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Male circumcision may not make much difference to overall male HIV incidence in Caribbean context
Gus Cairns, 2012-08-28 07:50:00

A cross-sectional study of men attending a large HIV/STI clinic in San Juan, Puerto Rico, has found that, without adjusting for other factors, self-reported HIV and STI prevalence was actually higher in circumcised than in uncircumcised men.

The researchers conclude: “There is a need to apply caution to the use of circumcision as an HIV prevention strategy, particularly in areas like the Caribbean where more effective combinations of strategies for...prevention have yet to be fully implemented.”  

Similar findings from a survey in Zimbabwe (see page 215 of this report), which found an HIV prevalence of 14% in circumcised men and 12% in uncircumcised men recently, reignited controversy as to whether voluntary medical male circumcision (MMC) had a legitimate part to play in HIV prevention programmes.   

A deeper analysis of the Puerto Rico study shows, however, that circumcised men were 38% more likely to have had recent sex with men than uncircumcised men, and were two to three times more likely to have had unprotected anal sex without a condom.

Although the study cannot determine why this should be, it may be related to the fact that circumcised men were more than three times more likely to come from mainland USA than uncircumcised men and, as the researchers point out, “Puerto Rico is a primarily Christian society with strong prohibitions against sexual contact between men.”

In other words, US-born immigrants may be more likely to be openly gay and/or to have had the chance to have sex with other men than Puerto Rican natives – and were also more likely to be circumcised.

Source:1