Millett et al in 2008 .…”

“…Conversely, Wiysonge et al found that the protective effect was significant in this subgroup. These authors also indicated that the relationship for predominantly receptive men was inconclusive, supporting the findings of the present analysis .…”

Pros and cons of circumcision: an evidence-based overview

“…A Cochrane systematic review published in 2011 included 20 observational studies in high-and middle-income countries with a total of 65 784 participants. The meta-analysis showed that circumcision may reduce HIV acquisition among MSM reporting an insertive anal role (seven studies), but might not have an effect among MSM practicing a receptive role (three studies), low-quality evidence [21]. Similar results were reported in another systematic review, highlighting that a protective effect was demonstrated only in studies conducted before the highly active antiretroviral therapy era [22].…”

Male Circumcision and Infection

“…One review of 20 observational studies (N = 71,693), reported that the pooled effect estimate for HIV acquisition in homosexual men was not statistically significant. However, when subgroups were analyzed, the results of 7 studies of men reporting an insertive role were statistically significant for a 27% reduction in HIV acquisition in contrast to the 3 studies of men reporting a receptive role [53]. However, a more recent metaanalysis by Sharma et al that examined the impact of sexual roles among homosexual men reported that MC did not definitively have a protective effect among predominantly insertive homosexual men or receptive men but acknowledged that there were a small number of studies reporting the effect of sexual role on HIV acquisition [54].…”