Background:  A recent clinical trial in South Africa demonstrated that circumcision reduced the risk of HIV acquisition by 61% among heterosexual men; and 1 longitudinal US cohort study documented decreased risk of HIV infection among circumcised MSM. We examined the prevalence of circumcision, willingness to be circumcised, and perceived benefits of and concerns about adult circumcision among MSM in the United States. 

Methods:  We analyzed survey data from 415 MSM respondents not known to be HIV⁺ who were interviewed at 5 Gay Pride events in 2006 (182 at minority Gay Pride events in Chicago, Illinois, Charlotte, North Carolina, and St Louis, Missouri, and 233 at Gay Pride events in Birmingham, Alabama and Anchorage, Alaska). We asked uncircumcised men if they would be willing to be circumcised if scientific studies showed that circumcision reduced risk of HIV infection for MSM, and about potential benefits of and concerns about circumcision. Among uncircumcised MSM, we used a χ² test to determine if significant differences (p <0.05) existed in demographic characteristics and sexual orientation, and the Wilcoxon-Mann-Whitney test to compare median Likert scale values (1 = strongly disagree, 5 = strongly agree) of perceived benefits of and concerns about circumcision, by willingness to be circumcised.

Results:  Of 415 MSM respondents, 331 (80%) were circumcised. Of 84 uncircumcised men, 59 (70%) belonged to a racial minority; 45 (54%) indicated that they would be willing to be circumcised if it were shown to reduce risk of HIV infection and 13 (15%) were uncertain. There were no significant differences between MSM willing and unwilling to be circumcised by age, ethnicity, race, education level, health insurance status, or sexual orientation. Compared to MSM unwilling to be circumcised, MSM willing to be circumcised were more likely to agree that increased sexual pleasure (p = 0.03) and reduced risk of penile cancer (p <0.01), sexually transmitted diseases (p = 0.03), and HIV (p = 0.03) were benefits to circumcision and that post-operative penile bleeding was a concern (p = 0.01).

Conclusions:  Only 20% of MSM respondents were uncircumcised, and over half of uncircumcised MSM reported they would be willing to be circumcised if it were scientifically proven to reduce risk of HIV infection. If circumcision is shown to be an effective intervention to reduce risk of HIV infection among MSM in the United States, data on perceived benefits of and concerns about circumcision should be used to develop circumcision education programs.