Circumcision Among Men Who Have Sex With Men in Scotland: Limited Potential for HIV Prevention

Male circumcision has been shown to reduce the risk of HIV acquisition among heterosexual men, but the impact among men who have sex with men is not known," reported the study authors. Their aim was to describe sexual practices by circumcision status, and to explore the feasibility of conducting research on male circumcision for HIV prevention among MSM in Scotland.

Men visiting Glasgow and Edinburgh's commercial gay scenes were recruited to fill out anonymous, self-completed questionnaires and provide oral fluid samples. Data were analyzed using SPSS 15.0. Logistic regression was used to estimate odds ratio (OR) and 95 percent confidence interval (CI). ORs were adjusted for age and nationality, which were significantly associated with circumcision status.

A total of 1,508 men completed questionnaires (70.5 percent response rate) and 1,277 provided oral fluid samples (59.7 percent response rate). Overall, 1,405 men were eligible for inclusion in the study. Of the men, 233 (16.6 percent) reported having been circumcised. Compared to Scottish men, nationals from non-European countries (the United States, Canada, Australia and New Zealand) were more likely to be circumcised (13.1 percent vs. 50.0 percent, respectively, p<0.001).

HIV prevalence was comparable among circumcised and uncircumcised men (4.2 percent and 4.6 percent, respectively). "Although biologically, circumcision is most likely to protect against HIV for men practicing unprotected insertive anal intercourse (UIAI), only 7.8 percent (91/1,172) of uncircumcised men reported exclusive UIAI in the past 12 months," the authors found. Few men (13.9 percent) reported being willing to participate in HIV prevention research on circumcision, and just 11.3 percent of uncircumcised men said they were willing to do so.

"The lack of association between circumcision and HIV status, low levels of exclusive UIAI, and low levels of willingness to take part in circumcision research suggest circumcision is unlikely to be a feasible HIV prevention strategy for MSM in the UK. Behavior change should continue to be the focus of HIV prevention in this population," the authors concluded.