Willingness of Men Who Have Sex with Men (MSM) in the United States to Be Circumcised as Adults to Reduce the Risk of HIV Infection

Elin B Begley,Krishna Jafa,Andrew C Voetsch,Craig B Borkowf,James D Heffelfinger,Patrick S Sullivan,Landon Myer

doi:10.1371/journal.pone.0002731

Abstract

BackgroundCircumcision reduces HIV acquisition among heterosexual men in Africa, but it is unclear if circumcision may reduce HIV acquisition among men who have sex with men (MSM) in the United States, or whether MSM would be willing to be circumcised if recommended.MethodsWe interviewed presumed-HIV negative MSM at gay pride events in 2006. We asked uncircumcised respondents about willingness to be circumcised if it were proven to reduce risk of HIV among MSM and perceived barriers to circumcision. Multivariate logistic regression was used to identify covariates associated with willingness to be circumcised.ResultsOf 780 MSM, 133 (17%) were uncircumcised. Of these, 71 (53%) were willing to be circumcised. Willingness was associated with black race (exact odds ratio [OR]: 3.4, 95% confidence interval [CI]: 1.3–9.8), non-injection drug use (OR: 6.1, 95% CI: 1.8–23.7) and perceived reduced risk of penile cancer (OR: 4.7, 95% CI: 2.0–11.9). The most commonly endorsed concerns about circumcision were post-surgical pain and wound infection.ConclusionsOver half of uncircumcised MSM, especially black MSM, expressed willingness to be circumcised. Perceived risks and benefits of circumcision should be a part of educational materials if circumcision is recommended for MSM in the United States.

Highlights

Circumcision has recently been shown to be effective in decreasing HIV acquisition among adult heterosexual males in several sub-Saharan African countries
= somewhat likely, 4 = likely, 5 = very likely), ‘‘If scientific studies in the United States among men who have sex with men showed that circumcision reduced the risk of HIV infection, would you be willing to be circumcised as an adult?’’ Preliminary analyses of willingness as an ordinal outcome variable with 5 levels in logistic regression indicated that ordinal regression violated the assumption of proportional odds; we chose to analyze the dichotomized outcome, classified as willing and unwilling
Results of the multivariate analysis In the age-adjusted multivariate model among 127 uncircumcised men who have sex with men (MSM) who provided complete data on the perceived risks and benefits of circumcision, black MSM (OR: 3.4; 95% CI: 1.3– 9.8) were more likely than MSM of all other races to be willing to be circumcised as an adult (Table 3)

Summary

Introduction

Circumcision has recently been shown to be effective in decreasing HIV acquisition among adult heterosexual males in several sub-Saharan African countries. Recent clinical trials in South Africa, Kenya and Uganda showed that adult circumcision reduced HIV acquisition by 50–60%.[1,2,3] As a result, the World Health Organization currently recommends male circumcision as part of a comprehensive HIV prevention approach in Africa.. Recent clinical trials in South Africa, Kenya and Uganda showed that adult circumcision reduced HIV acquisition by 50–60%.[1,2,3] As a result, the World Health Organization currently recommends male circumcision as part of a comprehensive HIV prevention approach in Africa.4 These trials do not provide direct evidence that circumcision decreases HIV acquisition among men who engage in insertive or receptive anal sex. Circumcision reduces HIV acquisition among heterosexual men in Africa, but it is unclear if circumcision may reduce HIV acquisition among men who have sex with men (MSM) in the United States, or whether MSM would be willing to be circumcised if recommended

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Conclusion