Wednesday, August 22, 2012

PUERTO RICO: No benefit from circumcision for HIV, STDS

Journal of Sexual Medicine
August 15, 2012

Puero Rico: Circumcision not protective

Circumcision does not protect men against HIV or other sexually transmitted diseases, according to a study conducted in Puerto Rico.

The 660 men were randomly sampled from an STD clinic waiting room. Almost a third of them were circumcised.

The circumcised men reported significantly (but not greatly) more STDs in their lifetimes, were more likely to have been diagnosed with warts, and were more likely to have HIV.

J Sex Med. 2012 Aug 15. doi: 10.1111/j.1743-6109.2012.02871.x. [Epub ahead of print]
More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico.
Rodriguez-Diaz CE, Clatts MC, Jovet-Toledo GG, Vargas-Molina RL, Goldsamt LA, GarcĂ­a H.
Introduction. Circumcision among adult men has been widely promoted as a strategy to reduce human immunodeficiency virus (HIV) transmission risk. However, much of the available data derive from studies conducted in Africa, and there is as yet little research in the Caribbean region where sexual transmission is also a primary contributor to rapidly escalating HIV incidence.
Aim. In an effort to fill the void of data from the Caribbean, the objective of this article is to compare history of sexually transmitted infections (STI) and HIV diagnosis in relation to circumcision status in a clinic-based sample of men in Puerto Rico.
Methods. Data derive from an ongoing epidemiological study being conducted in a large STI/HIV prevention and treatment center in San Juan in which 660 men were randomly selected from the clinic's waiting room.
Main Outcome Measures. We assessed the association between circumcision status and self-reported history of STI/HIV infection using logistic regressions to explore whether circumcision conferred protective benefit.
Results. Almost a third (32.4%) of the men were circumcised (CM). Compared with uncircumcised (UC) men, CM have accumulated larger numbers of STI in their lifetime (CM = 73.4% vs. UC = 65.7%; P = 0.048), have higher rates of previous diagnosis of warts (CM = 18.8% vs. UC = 12.2%; P = 0.024), and were more likely to have HIV infection (CM = 43.0% vs. UC = 33.9%; P = 0.023). Results indicate that being CM predicted the likelihood of HIV infection (P value = 0.027).
Conclusions. These analyses represent the first assessment of the association between circumcision and STI/HIV among men in the Caribbean. While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. [Actually, what the the data indicate is that intactness confers significant protection, compared to being circumcised.] Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented. [They actually suggest that circumcision should not be used because it is not a prevention strategy.] ...

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