Friday, September 26, 2008

Should Gay Men Be Circumcised?


Findings reported at the Australasian Sexual Health Conference shed new light on male circumcision’s role in preventing HIV infection.

“We have shown for the first time that [men who have sex with men] who predominantly take on the insertive role in sex are less likely to contract HIV if they’ve been circumcised,” said David Templeton from the National Center for HIV Epidemiology and Clinical Research in Sydney. He went on to note, however, “Most HIV infections are contracted in the receptive role, so what we’re talking about is a risk reduction for a small group of men who didn’t have a huge risk in the first place.”

In the study, University of New South Wales researchers recruited 1,400 HIV-negative men, two thirds of whom were circumcised. During the four-year study, 53 men acquired HIV. There was no evidence that circumcision reduced the HIV risk among gay men in general. But in looking at the men who predominantly took the insertive role in intercourse, there was an 85% reduction in the risk of HIV infection if they were circumcised. Only seven of the 53 HIV infections occurred among insertive partners; the study’s model indicated that five of these infections could have been avoided if the men had been circumcised.

Templeton was quick to note, however, “That’s only 9% of all HIV infections overall that can be attributed to being uncircumcised, not enough to advocate throwing out condoms or advocating widespread circumcision.”

Indeed, the study’s model projected that circumcising all Australian gay men would prevent 37 infections a year in the first decade and 57 per year by 2030, at a cost of $196 million in the first two years.

What are YOUR thoughts? Leave a comment!


TLC Tugger said...

It's all so silly. They're doing cost/benefit analysis without factoring in the value of having a whole natural body.

Foreskin feels REALLY good.

Without the foreskin, the glans becomes dull and desensitized from the drying and abrasive effects of air and clothing. The foreskin itself includes over half the male's pleasure recepetive nerve endings and it provides an exquisite frictionless rolling/gliding mode of stimulation for a man and his partner.

HIS body, HIS decision.

robert said...

This news report has been circulating, unfortunately, with a provocative title or headline that doens't look enough at the data or outcome, most of which is not presented in full. If you try to count behind the numbers, ~975 of the men were circumcized, but we don't know how many of those were "insertive partners" which I believe must be the euphemism they use for exclusive 100% total studly tops. So you'd want to know what percentage of the total tops those 7 men who were insertive represent, whether the dtermination of exclusive top behavior is reliable and whether it's affected by - um- how should I put this - the forcefulness of the activity or other confounding factors. Other studies have shown no benefit. and then the study authors' own conclusions are worthwhile about whether circumcision should be recommended or not. These studies make me believe more and more that the need to support research for an effective vaccine continues to grow while other interventions do what they can in the interim

Hugh7 said...

TLC T and Robert are right: circumcision getting its usual free ride.

Nobody's looking at any effect of circumcision in the other direction. It would be almost impossible to measure the HIV infection rate of receptive men against the circumcision status of the men who gave it to them, but it seems highly likely that the keratinised (hardened) glans of a penis lacking its moving part is more likely to damage a man's rectum (or a woman's vagina) than an intact one. And there's lots of anecdotal evidence that circumcised men are more vigorous in intercourse than intact ones (and plenty of visual evidence from US vs European porn), and we know why that should be, too. With fewer nerve endings, they need more stimulation to achieve the same effect. Therefore, it seems at least plausible that circumcising insertive men would INCREASE HIV transmission to their more numerous partners.

But never mind, circumcision here, less HIV there, give it a headline: "Circumcision GOOOOOD! Foreskin BAAAAAD!"

Jim Pickett said...

Well, as far as gay men and MSM go, this article is pretty clear that circumcision is not really a viable strategy to help control the spread of HIV. I don't think there are any prevention experts saying that gay men should get circumcised. Obviously, it is unprotected receptive anal intercourse that drives HIV infections among gay/MSM. Circumcision (or not) in this scenario is really not a factor.

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