HIV 01

[thanks to Hugh Young]

In a review of the literature, de Vincenzi and Mertens concluded that ...lack of distinction between susceptibility and infectivity, inadequate control for confounding variables, potential selection bias and misclassification of exposure, inappropriate choice of a comparison group, and publication bias, may lead to under- or overestimation of the association [between circumcision and HIV status]. It is difficult to predict the net effect of these sources of bias. Furthermore, the magnitude of the association varies strongly between studies and its crude measure is overestimated in some reports.

de Vincenzi, I, and Thierry Mertens (1994) Male circumcision: a role in HIV prevention? AIDS 8: 153-160

Third report
> DO CN AD941117
> TI   "Circumcision as a Safer Sex Intervention?"
> DT   940500
> SO   Volunteer (05/94-06/94) P. 6
> AB   Sexually active, but uncircumcised gay men 
>have a two-fold risk of HIV infection, according to a 
>study by researchers at the University of 
>Washington.  The scientists surveyed more than 
>500 homosexual men,85 percent of whom were 
>circumcised.  The findings suggested that"the role 
>of circumcision as an intervention strategy to 
>reduce sexual transmission of HIV warrants 
>consideration."

This is the Kreiss study, which also found a correlation between circumcision and IV drug use. (They did not, however, recommend non-circumcision as a prohylaxis against IV drug use.) They established (un)circumcision status by asking, though the small number of men described as uncircumcised (77, 59 of them HIV seropositive and only 18 HIV seronegative) meant a small number of incorrect reports could significantly change the outcome. Three men's statuses were not recorded.

Surick et al (cited in Vincenzi (1994)) found that 17.7% of uncircumcised men and 8.4% of circumcised men misclassified themselves, throwing serious doubt on any study relying on self-reporting, especially where the number of men in either category is small.

Kreiss et al. assume that men choose their sexual partners regardless of their circumcision status. The existence of magazines and clubs for circumcised men and others for whole men indicatesthat this is not so.

Kreiss, Joan and Hopkins S. (1992) The association between circumcision status and HIV infection among homosexual men. VIIIth International AIDS Conference, Amsterdam (Abstract PoC 4091)
Kreiss, Joan and Hopkins S. (1993) The association between circumcision status and HIV infection among homosexual men. J. Infections Diseases 168:1404-8

The conclusion was toned down in the second of these two reports on the same study.

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