Circumcision and risk of HIV infection in Australian homosexual men

Templeton, David Ja,b; Jin, Fengyia; Mao, Liminc; Prestage, Garrett Pa; Donovan, Basila,d; Imrie, Johnc; Kippax, Susanc; Kaldor, John Ma; Grulich, Andrew Ea

doi: 10.1097/QAD.0b013e32833202b8
Epidemiology and Social:Concise Communications

Objective: To assess circumcision status as a risk factor for HIV seroconversion in homosexual men.

Design, setting and participants: The Health in Men (HIM) study was a prospective cohort of homosexual men in Sydney, Australia. HIV-negative men (n = 1426) were recruited primarily from community-based sources between 2001 and 2004 and followed to mid-2007. Participants underwent annual HIV testing, and detailed information on sexual risk behaviour was collected every 6 months.

Main outcome measure: HIV incidence in circumcised compared with uncircumcised participants, stratified by whether or not men predominantly practised the insertive role in anal intercourse.

Results: There were 53 HIV seroconversions during follow-up; an incidence of 0.78 per 100 person-years. On multivariate analysis controlling for behavioural risk factors, being circumcised was associated with a nonsignificant reduction in risk of HIV seroconversion [hazard ratio 0.78, 95% confidence interval (CI) 0.42–1.45, P = 0.424]. Among one-third of study participants who reported a preference for the insertive role in anal intercourse, being circumcised was associated with a significant reduction in HIV incidence after controlling for age and unprotected anal intercourse (UAI) (hazard ratio 0.11, 95% CI 0.03–0.80, P = 0.041). Those who reported a preference for the insertive role overwhelmingly practised insertive rather than receptive UAI.

Conclusions: Overall, circumcision did not significantly reduce the risk of HIV infection in the HIM cohort. However, it was associated with a significant reduction in HIV incidence among those participants who reported a preference for the insertive role in anal intercourse. Circumcision may have a role as an HIV prevention intervention in this subset of homosexual men.

aNational Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Australia

bRPA Sexual Health, Royal Prince Alfred Hospital, Australia

cNational Centre in HIV Social Research, The University of New South Wales, Australia

dSydney Sexual Health Centre, Sydney Hospital, Sydney, Australia.

Received 11 February, 2009

Revised 29 July, 2009

Accepted 18 August, 2009

Correspondence to Dr David J. Templeton, MBChB, PhD, National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Level 2, 376 Victoria Street, Sydney NSW 2010, Australia. Tel: +61 2 9385 0900; fax: +61 2 9385 0920; e-mail: dtempleton@nchecr.unsw.edu.au

© 2009 Lippincott Williams & Wilkins, Inc.