Circumcision doesn't seem to protect gay men from HIV infection, casting doubt on the benefits of the procedure in men who have sex with men.
The conclusion comes from a review of 15 studies that each examined whether circumcision affects the spread of HIV between gay men.
"We found insufficient evidence it offers protection to men who have sex with men," says Gregorio Millett of the US Centers for Disease Control, who led the study.
But researchers say that the findings don't diminish the value ofcircumcision as a protective measure in Africa, where studies showed that circumcision cut the risk of infection in heterosexual men by up to 60%.
"We must be very clear that male circumcision maybe be much more effective where there's a very high general prevalence of HIV – as with 20% infected in Africa – and where the virus spreads mainly through heterosexual contact," says Willett.
He suggests that the procedure may be less effective in gays because unlike heterosexual men, they engage in receptive as well as insertive sex. This echoes findings in other studies that circumcision only lowers the risk for men, not women "receivers".
Willett did find limited but statistically insignificant evidence that gay men were at lower risk if they only engaged in insertive sex. He also found that circumcision did have a protective effect before 1996 when highly effective antiviral therapies became available. He speculates that the effect disappeared because the protection afforded by the drugs encouraged men to resume riskier sexual practices.
In the wake of three studies showing a protective effect in African men, the WHO last year announced a new policy encouraging African countries where HIV is most prevalent to consider circumcision programmes.
Thanks for clearing that up, now let's go back to our lives and continue to remind people that condoms work better than circumcision any day.
(Thanks, TY)
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