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Male circumcision and risk of HIV in Australian homosexual men.

In contrast to findings among African heterosexuals, data on the association of circumcision and HIV infection in men who have sex with men are few and conflicting. The Health in Men (HIM) prospective cohort study recruited 1,426 HIV-negative homosexual men from community-based sources in Sydney, Australia, between 2001 and 2004 and followed them until mid-2007. 66% were circumcised. Participants underwent annual HIV testing, and detailed information on sexual risk behaviour was collected biannually. Median follow-up time was 3.9 years. There were 53 HW seroconversions during the 5,161 person years of follow-up: an incidence of 0.78 per 100 person-years. Overall, circumcision did not significantly reduce the risk of HIV infection (hazard ratio 0.78, p=0.42). However, circumcision was associated with a significant reduction in HIV incidence among the one-third of participants who reported a preference for the insertive role in anal intercourse (hazard ratio 0.11, p=0.041) and whose sexual behaviour closely and consistently reflected this preference. This finding is based on only seven infections amongst men with such a preference, five of which were in uncircumcised men, and these small numbers are a key limitation of the analysis. Amongst the 10% of person-years in men who reported only insertive sex and no receptive sex, circumcision did not significantly reduce HIV risk. The investigators call for randomised controlled trials to further explore the relationship. (1)

(1.) Templeton D J, Fengyi J, Mao L, et al. Circumcision and risk of HIV infection in Australian homosexual men. AIDS 2009;23(17):2347-51.

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Title Annotation:ROUND UP: HIV and AIDS
Publication:Reproductive Health Matters
Article Type:Brief article
Geographic Code:8AUST
Date:May 1, 2010
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