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Circumcision may not curb gay HIV transmission

A new study indicates that the value of circumcision for homosexual men remains questionable.

Circumcision may not curb gay HIV transmission

While circumcision has been shown to lower a man's risk of contracting HIV through heterosexual sex, a new study indicates that the value of circumcision for homosexual men remains questionable.

Previous studies in Africa have shown that circumcision can reduce a man's risk of HIV infection through heterosexual sex by up to 60 percent. The World Health Organization now recommends medically supervised circumcision as one way to lower men's risk of HIV in countries where heterosexual transmission is common.

Circumcision is thought to lower the heterosexual transmission of HIV and other sexually transmitted diseases through several mechanisms. One is by reducing the amount of mucosal tissue exposed during sex, which limits the viruses' access to the body cells they target. Another theory is that the thickened skin that forms around the circumcision scar helps block the viruses' entry. To assess the association between male circumcision, insertive anal sex practices, and HIV acquisition, researchers studied 1,824 men from America and Peru.

Over the study period, 5 percent of the 1,365 uncircumcised men became HIV-positive, as did 4 percent of the 457 circumcised men. All of the men in the study reported having sex with other men and were considered to be on higher risk of HIV infection because they were already infected with the genital herpes virus (herpes simplex type 2), which can make people more susceptible to HIV.

The researchers did find some hints that circumcision could be protective among men who primarily had insertive sex with other men. Among men who said they'd had insertive sex with their last three male partners at least 60 percent of the time, circumcision was linked to a 69 percent lower HIV risk. That difference, however, was not statistically significant, which means the finding could be due to chance.

Taken together, the results indicate no overall protective benefit from male circumcision when it comes to male-to-male HIV transmission. One reason circumcision might have little effect on homosexual HIV transmission is that it would have no impact on the risk from receptive anal sex. It is also pointed out that in wealthier countries, many HIV-positive people are on powerful anti-viral drugs that reduce the risk of transmission, and any added effect of circumcision might be small.

Further studies are needed in larger, more diverse study groups to look at whether circumcision affects HIV risk from insertive sex and the researchers recommended that homosexual men should use condom for HIV prevention.
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