The association between circumcision status and human immunodeficiency virus infection among homosexual men

Journal of Infectious Diseases, Volume 168, Issue 6: Pages 1404-1408, December 1993.

AUTHORS: Kreiss JK; Hopkins SG

METHODS: A cross-sectional questionnaire survey of 316 HIV seropositive and 186 seronegative homosexual men.

ABSTRACT: To evaluate whether uncircumcised status is correlated with acquisition of human immunodeficiency virus HIV, 502 homosexual men were surveyed: 85 per cent were circumcised. HIV infection was significantly associated with uncircumcised status -odds ratio OR- 2.2: 95 per cent confidence interval -CI- 1.2, 3.8, nonwhite race, intravenous drug use, sexual contact with an intravenous drug user, number of male partners, frequency of unprotected receptive anal intercourse, and with history of genital herpes, anal herpes, or syphilis. Uncircumcised status was significantly associated with older age, nonwhite race, and history of syphilis: it was inversely associated with intravenous drug use. Using logistic regression analysis, the adjusted OR for the association between HIV infection and uncircumcised status was 2.0 (95 per cent CI, 1.0 4.0. Uncircumcised homosexual men has 2-fold increased risk of HIV infection. The role of circumcision as an intervention strategy to reduce sexual transmission of HIV warrants consideration.

[Comment (Ken Derifield): Other surveys emphasize the need for physical exam to determine circumcision status on all or part of the study groups due to a significant rate of misclassification in some self-report groups (questionnaires). With the small number of men in the survey self-reporting, the odds ratio of 2.0 could easily go to 1.0 with an examination (or less than 1.0 reversing the concern). Usually any odds ratio of 1.5 to 2.0 in a small study population isconsidered chance.]

[Comment (George Hill): This study only applies to homosexual men. Since no one knows at birth which boys will become homosexual men, this cannot be used as a reason to carry out neonatal circumcision.]

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